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<p>Indocyanine green (ICG) fluorescence cholangiography and intraoperative ultrasound (IOUS) are established adjuncts for visualizing biliary anatomy in minimally invasive biliary surgery. We present a case of a 48-year-old woman with a symptomatic gallbladder remnant after prior cholecystectomy. She had persistent right upper quadrant pain, and preoperative imaging (MRI and ultrasound) demonstrated a 2.5&#xa0;cm cystic remnant containing gallstones. We performed laparoscopic completion cholecystectomy with intraoperative ICG fluorescence cholangiography. Fluorescent imaging clearly outlined the extrahepatic bile ducts, allowing safe identification and dissection of the remnant cystic duct. Subsequent IOUS confirmed intact hepatic arterial and portal venous flow after dissection. The patient’s postoperative course was uneventful, and her pain resolved. This case highlights the potential benefits of combining ICG cholangiography with IOUS to enhance both anatomical orientation and vascular assessment in complex reoperative biliary procedures. While prior studies have supported the individual utility of these modalities, this report suggests that their combined, selective use may offer additional advantages in anatomically challenging reoperative biliary procedures. Further studies are needed to validate this approach in larger cohorts.</p>

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Combined Indocyanine Green Fluorescence and Intraoperative Ultrasound for Laparoscopic Resection of a Gallbladder Remnant: A Case Report

  • 期刊论文

  • 发表日期：

    2026年1月30日

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  • Ghassan Batikha,
  • Afif Alshwaiki

摘要

Indocyanine green (ICG) fluorescence cholangiography and intraoperative ultrasound (IOUS) are established adjuncts for visualizing biliary anatomy in minimally invasive biliary surgery. We present a case of a 48-year-old woman with a symptomatic gallbladder remnant after prior cholecystectomy. She had persistent right upper quadrant pain, and preoperative imaging (MRI and ultrasound) demonstrated a 2.5 cm cystic remnant containing gallstones. We performed laparoscopic completion cholecystectomy with intraoperative ICG fluorescence cholangiography. Fluorescent imaging clearly outlined the extrahepatic bile ducts, allowing safe identification and dissection of the remnant cystic duct. Subsequent IOUS confirmed intact hepatic arterial and portal venous flow after dissection. The patient’s postoperative course was uneventful, and her pain resolved. This case highlights the potential benefits of combining ICG cholangiography with IOUS to enhance both anatomical orientation and vascular assessment in complex reoperative biliary procedures. While prior studies have supported the individual utility of these modalities, this report suggests that their combined, selective use may offer additional advantages in anatomically challenging reoperative biliary procedures. Further studies are needed to validate this approach in larger cohorts.