Indocyanine Green Fluorescent Cholangiography During Laparoscopic Cholecystectomy: JAMA Surgery | July 2026

Introduction:

Common bile duct (CBD) injury is one of the most serious complications of laparoscopic cholecystectomy. This large national cohort study evaluated whether indocyanine green (ICG) fluorescent cholangiography improves biliary visualisation and reduces the risk of bile duct injury.

Why was this study needed?

• CBD injury remains a rare but devastating complication of laparoscopic cholecystectomy.
• Conventional identification of biliary anatomy can be challenging, particularly in difficult gallbladders.
• ICG fluorescent cholangiography provides real-time biliary mapping without radiation.
• High-quality evidence supporting routine ICG use has been limited.
• Strategies to improve operative safety and reduce complications are needed.

Results:

• ICG fluorescent cholangiography significantly reduced common bile duct injury by approximately 38% compared with conventional laparoscopic cholecystectomy.
• Patients undergoing ICG-guided surgery required fewer subsequent biliary interventions, had lower conversion rates to open surgery, and experienced fewer postoperative non-biliary complications.
• ICG adoption increased markedly between 2016 and 2024, reflecting growing acceptance of fluorescence-guided surgery in routine clinical practice.

Clinical Impact:

This analysis of more than 1.2 million laparoscopic cholecystectomies provides the strongest real-world evidence to date that ICG fluorescence cholangiography enhances biliary safety. Routine ICG use may improve visualisation of biliary anatomy, reduce major bile duct injuries, decrease conversion to open surgery, and improve overall surgical outcomes.

Bottom Line:

Indocyanine green fluorescent cholangiography is a simple, safe, and effective adjunct during laparoscopic cholecystectomy. Its routine use is associated with significantly fewer bile duct injuries, fewer postoperative biliary procedures, lower conversion to open surgery, and improved overall surgical safety, supporting wider adoption in everyday practice.