A meta-analysis of the efficacy and safety of indocyanine green fluorescence imaging-guided laparoscopic cholecystectomy.

Abstract

Objective: To systematically evaluate the efficacy and safety of indocyanine green fluorescence imaging-guided laparoscopic cholecystectomy (FI-LC).

Methods: A comprehensive search of Web of Science, PubMed, Embase, and the Cochrane Library was conducted to identify randomized controlled trials and cohort studies comparing FI-LC with conventional laparoscopic cholecystectomy (C-LC), published from database inception to June 2025. Eligible studies were assessed for quality, and a meta-analysis was performed using Stata 12.

Results: Twenty-six studies involving 4,436 patients were included. Compared with C-LC, FI-LC significantly reduced operative time (weighted mean difference, WMD = -12.11, 95% CI: -19.63 to -4.60, P = 0.002) and biliary structure identification time (WMD = -4.39, 95% CI: -6.75 to -2.03, P < 0.001), had a higher success rate in identification of cystic duct (odds ratio, OR = 3.76, 95% CI: 2.66 to 5.33, P < 0.001) and identification of common bile duct (odds ratio, OR = 2.94, 95% CI: 2.31 to 3.74, P < 0.001), lowered the conversion to open surgery rate (OR = 0.22, 95% CI: 0.13 to 0.39, P < 0.001), and shortened hospital stay (WMD = -0.60, 95% CI: -0.82 to -0.38, P < 0.001). However, no statistically significant differences were found between the two groups in intraoperative blood loss, bile duct injury rates, or postoperative complications.

Conclusion: Fluorescence imaging enhances surgical efficiency, reduces the risk of conversion to open surgery, and shortens hospital stay. Its safety and efficacy are superior to those of C-LC, especially in cases with complex Calot's triangle anatomy.