{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:25:09Z","timestamp":1793319909390,"version":"4.5.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Indocyanine green (ICG) fluorescence cholangiography may improve visualization of the extrahepatic biliary tree during laparoscopic cholecystectomy (LC). We examined whether its use was associated with biliary structure identification and with two time-based measures of operative efficiency in patients undergoing LC for benign gallbladder disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive adult patients assessed for cholecystectomy for benign gallbladder disease between January and December 2025 were retrospectively screened. After the ICG-assisted and conventional white-light approaches had been explained, patients chose their preferred procedure; allocation was therefore non-random. The primary outcome was complete identification of the cystic duct, common bile duct, common hepatic duct, and cystic duct-common bile duct junction. The operating surgeon recorded identification during surgery, and a senior physician subsequently reviewed the operative video. Operative efficiency comprised time to achieve the critical view of safety (CVS) and total operative time. Drain placement was analyzed separately. Multivariable models were used to adjust for clinically relevant covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 198 patients, 103 underwent ICG fluorescence-assisted LC and 95 underwent conventional white-light LC. All four biliary structures were identified in 91.3% of the ICG group and 56.8% of the white-light group (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Median time to CVS was 12.0 versus 21.0\u202fmin (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), median operative time was 36.0 versus 48.0\u202fmin (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and drains were placed in 17.5% versus 38.9% of patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). The associations remained significant after multivariable adjustment. No BDI, bile leakage, conversion to open surgery, reoperation, or ICG-related adverse event occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ICG fluorescence use was associated with more frequent identification of extrahepatic biliary structures and shorter time to CVS and completion of LC. Because patients selected the surgical approach and assessment of anatomical identification included clinical judgment, these results should be interpreted as observational. They do not show that ICG reduces the risk of BDI. Prospective multicenter studies are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1869510","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T04:22:30Z","timestamp":1786076550000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of indocyanine green fluorescence navigation with extrahepatic biliary anatomy identification and operative efficiency in laparoscopic cholecystectomy: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Jingyi","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Liver Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Liver Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Liver Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liusheng","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Liver Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuehua","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Liver Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xialin","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Liver Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenqiang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Liver Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Basic Medicine, Beijing Health Vocational College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Liver Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/SLA.0000000000003791","article-title":"Safe cholecystectomy multi-society practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy","volume":"272","author":"Brunt","year":"2020","journal-title":"Ann Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s13017-021-00369-w","article-title":"WSES guidelines for the detection and management of bile duct injury during cholecystectomy","volume":"16","author":"de' Angelis","year":"2021","journal-title":"World J Emerg Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s13017-020-00336-x","article-title":"World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis","volume":"15","author":"Pisano","year":"2020","journal-title":"World J Emerg Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1007\/s00268-022-06842-0","article-title":"Critical view of safety in laparoscopic cholecystectomy: a systematic review of current evidence and future perspectives","volume":"47","author":"Manatakis","year":"2023","journal-title":"World J Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"201","DOI":"10.14701\/ahbps.22-064","article-title":"How to achieve the critical view of safety for safe laparoscopic cholecystectomy: technical aspects","volume":"27","author":"Gupta","year":"2023","journal-title":"Ann Hepatobiliary Pancreat Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1491","DOI":"10.3390\/medicina59081491","article-title":"When critical view of safety fails: a practical perspective on difficult laparoscopic cholecystectomy","volume":"59","author":"Alius","year":"2023","journal-title":"Medicina"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1186\/s12893-025-02847-3","article-title":"The difficult laparoscopic cholecystectomy: a narrative review","volume":"25","author":"Abdallah","year":"2025","journal-title":"BMC Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"4837","DOI":"10.3390\/jcm13164837","article-title":"Bile duct injuries after cholecystectomy: an individual patient data systematic review","volume":"13","author":"Vincenzi","year":"2024","journal-title":"J Clin Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"zraf076","DOI":"10.1093\/bjsopen\/zraf076","article-title":"Risk factors and mitigating measures associated with bile duct injury during cholecystectomy: meta-analysis","volume":"9","author":"Burns","year":"2025","journal-title":"BJS Open"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1824","DOI":"10.1016\/j.hpb.2021.04.017","article-title":"The critical view of safety and bile duct injuries in laparoscopic cholecystectomy: a photo evaluation study on 1532 patients","volume":"23","author":"Terho","year":"2021","journal-title":"HPB"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"S21","DOI":"10.1016\/j.surg.2022.07.012","article-title":"Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy: results of an