High-Quality Indocyanine Green Florescence Cholangiography with Single-Shot Intravenous 0.025 mg Injection in Cholecystectomy

Background: Indocyanine green (ICG) florescence cholangiography is a method to help recognize biliary structures during cholecystectomy. However, the optimal dosage and timing of ICG injection are still under investigation, and there is no consensus internationally. Previous studies revealed the use of various dosages of ICG, ranging from 0.05 mg/kg to 7.5 mg regardless of body weight, while it was revealed that the majority of the quality of ICG cholangiography was suboptimal, i.e., grade B/C. Recently, it has been advocated the use of much diluted ICG, as a higher dose might result in over-detection of adjacent structures, making the biliary tract more difficult to distinguish from its surroundings. This study aimed to investigate the efficacy and safety of a super-diluted intravenous dose, 0.025 mg, given on induction of general anesthesia, for ICG cholangiography in cholecystectomy. Methods: From 19th December 2024 to 14th February 2025, ICG cholangiography was performed with intravenous ICG .025 mg on induction of general anesthesia in all cholecystectomies in a hepatobiliary team. Grading of ICG cholangiography was observed. Results: Totally 18 patients underwent cholecystectomy with ICG cholangiography performed. Sixteen out of 18 (88.9%) ICG cholangiographies were grade A. Two (11.1%) ICG cholangiograpies were grade B. Two (11.1%) patients required conversion to open surgery. There was no bile duct injury. Conclusions: High-quality ICG cholangiography can be safely performed in cholecystectomy with a single-shot intravenous 0.025 mg ICG on induction of general anesthesia.