Indocyanine green fluorescence navigation for extrahepatic bile duct visualization in laparoscopic cholecystectomy: a prospective cohort study

Objective: To systematically evaluate the effectiveness of indocyanine green (ICG) fluorescence navigation in visualizing extrahepatic bile ducts during laparoscopic cholecystectomy, and to identify factors influencing imaging quality. Methods: A total of 217 patients who underwent ICG fluorescence-guided laparoscopic cholecystectomy at Chaoyang Central Hospital between January and August 2025 were prospectively included. The visualization of the cystic duct (CD), right hepatic duct (RHD), common hepatic duct (CHD), and common bile duct (CBD) was assessed at three stages: before Calot’s triangle dissection, after dissection, and after gallbladder removal. Clinical factors potentially affecting visualization quality were analyzed. Results: One case of a RHD anatomical variation accompanied by intraoperative bile leakage was identified. Before Calot’s triangle dissection, the CBD demonstrated the highest visualization rate (73.7%), whereas the RHD showed the lowest (15.2%). After dissection, visualization rates of the CD, CHD, and CBD all exceeded 90%, while 31.8% of the RHD remained inadequately visualized. Multivariate analysis revealed that unsatisfactory CD visualization was independently associated with inflammation (OR = 2.852, 95% CI: 1.496–5.435) and surgical type (OR = 9.528, 95% CI: 1.140–79.609); unsatisfactory RHD visualization correlated with tissue adhesion (OR = 26.913, 95% CI: 10.352–69.971); suboptimal CHD visualization was associated with inflammation (OR = 2.765, 95% CI: 1.470–5.200); and inadequate CBD visualization was also linked to inflammation (OR = 2.472, 95% CI: 1.234–4.951). Conclusion: ICG fluorescence navigation facilitates real-time visualization of extrahepatic bile ducts during laparoscopic cholecystectomy, with inflammation identified as a key factor affecting visualization quality.