Low‑dose indocyanine green fluorescence cholangiography in laparoscopic cholecystectomy: visualization performance across validated risk scores

BACKGROUND: Laparoscopic cholecystectomy(LC) is the standard treatment for gallbladder disease. However, complex cases may require conversion to open surgery. Indocyanine green near-infrared fluorescence cholangiography(ICG NIRF-C) enhances biliary visualization, potentially reducing conversion rates, surgical time and complications.This study evaluates ICG's role in improving LC outcomes using five predictive risk scores. STUDY DESIGN: Forty-four LC patients received a single 0.25 mg intravenous ICG dose during anesthesia induction. Data collected included demographics, biliary visualization before and after dissection, complications, operative time and risk scores. RESULTS: ICG fluorescence improved biliary visualization: common bile duct(CBD) was identified in 29% of cases before and 100% after dissection. Despite 61.4% of patients having a CLOC score > 6 and 43.2% a G10 score ≥ 3 no conversions occurred. Only 7% of cases exceeded 90 min (p = 0.03). CONCLUSION: ICG NIRF-C enhanced biliary visualization and, in this cohort, was associated with absence of conversions and favorable operative‑time profiles across risk strata. These findings are observational and hypothesis‑generating, supporting further comparative evaluation, particularly in complex cases.