Vía intravesicular VS. Endovenosa para colangiografía fluorescente con verde de indocianina: estudio comparativo: Intravesicular VS. Intravenous route for indocyanine green fluorescence cholangiography: A comparative study

Jonathan Mauricio Rosillo Maica; Fabio José  Jiménez Zarraga; Gustavo Adolfo Benítez Pérez; Carlos Roberto Fernández Roz; Abigail Alexandra Gómez Bello; Elsa Valentina Herrera Riveros

doi:10.37910/RDP.2026.15.2.e456

Authors

Jonathan Mauricio Rosillo Maica Hospital Universitario de Caracas https://orcid.org/0009-0007-4416-6482
Fabio José Jiménez Zarraga Hospital Universitario de Caracas https://orcid.org/0009-0009-7317-8604
Gustavo Adolfo Benítez Pérez Hospital Universitario de Caracas https://orcid.org/0000-0003-1689-2237
Carlos Roberto Fernández Roz Hospital Universitario de Caracas https://orcid.org/0000-0002-4030-9673
Abigail Alexandra Gómez Bello Hospital Universitario de Caracas https://orcid.org/0009-0000-0738-5079
Elsa Valentina Herrera Riveros Hospital Universitario de Caracas https://orcid.org/0009-0007-2693-4230

DOI:

https://doi.org/10.37910/RDP.2026.15.2.e456

Keywords:

Colecistectomía Laparoscópica, Verde de Indocianina, Fluorescencia, Intravesicular, Endovenosa, Vía Biliar

Abstract

Objective: To evaluate the efficacy and chronometric behavior of intravesicular versus intravenous indocyanine green fluorescence for the anatomical identification of the bile duct in patients undergoing laparoscopic cholecystectomy during the period from July 2024 to January 2026. Methods: A prospective and comparative study was conducted at the Hospital Universitario de Caracas to evaluate the biliary efficacy of indocyanine green (ICG). The sample of 36 patients was divided into two groups: intravenous and intravesicular administration. Using OptoMedic® FloNavi technology, latency times and sharpness in the bile duct were recorded prior to surgical dissection. Statistical analysis, using Student's t-test and Fisher's exact test, contrasted averages and frequencies, with the purpose of identifying the technique that optimizes safety and anatomical precision. Results: The study of 36 patients compared intravesicular and intravenous indocyanine green (ICG) cholangiography. The intravesicular route showed significantly shorter latency times, with medians of 1.5 to 3.75 minutes to identify the fundus and the common bile duct. In contrast, the intravenous route recorded longer times, between 10 and 20 minutes. No statistically significant differences were found when comparing elective versus emergency surgeries (p>0.05). Conclusions: Both techniques demonstrated high efficacy, achieving a success rate in the visualization of biliary structures from 88.9% to 100%, consolidating themselves as reliable tools for safe anatomical identification during cholecystectomy.

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References

1. Pérez B, Toledano Trincado M, Pacheco Sánchez D. Uso de verde de indocianina para prevenir lesiones yatrogénicas de la vía biliar durante colecistectomía laparoscópica. Cir Andal. 2019;30(2):228-34.

2. Ishizawa T, Tamura S, Masuda K, Aoki T, Hasegawa K, Imamura H, et al. Intraoperative fluorescent cholangiography using indocyanine green: a biliary road map for safe surgery. J Am Coll Surg. 2009;208(1):1-4.

3. Wong HP, Huang SW, Huang MH, Chou DA, Wu HS. Fluorescent cholangiography during laparoscopic cholecystectomy by intracholecystic administration of indocyanine green. Surg Endosc. 2016;30(Suppl 1):510.

4. Benítez G, Rosillo J, Mata Y, Fernández C, Herrera E, Gómez A. Fluorescencia con verde de indocianina intravesicular en colecistectomía laparoscópica. Rev Digit Postgrado. 2024;13(3):e408. doi: 10.37910/RDP.2024.13.3.e408.

5. Cai Y, Chen Q, Cheng K, Chen Z, et al. Intragallbladder versus intravenous indocyanine green (ICG) injection for enhanced bile duct visualization by fluorescent cholangiography during laparoscopic cholecystectomy: a retrospective cohort study. Gland Surg. 2024;13(9):1628-38.

6. Christopher A, Sharma SL, Gaikwad P, George AJ, Thomas CT, Lazarus E. Identification of vasculo-biliary anatomy using indocyanine green during laparoscopic cholecystectomy: A prospective observational study-the IVA green study. Indian J Gastroenterol. 2025 Oct 29. doi: 10.1007/s12664-025-01871-8. Epub ahead of print. PMID: 41160323.

7. Oyamada K, Shirata C, Kataoka T, Ide R, Oshima Y, Yamada N, et al. Laparoscopic Cholecystectomy Using Indocyanine Green Fluorescence Imaging in a Patient with a Type I Accessory Hepatic Duct (Hisatsugu Classification): A Case Report. Surg Case Rep. 2025;11(1):25-0512. doi: 10.70352/scrj.cr.25-0512. Epub 2025 Oct 28. PMID: 41194790; PMCID: PMC12583977.

8. Tang K, Zhou Y, Liu Y, Xu X, Liao L. Evaluating the Safety and Efficacy of Indocyanine Green Fluorescence Imaging for Difficult Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis. Am Surg. 2025 Nov 25:31348251387150. doi: 10.1177/00031348251387150. Epub ahead of print. PMID: 41289059.

9. Pujol-Cano N, Morón-Canis JM, Palma-Zamora E, Bonnin-Pascual J, Coll-Sastre M, González-Argenté FX, et al. Low dose indocyanine green fluorescence cholangiography in laparoscopic cholecystectomy: visualization performance across validated risk scores. Langenbecks Arch Surg. 2026 Jan 14. doi: 10.1007/s00423-025-03934-y. Epub ahead of print. PMID: 41530562.

10. Cohen JT, Charpentier KP, Beard RE. An update on iatrogenic biliary injuries: identification, classification, and management. Surg Clin North Am. 2019;99(2):283-99.