Impact of Indocyanine Green (ICG) Fluorescence Cholangiography on Operative Time and Safety in Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Study

Background Laparoscopic cholecystectomy (LC) is the gold standard for treating gallbladder disease; however, bile duct injury (BDI) remains a significant concern. Indocyanine green (ICG) fluorescence cholangiography has emerged as a real-time, radiation-free technique to enhance biliary visualization and reduce surgical risks. This study evaluates the impact of ICG fluorescence imaging on LC outcomes compared to conventional methods. Aims and objectives This study aims to evaluate the effectiveness of ICG fluorescence cholangiography in improving intraoperative biliary visualization during LC. The objectives include comparing operative time between ICG-assisted and standard LC, assessing the incidence of bile duct injuries and conversions to open surgery, evaluating intraoperative complications such as bleeding and bile leaks, and analyzing postoperative recovery parameters, including hospital stay duration. Methods A prospective randomized controlled study was conducted at Sunshine Hospital, Secunderabad, India, from December 2021 to April 2022. One hundred patients undergoing LC were randomized into two groups: ICG-assisted LC (n = 50) and standard LC (n = 50). ICG (0.5 mL) was administered intravenously one hour preoperatively, and fluorescence imaging was performed intraoperatively. Primary outcomes included operative time, BDI rates, conversion to open surgery, and overall surgical safety. Data were analyzed using SPSS, with a p-value < 0.05 considered statistically significant. Results ICG fluorescence cholangiography significantly reduced operative time (mean: 42.6 ± 5.2 min vs. 48.3 ± 6.1 min; p = 0.002). No bile duct injuries or conversions to open surgery were reported. Excessive bleeding (>100 mL) occurred in six cases (four in the ICG group, two in the non-ICG group; p = 0.48). Hospital stay was shorter in the ICG group (median: 1 day, range: 1-2 days) than in the non-ICG group (median: 1.3 days, range: 1-2 days; p = 0.045). No postoperative bile leaks or ICG-related complications were observed. Conclusion ICG fluorescence cholangiography significantly improves intraoperative biliary visualization, reduces operative time, and enhances surgical efficiency without increasing complications. These findings support its routine use in LC, although further research is needed to standardize protocols and assess its role in complex cases.