Transforming biliary surgery: Innovations in fluorescence-guided imaging and indocyanine green application

Table 1 Comparison of imaging methods in laparoscopic cholecystectomy

Feature	Multicolor fluorescence imaging	Single-color fluorescence imaging	Non-ICG methods (white-light or conventional IOC)
Fluorescence signal	Multicolor spectrum (blue-to-purple)	Single green fluorescence	No fluorescence
Visualization of biliary anatomy	Enhanced differentiation of structures	Moderate clarity, visual fatigue risk	Poor visualization without contrast agents
Impact on surgeon fatigue	Reduced visual strain due to color mapping	Higher visual strain from single-color imaging	No impact from fluorescence, but relies on other techniques
Effectiveness in complex cases	Effective in inflammatory edema, fatty liver	Limited in complex cases	High dependency on contrast agents or preoperative imaging
Risk of liver fluorescence contamination	Lower	Higher	N/A
Cost and accessibility	Higher cost, newer technology	Lower cost, widely available	Varies, IOC requires X-ray and contrast dye
Safety concerns	Minimal toxicity, but requires further validation	Minimal toxicity	Exposure to radiation (IOC) and risk of bile duct injury

ICG: Indocyanine green; IOC: Intraoperative colonoscopy; N/A: Not applicable.

Table 2 Advantages, disadvantages, and clinical applications of multicolor fluorescence imaging and single-color fluorescence imaging

Factor	Multicolor fluorescence imaging	Single-color fluorescence imaging
Advantages	Enhanced anatomical differentiation; reduced visual fatigue for surgeons; improved visualization in complex cases	Simple and effective for routine case; more accessible and lower cost; established in current surgical practice
Disadvantages	Higher cost and limited availability; requires additional training for surgeons; need for standardization in protocols	Increased visual fatigue; poor performance in complex cases (e.g., severe inflammation, fatty liver); higher risk of liver fluorescence contamination
Clinical applications	Laparoscopic cholecystectomy, especially in complex biliary anatomy; potential applications in oncologic and colorectal surgeries; could be integrated into robotic-assisted procedures	Routine laparoscopic cholecystectomy; may be sufficient for standard biliary imaging; already widely used in clinical practice