A randomized trial to visualize extrahepatic biliary structures with or without indocyanine green in patients undergoing difficult laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of symptomatic gall stone disease which is a major health problem affecting 1.39 per 100 person-years. Surgeons often encounter a ―Difficult Gall bladder during  which  achieving Critical view of safety  is difficult and unsafe. Additionally, anatomical variations, such as a short cystic duct or low-lying gallbladder , complicate the procedure and heighten the risk of bile duct injury .Dense adhesions ,previous  surgeries or inflammation can obscure the surgical field, making the identification and dissection of the cystic duct and artery difficult. Fluorescent cholangiography using ICG will enable real-time identification of  the cystic duct , common hepatic duct and common bile duct ,as well as accessory hepatic ducts  during the dissection of the triangle of Calot. This safe and simple technique is helpful in  improve safety in difficult cases of laparoscopic cholecystectomy and thereafter avoiding bile duct injury.In this study, we wish to evaluate the impact of ICG in improving operative efficacy and safety during difficult laparoscopic cholecystectomy, along with long term outcomes and Quality of life.