# Laparoscopic Cholecystectomy Completely Guided by Indocyanine Green Fluorescence: A Case Report and Narrative Review of the Literature

## TL;DR

This paper presents a case of laparoscopic cholecystectomy fully guided by indocyanine green fluorescence, offering a safer alternative to traditional methods.

## Contribution

The novelty lies in describing a complete laparoscopic cholecystectomy guided entirely by ICG fluorescence, a rare approach in current literature.

## Key findings

- A 48-year-old male successfully underwent cholecystectomy using ICG fluorescence for the entire procedure.
- The technique allowed visualization of the biliary tract and cystic artery with minimal blood loss and a short operative time.
- This approach may offer improved safety compared to conventional methods, though further evaluation is needed.

## Abstract

Although laparoscopic cholecystectomy is the cornerstone of treatment for benign gallbladder diseases, the Achilles heel of this operation is the possibility of bile duct injury, which is a rare but potential devastating complication. In recent years, using indocyanine green (ICG) to guide laparoscopic cholecystectomy has gained popularity. It is an innovative method that facilitates the identification of the extrahepatic biliary tract and, occasionally, the cystic artery. Laparoscopic cholecystectomy entirely guided by ICG has been described rarely in the literature. Herein, we described the case of a 48-year-old male who underwent laparoscopic cholecystectomy under complete ICG guidance. A total of 2.5 ml of ICG was administered 45 minutes before the procedure. The extrahepatic biliary tract was visualized using ICG cholangiography. The cystic artery was visualized just 60 seconds after an intraoperative injection of 3 ml of the ICG solution via ICG angiography. Following this, the cystic duct and cystic artery were clipped and divided, and the gallbladder was detached from the liver bed under fluorescence guidance. The total operative time was 43 minutes, with minimal intraoperative blood loss of 10 ml. This technique may provide a safer alternative compared to conventional laparoscopic cholecystectomy under ICG guidance, as the entire procedure is performed under ICG visualization. Nonetheless, the safety and efficacy of this approach should be further evaluated in future case series.