international Delphi survey","volume":"172","author":"Dip","year":"2022","journal-title":"Surgery"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"4574","DOI":"10.1007\/s00464-023-09935-6","article-title":"Near-infrared fluorescence cholangiography assisted laparoscopic cholecystectomy (FALCON): an international multicentre randomized controlled trial","volume":"37","author":"van den Bos","year":"2023","journal-title":"Surg Endosc"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"4442","DOI":"10.1007\/s00464-021-08795-2","article-title":"Routine use of ICG to enhance operative safety in emergency laparoscopic cholecystectomy: a randomized controlled trial","volume":"36","author":"She","year":"2022","journal-title":"Surg Endosc"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/j.asjsur.2020.11.002","article-title":"Early identification of the critical view of safety in laparoscopic cholecystectomy using indocyanine green fluorescence cholangiography: a randomised controlled study","volume":"44","author":"Koong","year":"2021","journal-title":"Asian J Surg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"864","DOI":"10.3390\/jcm13030864","article-title":"Biliary anatomy visualization and surgeon satisfaction using standard cholangiography versus Indocyanine green fluorescent cholangiography during elective laparoscopic cholecystectomy: a randomized controlled trial","volume":"13","author":"Symeonidis","year":"2024","journal-title":"J Clin Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1007\/s00268-022-06854-w","article-title":"Fluorescence cholangiography using Indocyanine green improves the identification of biliary structures during laparoscopic cholecystectomy","volume":"47","author":"D'Acapito","year":"2023","journal-title":"World J Surg"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"109149","DOI":"10.1016\/j.surg.2025.109149","article-title":"Indocyanine green fluorescent cholangiography in laparoscopic cholecystectomy: a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials","volume":"181","author":"Pimentel","year":"2025","journal-title":"Surgery"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"105245","DOI":"10.1016\/j.pdpdt.2025.105245","article-title":"A meta-analysis of the efficacy and safety of indocyanine green fluorescence imaging-guided laparoscopic cholecystectomy","volume":"56","author":"Tang","year":"2025","journal-title":"Photodiagn Photodyn Ther"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1089\/lap.2022.0495","article-title":"Efficacy and safety of near-infrared florescence cholangiography using Indocyanine green in laparoscopic cholecystectomy: a systematic review and Meta-analysis","volume":"33","author":"Lie","year":"2023","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s00068-023-02340-7","article-title":"Near-infrared indocyanine green fluorescent cholangiography in urgent and emergency laparoscopic cholecystectomy: a preliminary study after propensity score-matched study","volume":"50","author":"Losurdo","year":"2024","journal-title":"Eur J Trauma Emerg Surg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"4946","DOI":"10.1007\/s00464-025-11867-2","article-title":"Surgical outcomes of conventional versus indocyanine green fluorescence-guided laparoscopic cholecystectomy in acute cholecystitis: a propensity score-matched analysis","volume":"39","author":"Ram\u00edrez-Giraldo","year":"2025","journal-title":"Surg Endosc"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e1827","DOI":"10.1590\/0102-6720202400034e1827","article-title":"Critical view of safety: a prospective surgical and photographic analysis in laparoscopic cholecystectomy - does it help to prevent iatrogenic lesions?","volume":"37","author":"Blitzkow","year":"2024","journal-title":"Arq Bras Cir Dig"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1186\/s12893-026-03549-0","article-title":"Intraoperative differences between near-infrared fluorescence cholangiography with indocyanine green and conventional white light laparoscopic cholecystectomy: an integrative review of evidence base","volume":"26","author":"Panin","year":"2026","journal-title":"BMC Surg"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1778","DOI":"10.1007\/s00464-024-11481-8","article-title":"DOse and administration time of Indocyanine green in near-infrared fluorescence cholangiography during laparoscopic cholecystectomy (DOTIG): a randomized clinical trial","volume":"39","author":"L\u00f3pez-S\u00e1nchez","year":"2025","journal-title":"Surg Endosc"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1097\/XCS.0000000000001226","article-title":"Efficacy of intraoperative vs preoperative Indocyanine green Administration for Near-Infrared Cholangiography during Laparoscopic Cholecystectomy: an open-label, noninferiority, randomized controlled trial","volume":"240","author":"Lin","year":"2025","journal-title":"J Am Coll Surg"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1007\/s00595-022-02563-y","article-title":"Real-time fluorescent cholangiography with indocyanine green in laparoscopic cholecystectomy: a randomized controlled trial to establish the optimal indocyanine green dose within 30 min preoperatively","volume":"53","author":"Huang","year":"2023","journal-title":"Surg Today"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"6813","DOI":"10.1007\/s00464-025-12057-w","article-title":"How low can you go? Intraoperative microdosing of indocyanine green for fluorescence cholangiography during laparoscopic cholecystectomy","volume":"39","author":"Broderick","year":"2025","journal-title":"Surg Endosc"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1097\/XCS.0000000000000553","article-title":"Low vs standard-dose Indocyanine green in the identification of biliary anatomy using near-infrared fluorescence imaging: a multicenter randomized controlled trial","volume":"236","author":"Ladd","year":"2023","journal-title":"J Am Coll Surg"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1534","DOI":"10.1002\/jso.27684","article-title":"Efficacy of different indocyanine green doses in fluorescent laparoscopic cholecystectomy: a prospective, randomized, double-blind trial","volume":"129","author":"Wang","year":"2024","journal-title":"J Surg Oncol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1869510\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T04:22:31Z","timestamp":1786076551000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1869510\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":29,"alternative-id":["10.3389\/fmed.2026.1869510"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1869510","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]},"article-number":"1869510"}}