SAGES guidelines for the use of intraoperative imaging of the common bile duct

There are multiple intraoperative imaging techniques used to increase safety during laparoscopic cholecystectomy, including intraoperative cholangiography (IOC), fluorescence imaging (FI) with indocyanine green (ICG), and laparoscopic ultrasound (LUS). This guideline addresses the optimal intraoperative imaging technique during laparoscopic cholecystectomy for benign biliary disease.

A systematic review was conducted to address five key questions regarding the use of intraoperative imaging of the common bile duct. These results were then presented to a panel of practicing surgeons who formulated recommendations based on the best available evidence.

Conditional recommendations were made in favor of performing IOC in adult and pediatric patients and doing so routinely rather than selectively, IOC rather than FI with ICG, and either IOC or LUS.

These recommendations should provide guidance regarding the use of intraoperative imaging techniques during laparoscopic cholecystectomy. This guideline also identifies important areas where the future research should focus to strengthen the evidence base.

Published by Surgical endoscopy, 2025. The guideline itself is at the source linked here.

doi.org/10.1007/s00464-025-12142-0