Seeing beyond white light: fluorescence for safer laparoscopic cholecystectomy

Area of Science:

• Surgical Innovation
• Medical Imaging
• Gastrointestinal Surgery

Background:

• Laparoscopic cholecystectomy (LC) is standard for gallstones, but bile duct injury is a risk.
• Misidentification of biliary anatomy is a primary cause of these injuries.
• Enhanced intraoperative visualization is needed to improve safety.

Purpose of the Study:

• To review evidence for fluorescence-guided cholangiography using indocyanine green (ICG).
• To assess its utility in elective and acute settings for laparoscopic cholecystectomy.
• To provide an overview of technical aspects and clinical integration.

Main Methods:

• Mini-review synthesizing current evidence on ICG fluorescence cholangiography.
• Analysis of technical foundations, administration, and workflow integration.
• Compilation of data on visualization, complication rates, and operative outcomes.

Main Results:

• Improved visualization of biliary structures.
• Potential reduction in surgical complications, open conversions, and operative time.
• Identified limitations include dosing variability and equipment dependence.

Conclusions:

• ICG fluorescence imaging is a pragmatic, radiation-free tool for enhancing surgical precision in LC.
• It extends visual capabilities beyond standard white light.
• Further studies are needed to confirm benefits and standardize its routine use.