Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

This case report presents a fluorescence-guided laparoscopic cholecystectomy with common bile duct (CBD) exploration, fiberoptic choledochoscopic stone extraction, and primary duct closure. The patient was a 41-year-old male diagnosed with gallstones and secondary CBD stones. Intraoperatively, indocyanine green (ICG) fluorescence imaging was employed to delineate biliary anatomy precisely. Following cholecystectomy, the CBD was longitudinally incised, and stones were removed under choledochoscopic guidance. After confirming stone clearance and distal duct patency, the CBD was closed with an interrupted 6-0 polydioxanone suture (PDS) without T-tube drainage. The procedure lasted 196 min, with minimal blood loss (15 mL). No postoperative complications (e.g., bile leakage or stricture) occurred, and the patient was discharged on postoperative day 5. This case demonstrates that ICG-guided laparoscopy combined with choledochoscopy enables minimally invasive management of CBD stones, and primary suturing is a safe and feasible alternative to T-tube drainage, avoiding its associated complications in carefully selected patients with meticulous technique.