The use of near-infrared (NIR) imaging as a method of fluorescence
cholangiography during laparoscopic cholecystectomy as
a noninvasive alternative to the gold standard intraoperative
cholangiography (IOC) is increasing in both practice and in the
literature. Indocyanine green (ICG) is the most commonly used
dye and has been shown to be a safe and cost-effective alternative
to IOC. This study aims to extend both the safety and costeffectiveness
of ICG by demonstrating effective biliary tract
visualization at varying doses of ICG. Patients undergoing laparoscopic
cholecystectomy using NIR fluorescence cholangiography
at a community teaching hospital between August 2015
and November 2016 were retrospectively analyzed in a prospectively
maintained database. ICG dosing was left to the discretion
of the surgeon. The primary outcome was biliary tract visualization.
ICG dose was dichotomized to low-dose and non–low
dose, with non–low dose ICG defined as anything greater than
0.25 mg. Doses ranged from 0.25 mg to 3.75 mg. Fifty-four
patients were included. Twenty-seven patients received lowdose
ICG and 30 patients received non–low dose ICG. Cystic
duct (96% v. 86.2%, p > 0.05), common bile duct (100% v.
83.3%, p > 0.05) and common hepatic duct (44.4% v. 60%, p >
0.05) visualization rates showed no statistical difference. This study shows that low-dose ICG use in fluorescence cholangiography is safe and
effective. The advantages are less background signal from the
liver, decreased cost and potentially fewer adverse reactions
while not compromising the ability to visualize ductal structures.
Further research is necessary for dose optimization in
conditions beyond elective laparoscopic cholecystectomy

Low dose Indocyanine Green is effective for Near Infrared Fluorescence Cholangiography during Laparoscopic Cholecystectomy