Transforming biliary surgery: Innovations in fluorescence-guided imaging and indocyanine green application

In this editorial, we comment on the article by Li et al. We specifically focus on the novel use of multicolor near-infrared fluorescence imaging (MCFI) with indocyanine green in laparoscopic cholecystectomy, which is an innovative approach for enhancing biliary visualization during laparoscopic cholecystectomy. This study also highlighted the limitations of conventional single-color fluorescence imaging (SCFI), which relies solely on a green fluorescence signal, leading to challenges such as visual fatigue and difficulty in distinguishing biliary structures from background hepatic tissue. Given the complex anatomy of the biliary system and the challenges of visual fatigue encountered with SCFI, MCFI addresses these issues by enabling the differentiation of biliary structures by mapping the fluorescence intensity across a unique blue-to-purple color spectrum, thus improving the clarity of anatomical structures and reducing the visual strain for surgeons. We also focus specifically on the complications and cautious usage of indocyanine green in this context, as well as the advantages and disadvantages of MCFI and SCFI. Overall, MCFI represents a significant advancement in fluorescence-guided surgery, with the potential to become a standard imaging modality for safer and more effective laparoscopic procedures.