Improving precision of laparoscopic cholecystectomy: A review on the role of newer intraoperative imaging aids and artificial intelligence

Table 3 Utility and limitations of various imaging aids, endo vision systems and artificial intelligence in detection of biliary anatomy and pathology in laparoscopic cholecystectomy

Mode	CBD detection rates	Benefits	Limitations
WLI	49.7%[17]	No additional training or equipment is needed	Low sensitivity in difficult grades
IOC	87% to 95%[10]	Good for biliary anatomy particularly aberrant ducts. Good visualization of entire biliary tree. Detection of simultaneous CBD stones. Simultaneous intervention possible for stones	Learning curve, need for CD cannulation, radiation exposure, visualization is not real time, not for vascular anatomy delineation, false positives, routine use advocated can increase time and cost, not repeatable
IOU	92%-100%[13]	Good for biliary anatomy particularly aberrant ducts. Detection of simultaneous CBD stones. Good for vascular anatomy delineation. No CD cannulation needed. No risk of radiation or dye allergies. Can be repeated easily	Steep learning curve. Operator dependent. Difficulty visualizing distal CBD. Inflammatory interference. Limited “Map” of injury
ICG NIR	96% vs 78%-86% in easy vs difficult cases[14,25,26]	Short learning curve, no radiation exposure, real time visualization, no CD cannulation, intraoperative navigation of safe dissection zones	Dye spillage from bile leak/GB perforation can impede visualization. Non-visualization-blocked CD/stones. Hepatic fluorescence interference. Penetration limited in fat/inflammation. Not useful for CBD stones. Small chance of dye allergy
YE and other spectral modes	No concrete data available presumed to be same as WLI	Improved vascular anatomy detection particularly cystic artery. Detection of cystic plate. Rouviere’s sulcus and other surface topography	Role still evolving, limited evidence only few case reports
AI in WLI	71% anatomy detection 92% CVS detection 92% accuracy for safe zones[44,46,47]	Moderate sensitivity for anatomy detection. High sensitivity for CVS detection	Needs validation in further studies. Requires AI enabled endo vision systems for real time mapping
AI and ICG integration	94.39% with YOLO. 82%-100% depending on difficulty grades[51]	High sensitivity in difficult grades. May be helpful for real time definition of safe dissection zones	Needs validation in further studies. Requires AI enabled endo vision systems for real time mapping

CBD: Common bile duct; CD: Cystic duct; GB: Gallbladder; CVS: Critical view of safety; WLI: White light imaging; IOC: Intraoperative cholangiography; IOU: Intraoperative ultrasound; ICG NIR: Indocyanine green near infrared fluorescence; YE: Yellow enhancement; AI: Artificial intelligence; YOLO: You only look once.