Intraoperative Cholangiography During Cholecystectomy: Contemporary Evidence, Evolving Techniques, and a Risk-Based Approach

Authors

• Katie A. Duffy, West Coast University, TexasFollow

Specialty

General Surgery

Advisor

Dr. Christopher Bell

Abstract

Intraoperative cholangiography (IOC) has been an essential technique for visualizing biliary anatomy and reducing complications during cholecystectomy for over a century. As gallbladder surgery has evolved, from open to laparoscopic and now increasingly to robotic approaches, the precise role of IOC has remained debated. Contemporary evidence shows that while routine IOC increases the detection of common bile duct (CBD) stones, it does not significantly lower rates of bile duct injury (BDI), retained stones, or readmissions compared with a selective approach based on patient risk and intraoperative findings. New imaging modalities, such as fluorescence cholangiography and laparoscopic ultrasound, offer radiation-free alternatives that may further improve intraoperative visualization, particularly in complex and high-risk cases. Resource considerations, including operative time, costs, and radiation exposure, further support a tailored, risk-adapted approach to IOC. This review synthesizes current evidence, elucidates the evolving field of surgical technology, and recommends selective IOC as the most efficient, patient-centered, and evidence-based strategy for contemporary biliary surgery. Ongoing research is needed to clarify best practices for integrating emerging imaging technologies, particularly as robotic surgery continues to be adopted.

Recommended Citation

Duffy KA. Intraoperative Cholangiography During Cholecystectomy: Contemporary Evidence, Evolving Techniques, and a Risk-Based Approach. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).