Application of three-step laparoscopic cholecystectomy combined with indocyanine green fluorescence imaging in acute difficult cholecystitis

Jian-Yuan Lin, Shaoxiong Zheng, Lin Feng, Chun-Cheng Li, Jianping Wu, De-Xian Xiao, Deng-Fang Guo, Chun Zhang

Introduction This study aimed to evaluate the clinical value of three-step laparoscopic cholecystectomy combined with indocyanine green (ICG)-guided fluorescence imaging in patients with complicated acute cholecystitis. Methods We retrospectively reviewed the clinical data of 115 patients with complicated acute cholecystitis treated at three hospitals in Ningde between January 2022 and June 2024. The patients were assigned to either a conventional laparoscopic surgery group (60 cases) or a three-step laparoscopic cholecystectomy combined with ICG fluorescence imaging group (55 cases). Operative time, intraoperative blood loss, postoperative recovery indicators, and complication rates were compared between the two groups. Results The combined group showed significantly better outcomes than the conventional group with respect to operative time, intraoperative blood loss, time to postoperative flatus, drainage duration, and length of hospital stay ( P < 0.001). The complication rate in the combined surgery group was 7.2%, which was significantly lower than the 20.0% observed in the conventional surgery group ( P < 0.05). Conclusion Three-step laparoscopic cholecystectomy combined with ICG fluorescence imaging can clearly delineate biliary anatomy, enhance surgical exposure; it reduces the risk of postoperative complications and bile duct injury, improves surgical safety in complicated acute cholecystitis, accelerates postoperative recovery, and has considerable value for clinical application.