Laparoscopic cholecystectomy (LC) is the standard treatment for gallbladder disease, offering less invasive treatment and quicker recovery. However, bile duct injury (BDI) remains a critical complication. Indocyanine green (ICG) fluorescence imaging has emerged as a valuable technique to improve biliary structure visualization and potentially reduce BDI during LC. This systematic review assesses the efficacy of ICG in reducing BDI over the past decade. A comprehensive search of studies comparing ICG fluorescence and conventional white light (WL) in LC identified 14 studies. Key outcomes such as operative time, incidence of BDI, and visualization of biliary anatomy were analyzed. The results indicate that ICG significantly reduced operative times in complex cases, with an average reduction of approximately 20 minutes compared to WL (p<0.0001). In routine cases, no significant difference in operative time was observed between the two methods. ICG consistently enhanced visualization of key biliary structures, such as the cystic duct and common bile duct, with the greatest benefits seen in anatomically challenging cases. Although the overall incidence of BDI was low, use of ICG showed a trend toward lower BDI rates compared to WL, though the difference was not statistically significant.
In conclusion, the use of ICG fluorescence in LC offers notable advantages, particularly in improving visualization of biliary anatomy and reducing operative time in complex cases. While the overall reduction in BDI rates may appear marginal, the clinical importance of avoiding even a single BDI should not be understated, given the serious complications associated with BDI. Our review suggests that the benefits of ICG are most pronounced in more complex cases where biliary anatomy is challenging to identify.
