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Cohort studyJAMA surgery · 2026

Indocyanine Green Fluorescent Cholangiography During Laparoscopic Cholecystectomy and Bile Duct Injury.

Nicholas C Neel, Lola Van Doosselaere, Nikita S Thareja … Winta T Mehtsun

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SurgeryCohort study

Indocyanine green use is associated with lower common bile duct injury rates.

Indocyanine Green Fluorescent Cholangiography During Laparoscopic Cholecystectomy and Bile Duct Injury.

Nicholas C Neel et al. · JAMA surgery · 2026

Background

IMPORTANCE: Common bile duct (CBD) injury is a rare but devastating complication of laparoscopic cholecystectomy.

Purpose

To evaluate the association between intraoperative ICG use and CBD injury after laparoscopic cholecystectomy.

Methods

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included data from multiple hospitals in the Epic Cosmos dataset for adult patients (18 years and older) undergoing laparoscopic cholecystectomy between 2016 and 2024.

n = 1143 patients

Results

using ICG leads to a 38% lower chance of common bile duct injury

RR 0.62 (95% CI 0.49 to 0.79)

CI excludes the null - significant

More results

Among them, 118 626 (72.0) were female and 46 069 (28.0) were male; the mean (SD) age was 51 (17) years.

ICG use increased from 1143 patients (1.6%) in 2016 to 47 816 (26%) in 2024.

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Conclusion · 1 of 2

In this large national cohort, intraoperative ICG use was associated with lower rates of CBD injury, fewer postoperative biliary procedures and nonbiliary complications, and reduced conversion to open surgery.

Conclusion · 2 of 2

These findings support the use of ICG to enhance biliary safety in laparoscopic cholecystectomy and demonstrate its utility in reducing CBD injury.

Post

Indocyanine Green Fluorescent Cholangiography During Laparoscopic Cholecystectomy and Bile Duct Injury.

Indocyanine green use is associated with lower common bile duct injury rates.

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