Intraoperative outcomes of 2-dose indocyanine green fluorescence imaging strategies versus white light in laparoscopic cholecystectomy for cystic duct stones: A retrospective comparative study

To compare the intraoperative outcomes of 2 indocyanine green (ICG) fluorescence imaging strategies (low-dose 0.25 mg vs conventional-dose 2.50 mg) with conventional white-light (WL) imaging during laparoscopic cholecystectomy for cystic duct (CD) stones and to determine whether a reduced ICG dose improves duct-to-liver contrast in the setting of biliary inflammation. This retrospective study included 138 patients with CD stones undergoing laparoscopic cholecystectomy between January 2024 and February 2026, allocated to 3 groups: low-dose ICG (0.25 mg), conventional-dose ICG (2.50 mg), or WL imaging. Propensity score matching (1:1 nearest-neighbor, caliper 0.2 standard deviation) was performed to balance baseline covariates. Primary outcomes were operative time, bile duct identification time, and the fluorescence intensity comparison value (FICV). Secondary outcomes included postoperative recovery parameters. After matching, 110 patients were included in the final analysis, and baseline characteristics were well balanced (all P > .05). Both ICG groups had significantly shorter operative time and bile duct identification time than the control group (both P < .001). Post hoc comparison between the 2 ICG protocols showed no significant difference for operative or bile duct identification time. The 0.25 mg group achieved a higher fluorescence success rate (78.6% vs 51.9%, P = .037) and a positive FICV, whereas the 2.50 mg group frequently showed a negative FICV ( P < .001), indicating hepatic oversaturation. No significant differences were observed among the groups in postoperative recovery parameters (all P > .05). Fluorescence-guided surgery improves intraoperative efficiency and bile duct visualization in patients with CD stones compared with conventional WL imaging. Low-dose ICG (0.25 mg) provides enhanced duct-to-liver contrast versus 2.50 mg, highlighting the potential of pathology-specific dosing to improve surgical precision in inflammatory biliary conditions.