The Role of ICG-Guided Fluorescent Mode in Boosting the Learning Curve of Laparoscopic Cholecystectomy

The most common therapy for gallstones is laparoscopic cholecystectomy (LC). How to help young residents avoid bile duct injuries (BDI) during surgery and grasp LC seems to be a paradox. We retrospectively reviewed 145 cases of LC operated by two residents under indocyanine green (ICG)-guided mode or normal LC procedures to illustrate the role of ICG mode in boosting the LC learning curve. The clinic data were analyzed by logistic regression, receiver operator curve tests, Cumulative Sum (CUSUM), and Risk-Adjusted Cumulative Sum (RA-CUSUM) analysis. The operation failure rate is similar. However, operation time under ICG mode is shorter than that under normal mode. The peak at the 49^th case represented the normal resident's complete mastery of the surgery, while the peak point of ICG mode appeared at the 36^th case in the fitting curve. The most significant cumulative risk (peak point) of operation failure of LC was at the 35^th case in ICG LC mode, while it appeared in the 49^th in normal LC mode. Owing to the advantage of real-time imaging and the stable success rate of cholangiography, ICG-guided LC helps residents shorten the operation time, boost the learning curve, and manage to control the operation failure rate.