ICG-cholangiography in assessing biliary tract anatomy during cholecystectomy

Aim. To evaluate the effectiveness of integrating ICG-cholangiography into the safety system during laparoscopic cholecystectomy for the prevention of extrahepatic bile duct injuries by improving the accuracy of anatomical navigation and reducing the risk of cognitive biases in surgeons.

Materials and methods. An analysis of current literature was conducted, with a particular focus on improving the accuracy of intraoperative identification of anatomical structures during laparoscopic cholecystectomy using fluorescent ICG-cholangiography. Step-by-step photographic documentation of key stages was performed in 76 surgical procedures, followed by expert evaluation using a scoring system aimed at objectively assessing compliance with surgical safety criteria.

Results. The implementation of the Critical View of Safety (CVS) concept demonstrated high effectiveness in preventing iatrogenic injuries. However, achieving complete CVS is not always possible due to anatomical variability and adhesions. Navigation-assisted surgical methods, particularly ICG-cholangiography, represent promising tools for enhancing surgical safety. Their use facilitates the identification of hepatobiliary structures by influencing key cognitive mechanisms underlying surgical errors. An algorithm for a typical cholecystectomy meeting CVS criteria and incorporating intraoperative ICG-fluorescent cholangiography is presented.

Conclusion. Strict compliance with the principles of safe laparoscopic cholecystectomy, including the Critical View of Safety (CVS), significantly improves the accuracy of identification of anatomical structures. The use of ICGcholangiography enhances the detection of key anatomical landmarks, facilitates the surgeon’s spatial orientation, and reduces the likelihood of error. Thus, ICG-cholangiography is a valuable tool within the CVS concept and should be considered an important component of a multi-level system for preventing extrahepatic bile duct injuries.

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