Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2024; 16(4): 1017-1029
Published online Apr 27, 2024. doi: 10.4240/wjgs.v16.i4.1017
Near-infrared cholangiography with intragallbladder indocyanine green injection in minimally invasive cholecystectomy
Savvas Symeonidis, Ioannis Mantzoros, Elissavet Anestiadou, Orestis Ioannidis, Panagiotis Christidis, Stefanos Bitsianis, Vasiliki Bisbinas, Konstantinos Zapsalis, Trigona Karastergiou, Dimitra Athanasiou, Stylianos Apostolidis, Stamatios Angelopoulos
Savvas Symeonidis, Ioannis Mantzoros, Elissavet Anestiadou, Orestis Ioannidis, Panagiotis Christidis, Stefanos Bitsianis, Konstantinos Zapsalis, Trigona Karastergiou, Dimitra Athanasiou, Stamatios Angelopoulos, Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
Vasiliki Bisbinas, ENT Department, Royal Cornwall Hospitals NHS Trust, Cornwall TR1 3LJ, United Kingdom
Stylianos Apostolidis, 1st Propedeutic Surgical Department, University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
Author contributions: Symeonidis S, Mantzoros I, and Anestiadou E equally contributed to this study; Symeonidis S, Anestiadou E, and Ioannidis O designed the research; Christidis P, Bitsianis S, Zapsalis K, Karastergiou T, Athanasiou D, and Bisbinas V performed the research; Symeonidis S and Anestiadou E wrote the paper; Mantzoros I, Angelopoulos S, and Apostolidis S supervised the paper; and all authors read and approved the final manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Orestis Ioannidis, MD, MSc, PhD, Assistant Professor, Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Exochi, Thessaloniki 57010, Greece.
Received: November 15, 2023
Peer-review started: November 15, 2023
First decision: January 6, 2024
Revised: February 2, 2024
Accepted: March 18, 2024
Article in press: March 18, 2024
Published online: April 27, 2024

Laparoscopic cholecystectomy (LC) remains one of the most commonly performed procedures in adult and paediatric populations. Despite the advances made in intraoperative biliary anatomy recognition, iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems. A series of methods have been proposed to prevent bile duct injury, among them the use of indocyanine green (ICG) fluorescence. The most commonly reported method of ICG injection is the intravenous administration, while literature is lacking studies investigating the direct intragallbladder ICG injection. This narrative mini-review aims to assess the potential applications, usefulness, and limitations of intragallbladder ICG fluorescence in LC. Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy, as well as special issues regarding its use. Literature search retrieved four prospective cohort studies, three case-control studies, and one case report. In the three case-control studies selected, intragallbladder near-infrared cholangiography (NIRC) was compared with standard LC under white light, with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography (IOC). In total, 133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC. Literature includes several reports of intragallbladder ICG administration, but a standardized technique has not been established yet. Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping, overwhelming limitations of IOC including intervention and radiation exposure, as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence. Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into large registries.

Keywords: Minimally invasive cholecystectomy, Laparoscopic cholecystectomy, Biliary tract mapping, Indocyanine green, Near-infrared fluorescent cholangiography, Intracystic indocyanine green, Intragallbladder indocyanine green, Bile duct injury

Core Tip: Direct intragallbladder indocyanine green (ICG) administration is a scarcely reported technique of near-infrared fluorescence cholangiography during laparoscopic cholecystectomy. A series of advantages, such as high rates of biliary structure visualization, lower hepatic parenchyma background signal and intraoperative dye administration, render this option a feasible and promising alternative to the commonly used intravenous ICG fluorescent cholangiography. However, further studies are needed in order to standardize optimal aspects of this technique in clinical practice.