Seeing beyond white light: fluorescence for safer laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) remains the standard treatment for symptomatic gallstone disease, yet bile duct injury persists as a serious and feared complication, predominantly caused by misidentification of biliary anatomy. Fluorescence-guided imaging with indocyanine green (ICG) has gained prominence as an adjunct to enhance real-time anatomical interpretation and strengthen intraoperative safety. This mini review synthesizes current evidence supporting fluorescent cholangiography in both elective and acute care settings, where inflammation, distorted anatomy, and urgent decision-making heighten surgical risk. The manuscript provides an updated overview of the technical foundations of ICG fluorescence, practical considerations for its administration, and its incorporation into modern surgical workflows. It compiles data demonstrating improved visualization of key biliary structures, and potential reductions in complications, conversion to open surgery, and operative time. The review also addresses persistent limitations, such as heterogeneity in dosing protocols, interference from hepatic background fluorescence, and reliance on specialized imaging equipment, that continue to impede universal standardization. Taken together, these findings position fluorescence imaging as a pragmatic, radiation-free modality that extends the surgeon's visual capabilities "beyond white light," contributing to safer and more precise LC. Ongoing technological refinement and well-designed multicenter studies will be crucial to confirm its clinical benefits and define its place in routine surgical practice.