A meta-analysis of indocyanine green fluorescence image-guided laparoscopic cholecystectomy for benign gallbladder disease.

Background: This meta-analysis was conducted to evaluate the effectiveness and safety of indocyanine green fluorescence image-guided laparoscopic cholecystectomy for benign gallbladder disease.

Methods: Clinical studies were retrieved from PubMed, Embase, Cochrane Library, Medline, and the Web of Science databases. Study-specific effect sizes and their 95 % confidence intervals (CIs) were combined to calculate the pooled values, using fixed-effects or random-effects models.

Results: Eleven studies with combined total of 2221 patients were included. Compared to the control group, the indocyanine green fluorescence imaging-guided group experienced shorter operative time (standardized mean difference [SMD] = -0.30; 95 % CI = -0.45 - -0.15; P < 0.001), shorter biliary anatomy identification time (SMD = -2.34; 95 % CI = -2.58 - -2.10; P < 0.001), lower blood loss (SMD = -0.14; 95 % CI = -0.26 - -0.01; P = 0.035), higher success rate of biliary tract imaging (odds ratio [OR] = 2.37; 95 % CI = 1.09-5.12; P = 0.029), lower rate of conversion to open surgery (OR = 0.10; 95 % CI = 0.04 - 0.28; P < 0.001), shorter hospital stay (SMD = -0.23; 95 % CI = -0.39 - -0.06, P = 0.008), and lower biliary tract imaging costs (SMD = -247.88; 95 % CI, -274.31--221.45, P = 0.000). Postoperative complications did not differ between the groups.

Conclusion: This systematic review shows that indocyanine green fluorescence biliary tract imaging is a safe and feasible new way for biliary tract identification in laparoscopic cholecystectomy.