An Overview of Near Infrared Fluorescent Cholangiography with Indocyanine Green during Cholecystectomy

Laparoscopic cholecystectomy (LC) is one of the most common surgical procedures performed globally but continues to carry to an unacceptably high risk of iatrogenic bile duct injury (BDI). In recent years several centres have proposed Near Infrared Fluorescent Cholangiography (NIRFC) with Indocyanine Green (ICG) as a potential method of dynamic intraoperative extra hepatic bile duct mapping. We provide an overview of the current problem of BDI during laparoscopic cholecystectomy including the incidence, aetiology and medico legal ramifications. We also provide a short summary of the enduring argument for and against routine intraoperative cholangiogram (IOC) and we discuss the new technology of NIRFC with ICG in detail. We provide an informative summary of the small number of highly heterogeneous clinical trials of NIRFC with ICG currently available and briefly discuss limitations of the technology.