Preventing Bile Duct Injury in Laparoscopic Cholecystectomy: Anatomical Safety and Intraoperative Imaging

Background: Bile duct injury (BDI) is an uncommon but consequential complication of laparoscopic cholecystectomy. This narrative evidence review examines anatomical identification, intraoperative imaging, and bailout strategies for safer gallbladder surgery. Methods: Selected multi-society guidelines, systematic reviews, and comparative studies were examined, with emphasis on the critical view of safety (CVS), cholangiography, indocyanine green (ICG) fluorescence, and subtotal cholecystectomy. Results: Guidelines endorse routine efforts to obtain CVS, imaging when anatomy remains uncertain, and consideration of subtotal cholecystectomy when safe dissection is not feasible. ICG fluorescence often improves anatomical visualization, but randomized evidence has not established a statistically significant reduction in rare BDI events. Conclusion: A stepwise safety culture combining anatomical verification, timely imaging, appropriate bailout decisions, and specialist referral offers a pragmatic prevention framework; more high-quality studies are required to quantify incremental benefits of new imaging methods.