Perspective on Intraoperative Real-Time Biliary Tract Navigation: From Radiological to Fluorescent Imaging

Accurate identification of biliary anatomy is essential in hepatobiliary surgery, as misinterpretation remains the leading cause of bile duct injuries, resulting in significant postoperative morbidity. Traditional approaches, including visual inspection, palpation, and intraoperative cholangiography, are constrained by anatomical variability, radiation exposure, procedural complexity, and workflow disruption. In this perspective, we highlight the clinical challenges of biliary navigation, review the emerging role of fluorescence-guided surgery using near-infrared indocyanine green for real-time, low-toxicity visualization, and discuss advances in next-generation fluorophores and imaging platforms. Our discussion aims to stimulate tool development to enhance intraoperative precision, reduce reliance on radiation, and improve patient safety in biliary surgery.