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Related Experiment Video

Updated: Mar 10, 2026

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture
04:02

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

Published on: November 25, 2025

567

Routine or Selective Intraoperative Cholangiography?: A Single-Center Analysis of 1506 Laparoscopic

Josefina Principe1, Nicolas H Dreifuss1,2, Pablo Capitanich1,2

  • 1Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
|March 9, 2026
PubMed
Summary

Selective intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is safe and effective, showing comparable bile duct injury and residual stone rates to routine IOC. However, training is crucial due to lower IOC success rates with selective use.

Keywords:
bile duct injuriescommon bile duct stoneslaparoscopic cholecystectomyroutine cholangiographyselective cholangiography

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Area of Science:

  • Gastroenterology and Hepatobiliary Surgery
  • Surgical Outcomes Research

Background:

  • Intraoperative cholangiography (IOC) aids in visualizing biliary anatomy and detecting common bile duct (CBD) stones during laparoscopic cholecystectomy (LC).
  • The optimal strategy for IOC—routine versus selective—remains a subject of debate in surgical practice.

Purpose of the Study:

  • To compare the outcomes of routine IOC versus selective IOC policies during LC.
  • To evaluate rates of CBD stones, bile duct injuries (BDI), and other complications between the two IOC strategies.

Main Methods:

  • A prospective cohort study involving 1506 patients undergoing LC.
  • Patients were divided into routine IOC (RC) and selective IOC (SC) groups.
  • Selective IOC was applied in emergent LC for cholecystitis and in patients with preoperative risk factors for CBD stones.

Main Results:

  • The routine IOC group had a higher IOC success rate (93.5%) compared to the selective IOC group (82.6%).
  • Selective IOC showed higher rates of positive IOC findings and CBD stone detection.
  • Bile duct injury rates were comparable between groups (0.5% RC vs. 0% SC), and no injuries were detected by IOC.
  • Residual CBD stones, overall morbidity, readmissions, and reoperations were similar between the routine and selective IOC groups.

Conclusions:

  • Selective IOC is a safe and effective strategy for LC, yielding comparable bile duct injury and residual CBD stone rates to routine IOC.
  • Despite comparable safety outcomes, selective IOC demonstrated a lower success rate, underscoring the need for continued surgical training in IOC techniques.