“The purpose of these guidelines is to provide evidence-based recommendations for the use of intraoperative imaging modalities during laparoscopic cholecystectomy. We assessed surgical outcomes that were deemed to be important to both surgeons and patients by a panel of surgeons. Specifically, the imaging modalities investigated were contrast
intraoperative cholangiography (IOC), fluorescence imaging (FI) with indocyanine green (ICG), and laparoscopic ultrasound (LUS). The target audience for these guidelines
includes surgeons and patients. A patient–physician perspective was taken, so cost-effectiveness, resources requirements, and availability of said resources were not evaluated. These imaging modalities were primarily assessed in the context of the American healthcare system. Therefore, these recommendations may not apply in settings where the relevant
technology is not easily accessible.”

“Laparoscopic cholecystectomy is one of the most common abdominal operations performed in the United States. Injury to the common bile duct is a rare but dreaded complication, often requiring additional surgery or endoscopic intervention. Its occurrence has been increasing since the introduction and widespread adoption of laparoscopy
(0.4–1.5% of cases) compared to open cholecystectomy. Multiple factors may contribute to the risk of common bile duct injury, including the presence of acute inflammation and anatomical variability of the CBD. Strategies such as achieving the Critical View of Safety (CVS) were developed to mitigate this risk.”

“The panel believes that it is potentially feasible to successfully implement these recommendations into local practice and that the recommendations will be accepted by stakeholders. One potential limitation will be the availability of all the different technologies as well as the additional staff to operate the C-arm to perform intraoperative cholangiography. Additionally, fluoroscopy licensing requirements in some states may be a barrier for some providers and prevent them from utilizing IOC during cholecystectomy. Fluorescence capable equipment is not available at all centers. Finally, shortages of materials such as ICG and contrast may affect the ability to utilize intraoperative imaging techniques.”

Kumar, Sunjay K et al. “SAGES guidelines for the use of intraoperative imaging of the common bile duct.” Surgical endoscopy vol. 39,11 (2025): 7091-7102. Full Text for Emory Users