Advances in Indocyanine Green Near-Infrared Fluorescence for Extrahepatic Biliary Identification in Laparoscopic Cholecystectomy for Acute Cholecystitis: A Narrative Review.

Laparoscopic cholecystectomy, a minimally invasive procedure with rapid recovery, remains the standard surgical intervention for acute cholecystitis. Acute inflammation of the gallbladder can cause severe edema, dense adhesions, and anatomical distortion within Calot's triangle, frequently obscuring tissue planes and increasing the risk of iatrogenic bile duct injury, a significant surgical complication. Indocyanine green fluorescence serves as a valuable intraoperative navigation tool. Its hepatobiliary metabolic characteristics enable real-time near-infrared visualization of extrahepatic bile ducts, thereby compensating for the limitations of visual and tactile identification during routine cholecystectomy. This narrative review compiles published clinical evidence regarding the application of indocyanine green fluorescence in acute cholecystitis operations. We summarize its advantages in inflamed operative fields and categorize practical application experiences across varying grades of inflammation. Current data indicate enhanced biliary visualization and reduced operative time; however, robust high-level trials confirming a reduction in bile duct injury risks remain lacking. Additionally, we discuss emerging technical advancements, such as artificial intelligence and multispectral imaging. This article aims to evaluate the practical value of indocyanine green near-infrared fluorescence for the recognition of extrahepatic bile ducts in laparoscopic cholecystectomy performed on patients with acute cholecystitis.