Evaluating the Safety and Efficacy of Indocyanine Green Fluorescence Imaging for Difficult Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

Background Indocyanine green (ICG) fluorescence imaging has emerged as a valuable technique to improve biliary structure visualization and reduce potential risk of laparoscopic cholecystectomy (LC). This meta-analysis was conducted to evaluate the safety and efficacy of ICG fluorescence image-guided LC for difficult gallbladder disease. Methods Embase, PubMed, Web of Science, and Cochrane library databases were searched to obtain comparative studies. The randomized (RoB2) and non-randomized interventions (ROBINS-I) were used to assess the methodological quality of included studies. The primary outcomes included operative time, blood loss, hospital day, rate of conversion to open, and postoperative complication. Results 9 studies were included in the meta-analysis, including 1 randomized controlled trial, 6 retrospective studies, and 1 prospective study. A total of 1069 patients were included in the study, of whom 526 patients received indocyanine green fluorescent cholangiography (ICG-FC) during difficult laparoscopic cholecystectomy (DLC) and 543 patients received traditional DLC. Compared with the control group, ICG group significantly decreased operative time (SMD -1.08 min; 95% CI-1.99, −0.16. P < 0.05), lower rate of conversion to open (relative risk (RR) 0.25; 95% CI 0.08, 0.78. P = 0.202), and shorter length of hospital stay (SMD -0.30 d; 95% CI -0.58, −0.02. P < 0.05). The ICG group had similar results compared with the control group in intraoperative blood loss (SMD -1.31 mL; 95% CI-3.01, 0.38. P < 0.05) and postoperative complication (RR 0.64; 95% CI 0.38, 1.08. P = 0.179). Conclusion Compared with control group, ICG-FC had better results in operative time, rate of conversion to open, and length of hospital stay for DLC.