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Cirugía Española (English Edition) Green light for safer biliary surgery: the expanding role of fluorescent cholang...
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Systematic review
Pre-proof, online 9 January 2026
Green light for safer biliary surgery: the expanding role of fluorescent cholangiography
Luz verde para la cirugía biliar segura: el papel creciente de la colangiografía fluorescente
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Jaime López Sáncheza,b,
Corresponding author
, José E. Quiñones Sampedroa,b, Pedro A. Montalbán Valverdea,b, Luis M. González Fernándeza, Manuel J. Iglesias Iglesiasa,b,c, María C. Esteban Velascoa,b,c, Francisco Blanco Antonaa,b,c
a Hospital Universitario de Salamanca, Salamanca, Spain
b Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
c Facultad de Medicina, Universidad de Salamanca (USAL), Salamanca, Spain
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Abstract

Near-infrared fluorescent cholangiography (NIFC) has emerged as a promising technique in laparoscopic cholecystectomy (LC), enabling accurate anatomical identification of the biliary tract. Its use has been associated with improved visualization of critical structures, reduced incidence of complications, lower conversion rates to open surgery, and shorter operative times and hospital stays. Key advantages include its easy integration into routine practice, a short learning curve, and straightforward interpretation of images, provided that appropriate protocols are followed. Nevertheless, several limitations currently hinder its widespread standardization. The absence of high-quality evidence prevents consensus on the optimal indocyanine green dose and timing of administration, while the need for specialized imaging systems restricts universal adoption. Future research should focus on defining uniform protocols, validating their impact on LC outcomes, and consolidating the role of NIFC as an intraoperative reference technique for enhancing safety and efficiency in biliary surgery.

Keywords:
laparoscopic cholecystectomy
bile ducts
cholangiography
indocyanine green
Resumen

La colangiografía fluorescente por infrarrojo cercano se ha consolidado como una técnica prometedora en la colecistectomía laparoscópica, al facilitar la identificación anatómica precisa de la vía biliar. Su uso se ha asociado con una mejor visualización de las estructuras críticas, menor incidencia de complicaciones, una reducción de la conversión a cirugía abierta y una optimización de los tiempos quirúrgicos y estancia hospitalaria. Entre sus principales ventajas destacan la facilidad de integración en la práctica clínica habitual, una corta curva de aprendizaje y una interpretación sencilla de las imágenes, siempre que se apliquen protocolos adecuados. Sin embargo, persisten limitaciones que condicionan su estandarización: la falta de consenso sobre la dosis y el momento óptimo de administración del verde de indocianina, así como la dependencia de sistemas de imagen específicos, restringen su universalización. Futuras investigaciones deben centrarse en establecer protocolos uniformes y confirmar su papel como referencia intraoperatoria en la cirugía biliar.

Palabras clave:
colecistectomía laparoscópica
conductos biliares
colangiografía
verde de indocianina

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