{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:34:08Z","timestamp":1793504048958,"version":"4.5.0"},"reference-count":41,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Laparoscopic cholecystectomy is now established as the worldwide gold standard for the treatment of benign gallbladder disease. Despite technical advancements, bile duct injury (BDI) remains a major concern, especially in patients with obesity. It is well known that in patients with a Body Mass Index (BMI) \u2265 30 kg\/m2, identification of Calot\u2019s triangle and the achievement of the Critical View of Safety (CVS) during laparoscopic cholecystectomy (LC) are made more challenging due to excessive visceral adiposity and concomitant hepatic steatosis reducing the workspace. Near-Infrared Fluorescence Cholangiography (NIRF-C) with Indocyanine Green (ICG) has emerged as an innovative, safe and effective technique to visualize the biliary anatomy and minimize the risk of iatrogenic BDI. However, its specific benefit in patients with obesity remains under-discussed compared to the general population. The main aim of this narrative review is to evaluate whether the intraoperative use of ICG in patients with obesity may reduce operative times and the risk of BDI. A focused review of the literature is performed on articles from 2010 to 2025 published on PubMed, Scopus and Web of Science. The application of ICG fluorescence in LC for patients with obesity represents a tangible clinical advantage, not only for anatomical identification and significant improvement of procedural efficiency, but also for the reduction in operative time.<\/jats:p>","DOI":"10.3390\/life16050728","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T12:31:56Z","timestamp":1777465916000},"page":"728","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Overcoming Anatomical Challenges in Difficult Cholecystectomies: A Narrative Review on the Impact of ICG in Patients with Obesity"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4398-1262","authenticated-orcid":false,"given":"Marcello","family":"Agosta","sequence":"first","affiliation":[{"name":"Department of General Surgery, Cannizzaro Hospital, 95126 Catania, Italy"},{"name":"Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7386-3719","authenticated-orcid":false,"given":"Giorgio","family":"Melita","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Sofia","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cannizzaro Hospital, 95126 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Mazzone","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cannizzaro Hospital, 95126 Catania, Italy"},{"name":"Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Faletra","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cannizzaro Hospital, 95126 Catania, Italy"},{"name":"Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2930-3905","authenticated-orcid":false,"given":"Gaetano","family":"La Greca","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cannizzaro Hospital, 95126 Catania, Italy"},{"name":"Department of Medical, Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saverio","family":"Latteri","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cannizzaro Hospital, 95126 Catania, Italy"},{"name":"Department of Medical, Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,25]]},"reference":[{"key":"ref_1","unstructured":"Purnell, J.Q. (2000). Definitions, Classification, and Epidemiology of Obesity, South Dartmouth (MA): MDText.com, Inc."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Guh, D.P., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C.L., and Anis, A.H. (2009). The Incidence of Co-Morbidities Related to Obesity and Overweight: A Systematic Review and Meta-Analysis. 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