Evaluating the Safety and Efficacy of Indocyanine Green Fluorescence Imaging for Difficult Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

BackgroundIndocyanine green (ICG) fluorescence imaging has emerged as a valuable technique to improve biliary structure visualization and reduce potential risk of laparoscopic cholecystectomy (LC). This meta-analysis was conducted to evaluate the safety and efficacy of ICG fluorescence image-guided LC for difficult gallbladder disease.MethodsEmbase, PubMed, Web of Science, and Cochrane library databases were searched to obtain comparative studies. The randomized (RoB2) and non-randomized interventions (ROBINS-I) were used to assess the methodological quality of included studies. The primary outcomes included operative time, blood loss, hospital day, rate of conversion to open, and postoperative complication.Results9 studies were included in the meta-analysis, including 1 randomized controlled trial, 6 retrospective studies, and 1 prospective study. A total of 1069 patients were included in the study, of whom 526 patients received indocyanine green fluorescent cholangiography (ICG-FC) during difficult laparoscopic cholecystectomy (DLC) and 543 patients received traditional DLC. Compared with the control group, ICG group significantly decreased operative time (SMD -1.08 min; 95% CI-1.99, -0.16. <i>P</i> < 0.05), lower rate of conversion to open (relative risk (RR) 0.25; 95% CI 0.08, 0.78. <i>P</i> = 0.202), and shorter length of hospital stay (SMD -0.30 d; 95% CI -0.58, -0.02. <i>P</i> < 0.05). The ICG group had similar results compared with the control group in intraoperative blood loss (SMD -1.31 mL; 95% CI-3.01, 0.38. <i>P</i> < 0.05) and postoperative complication (RR 0.64; 95% CI 0.38, 1.08. <i>P</i> = 0.179).ConclusionCompared with control group, ICG-FC had better results in operative time, rate of conversion to open, and length of hospital stay for DLC.