Clinical Evaluation of Intraoperative Indocyanine Green (ICG) Fluorescent Cholangiography During Laparoscopic Cholecystectomy: A Comparative Study

Abstract

Background: Laparoscopic cholecystectomy (LC) is one of the most common surgical procedures performed globally. While it is generally considered safe, there remains a risk of serious biliary injuries occurring during the procedure.

Indocyanine green (ICG) is a water-soluble, non-toxic dye that allows real-time intraoperative visualization of the extrahepatic biliary tree. Aim: This study aims to compare the bile duct injury rate, duration of surgery, conversion rate, length of hospitalization, and overall outcomes between laparoscopic cholecystectomy with and without indocyanine green (ICG).  Methods: Ninety-two patients who underwent LC from October 2023 to October 2024 were included in the study; 42 of them underwent LC with ICG (group 1), and 50 did not receive it (group 2). Both groups were compared regarding intraoperative complications, duration of surgery, conversion rates, length of hospitalization, and overall outcomes. Results: The mean total operative time in minutes for group 1 was 44.6 minutes, compared to 51.1 minutes for group 2 (p-value = 0.001). No CBD or cystic duct injuries occurred in any patient in either group. Two patients were converted to open cholecystectomy in group 2, while none were converted in group 1; however, there was no statistically significant difference between the two groups (p-value = 0.174). There was no significant statistical difference in the length of hospital stay between both groups (p-value = 0.08). Conclusions: Indocyanine green (ICG) in LC allows for better visualization of the extrahepatic biliary system, leading to a significant reduction in operative time, gallbladder perforation, and bile spillage; however, there is no significant difference in bile duct injury rates, conversion rates to open surgery, or length of hospitalization in the ICG group.