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Updated: Aug 8, 2025
The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation
Published on: January 31, 2025
Near-infrared fluorescence cholangiography assisted laparoscopic cholecystectomy (FALCON): an international
J van den Bos1, R M Schols2, L Boni3
1Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. j.vandenbos@student.maastrichtuniversity.nl.
Aim:
To assess the added value of Near InfraRed Fluorescence (NIRF) imaging during laparoscopic cholecystectomy.
Methods:
This international multicentre randomized controlled trial included participants with an indication for elective laparoscopic cholecystectomy. Participants were randomised into a NIRF imaging assisted laparoscopic cholecystectomy (NIRF-LC) group and a conventional laparoscopic cholecystectomy (CLC) group. Primary end point was time to 'Critical View of Safety' (CVS). The follow-up period of this study was 90 postoperative days. An expert panel analysed the video recordings after surgery to confirm designated surgical time points.
Results:
A total of 294 patients were included, of which 143 were randomized in the NIRF-LC and 151 in the CLC group. Baseline characteristics were equally distributed. Time to CVS was on average 19 min and 14 s for the NIRF-LC group and 23 min and 9 s for the CLC group (p 0.032). Time to identification of the CD was 6 min and 47 s and 13 min for NIRF-LC and CLC respectively (p < 0.001). Transition of the CD in the gallbladder was identified after an average of 9 min and 39 s with NIRF-LC, compared to 18 min and 7 s with CLC (p < 0.001). No difference in postoperative length of hospital stay nor occurrence of postoperative complications was found. ICG related complications were limited to one patient who developed a rash after injection of ICG.
Conclusion:
Use of NIRF imaging in laparoscopic cholecystectomy provides earlier identification of relevant extrahepatic biliary anatomy: earlier achievement of CVS, cystic duct visualisation and visualisation of both cystic duct and cystic artery transition into the gallbladder.
