This paper examines Near-infrared fluorescent cholangiography (NIFC) using indocyanine green (ICG) to aid in the identification of extrahepatic biliary anatomy.

Evidence synthesis: Several factors can influence the quality of the fluorescence imaging, including the dose and timing of ICG injection, liver function, the thickness of fatty tissue and the presence of inflamed tissues due to acute pathology. Various devices tested also have a different sensitivity to the fluorescence signal. RCTs showed fluorescence cholangiography were comparable to traditional intraoperative cholangiogram in visualizing the extrahepatic biliary anatomy.

Conclusions: NIFC is demonstrated as a safe, non-irradiating technique to identify and aid in the visualization of extrahepatic biliary anatomy. Laparoscopic cholecystectomy with real-time NIFC enables a better visualization and identification of biliary anatomy and therefore it is potentially as a means of increasing the safety of laparoscopic cholecystectomy. Whether this translates into reducing complication rates must still be determined. The dosage and timing of the intravenous administration of ICG relative to the operative procedure still requires optimization to ensure reliable images.

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