Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgical procedures in the United States, with approximately 750,000 performed annually Although intraoperative cholangiogram (IOC) is useful for anatomy identification during complex cases and enables biliary interventions, this procedure requires additional equipment and personnel and exposes patients to ionizing radiation.

Near-infrared fluorescence cholangiography (NIRFC) after intravenous administration of indocyanine green (ICG) dye is an alternative technique that enables real-time intraoperative identification of extrahepatic biliary anatomy and avoids the potential drawbacks of IOC. Protein-bound ICG is exclusively excreted by the liver and fluoresces when illuminated with near-infrared (NIR) light. There is no absolute contraindication to the administration of ICG dye, and ICG has been used safely in patients with a documented iodine allergy. The routine use of ICG during LC has been shown to decrease operative times, decrease conversion to open and common bile duct (CBD) injury rates, and shorten hospital length of stay .

Despite the demonstrated benefits of routine NIRFC during LC, this practice has not yet gained widespread adoption to become the standard of care. In the following case example, we demonstrate the benefits of ICG and its ability to help surgeons clearly delineate extrahepatic biliary anatomy to avoid CBD injury.

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