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Updated: Mar 27, 2026

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Fluorescent Cholangiogram-Optimal Dose and Timing.

Tsanko I Yotsov1, Paolina Al Kamenova2, Adriana An Vricheva2

  • 1Department of Health Care, University of Ruse "Angel Kanchev," UMHAT Medica, Ruse, Bulgaria. (Dr. Yotsov).

JSLS : Journal of the Society of Laparoendoscopic Surgeons
|March 25, 2026
PubMed
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Fluorescent cholangiography (FC) using indocyanine green (ICG) is a valuable tool for preventing bile duct injuries during laparoscopic cholecystectomy. While most surgeons find FC useful, its routine adoption remains low, with a preference for 1-mg ICG administered 3 hours preoperatively.

Area of Science:

  • Surgical Innovation
  • Medical Imaging
  • Gastroenterology

Background:

  • Bile duct injury (BDI) is a significant complication of laparoscopic cholecystectomy (LC), occurring in approximately 0.2% of the 750,000 annual procedures in the US.
  • Fluorescent cholangiography (FC) utilizing indocyanine green (ICG) presents a novel approach to mitigate BDI incidence.
  • Optimal ICG dosage and timing for FC remain subjects of ongoing research and clinical debate.

Purpose of the Study:

  • To evaluate surgeon preferences for indocyanine green (ICG) dosage and administration timing in fluorescent cholangiography (FC) for laparoscopic cholecystectomy (LC).
  • To assess the perceived usefulness and current adoption rates of FC among surgical practitioners.
  • To identify factors influencing the routine implementation of FC in clinical practice.
Keywords:
Bile duct injuryFluorescence-guided surgeryFluorescent cholangiogramLaparoscopic cholecystectomy

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Main Methods:

  • Fluorescent cholangiography (FC) was performed using three distinct ICG doses (0.05 mg/kg, 1 mg, 2 mg) administered at three different pre-LC time intervals (1, 3, 6 hours), creating nine visualization scenarios.
  • Bile tree anatomy was imaged under both white light and near-infrared (NIR) light.
  • A survey questionnaire was distributed to surgical practitioners via Google Forms to gather data on preferences and usage.

Main Results:

  • A total of 122 practitioners completed the survey.
  • The preferred FC protocol was 1-mg ICG administered 3 hours preoperatively.
  • While 87% of respondents found FC useful, only 16% reported its routine use; specialists were significantly less likely to commit to routine use (P=.035).

Conclusions:

  • Fluorescent cholangiography (FC) is recognized as a useful technique for enhancing surgical safety during LC.
  • Despite high perceived utility, FC has not achieved widespread routine adoption in clinical practice.
  • Further research and potentially standardized protocols may be needed to facilitate broader implementation of FC.