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A randomized controlled clinical trial was conducted in patients who underwent LC for treatment of cholelithiasis. Using the OptoMedic 4K fluorescent endoscopic system, we compared four different doses of ICG (1, 10, 25, and 100\u00a0\u00b5g) administered intravenously within 30\u00a0min preoperatively and evaluated the fluorescence intensity (FI) of the common bile duct and liver background and the bile-to-liver ratio (BLR) of the FI at three timepoints: before surgical dissection of the cystohepatic triangle, before clipping the cystic duct, and before closure. Forty patients were randomized into four groups, and 33 patients were fully analyzed, with 10 patients in Group A (1\u00a0\u00b5g), 7 patients in Group B (10\u00a0\u00b5g), 9 patients in Group C (25\u00a0\u00b5g), and 7 patients in Group D (100\u00a0\u00b5g). The preoperative baseline characteristics were compared among groups (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&gt;\u20090.05). Group A showed no or minimal FI in the bile duct and liver background, while Group D showed extremely high FIs in the bile duct and in the liver background at the three timepoints. Groups B and C presented with visible FI in the bile duct and low FI in the liver background. With increasing ICG doses, the FIs in the liver background and bile duct gradually increased at the three timepoints. The BLR, however, showed no increasing trend with an increasing ICG dose. A relatively high BLR on average was found in Group B, without a significant difference compared to the other groups (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&gt;\u20090.05). An ICG dose ranging from 10 to 25\u00a0\u00b5g by intravenous administration within 30\u00a0min preoperatively was appropriate for real\u2010time fluorescent cholangiography in LC with a 4K fluorescent system.\n                    <jats:italic>Registration<\/jats:italic>\n                    : This study was registered in the Chinese Clinical Trial Registry (ChiCTR No: ChiCTR2200064726).\n                  <\/jats:p>","DOI":"10.1007\/s13304-023-01557-w","type":"journal-article","created":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T11:02:10Z","timestamp":1686740530000},"page":"1903-1910","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Investigation of the optimal indocyanine green dose in real-time fluorescent cholangiography during laparoscopic cholecystectomy with an ultra-high-definition 4K fluorescent system: a randomized controlled trial"],"prefix":"10.1007","volume":"75","author":[{"given":"Hui","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiao","family":"Kuang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujie","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianyang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9136-0882","authenticated-orcid":false,"given":"Peilin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zisheng","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0518-9239","authenticated-orcid":false,"given":"Shuai","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6788-6366","authenticated-orcid":false,"given":"Jiefeng","family":"Weng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueyuan","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaofeng","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0448-110X","authenticated-orcid":false,"given":"Weili","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6668-0702","authenticated-orcid":false,"given":"Yu","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,14]]},"reference":[{"key":"1557_CR1","doi-asserted-by":"publisher","first-page":"662","DOI":"10.3760\/cma.j.cn441530-20210623-00246","volume":"24","author":"XQ Su","year":"2021","unstructured":"Su XQ, Xu K (2021) Technological evolution of laparoscopic gastrointestinal surgery in China. 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This study was registered in the Chinese Clinical Trial Registry (ChiCTR No: ChiCTR2200064726). The informed, written consent was obtained from all patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}}]}}