Role of Indocyanine Green in Laparoscopic Cholecystectomy

Benefits and Recommendations

The World Society of Emergency Surgery recommends selective use of Indocyanine Green (ICG) for biliary tract visualization during difficult laparoscopic cholecystectomy or whenever bile duct injury is suspected 1
ICG provides real-time imaging of the extrahepatic biliary tract during laparoscopic cholecystectomy as a noninvasive, quick, safe, and easy-to-apply tool 1, 2
When comparing ICG cholangiography to intraoperative cholangiography (IOC), studies found no significant differences for visualization of the cystic duct, common bile duct, or common hepatic duct 1, 2
Despite its benefits, a survey of experienced surgeons found that routine use of adjuncts such as ICG was not significantly associated with a lower risk of bile duct injuries 1, 2
In cases of suspected bile duct injury, asking the opinion of another surgeon may be an easy, effective, and inexpensive alternative to IOC 1, 2
Geographic distance between facilities, equipment availability, expertise, and logistics significantly influence the implementation of ICG cholangiography across institutions 1, 2

ICG fluorescence cholangiography is a useful adjunct for confirming biliary anatomy during laparoscopic cholecystectomy without the need for X-ray imaging, helping prevent bile duct injuries, which occur in 0.4% of elective and 0.8% of emergency laparoscopic cholecystectomies 3
The American College of Surgeons recommends ICG cholangiography as a valuable tool in cases with difficult anatomy, acute cholecystitis, or when intraoperative cholangiography (IOC) cannot be used 3
While ICG cholangiography is promising, routine use to reduce bile duct injury rates is not yet recommended in guidelines, with a Grade 2C recommendation from the World Journal of Emergency Surgery 4
ICG cholangiography should be considered as an adjunct to, not a replacement for, the critical view of safety technique during laparoscopic cholecystectomy, according to the World Journal of Emergency Surgery 3, 4