Indocyanine Green Fluorescent Cholangiography in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis

Purpose: Laparoscopic cholecystectomy (LC) is the standard treatment for gallbladder diseases. While indocyanine green (ICG) fluorescent cholangiography offers real-time biliary visualization, its overall impact on operative efficiency and perioperative safety is a critical factor influencing surgical outcomes. This systematic review and meta-analysis evaluated the existing evidence to determine whether ICG improves operative efficiency and safety during LC. Methods: Conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251031001), we searched PubMed, Web of Science, Scopus, and Google Scholar from inception to November 2025. We included randomized controlled trials (RCTs) and cohort studies comparing ICG-guided LC with conventional LC. Results: Eight studies (five RCTs, three cohort studies; n = 1198) were included. ICG-guided LC significantly reduced operative duration compared with conventional LC (MD = −8.53 min; 95% CI −12.85 to −4.21; P = 0.0001), with no significant differences in postoperative complications (OR = 0.75; 95% CI 0.29-1.97; P = 0.56), intraoperative blood loss (MD = −7.06 mL; P = 0.30), or hospital stay (MD = 0.02 d; P = 0.91). Subgroup analyses based on study design and country did not demonstrate significant differences in efficacy or safety. Conclusions: ICG fluorescent cholangiography appears to improve operative efficiency without compromising safety. However, variability among studies and methodological limitations preclude definitive conclusions. Large, high-quality RCTs are essential to fully elucidate the long-term effects of ICG use. © 2026 Elsevier Inc.