Indocyanine green has been a popular near-infrared fluorescent reagent in recent years, and indocyanine green fluorescence imaging navigation surgery technology has been widely used in hepatobiliary surgery. Many factors affect imaging in various clinical scenarios, which are roughly divided into liver background fluorescence interference and penetrating tissue thickness, including the dose and timing of the drug, liver lesions of the patient, and individualization of the patient. Under the concept of precise surgery, we should individualise the treatment of patients to minimise the influence of unfavourable factors and further improve the safety and efficacy of surgery. Currently, there is no reliable research evidence to guide the use of indocyanine green in terms of influencing factors, and clinical studies are urgently needed to optimise the use of indocyanine green in hepatobiliary surgery.

Objective To investigate the safety and efficacy of combined confluence microdissection or balloon dilatation followed by laparoscopic transcystic common bile duct exploration (LTCBDE) in day surgery laparoscopic cholecystectomy. Methods The clinical data of 203 patients with day surgery laparoscopic cholecystectomy combined with LTCBDE from June 2021 to June 2024 in Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. They were divided into an observation group (59 cases, including 42 cases of confluent microdissection and 17 cases of balloon dilatation) and a conventional group (144 cases) according to the surgical technique used. Baseline characteristics, intraoperative exploration results, operation time, postoperative recovery and complications were compared between the two groups. Results The history of preoperative cholangitis or pancreatitis (P<0.001) was more common in the observation group. And total bilirubin level was significantly higher in the observation group than in the conventional group (P=0.035). The observation group had a longer operative time (P=0.014) and higher hospitalization costs (P=0.001), but there was no difference in intraoperative bleeding and postoperative discharge time. There were no serious postoperative complications in either group. Conclusions Under the premise of strict patient screening, day surgery LTCBDE combined with confluence microdissection or balloon dilatation can effectively solve the problem of difficult choledochoscopic access, with high safety and thoroughness of exploration. Both techniques provide a feasible minimally observation solution for day surgery biliary exploration.