PURPOSE: Indocyanine green (ICG) fluorescence imaging enhances biliary visualization during pediatric laparoscopic cholecystectomy (LC), helping to identify anatomical variants and prevent bile duct injury. Standard pediatric recommendations suggest ICG administration 16-24 h preoperatively; however, this may be impractical. This study aims to evaluate the safety and effectiveness of short-interval ICG administration. METHODS: A prospective single-center study (October 2024-June 2025) included pediatric LC patients receiving intravenous Verdye® preoperatively. Visualization of extrahepatic biliary anatomy was assessed intraoperatively using a 5-point Likert scale, HELPFUL (usefulness), and DISTURBED (liver background interference) scores. Data included indication, ICG timing, operative time, and complications according to the Clavien-Dindo classification (C-D). RESULTS: Eleven patients (64% female), median age 14 years (IQR 12,7-15,7) and median weight 65,5 kg (IQR 46,5-80), were included. Five had BMI > 25 kg/m2; five (46%) underwent preoperative ERCP. ICG (median dose 0.34 mg/kg) was administered a median of 225 min before surgery. Median operative time was 65 min (IQR 58-68). Median Likert score was 5; HELPFUL 3; DISTURBED 1. No ICG-related or C-D complications occurred. CONCLUSION: Short-interval ICG administration was safe, feasible, and effective in enhancing biliary visualization during pediatric LC. This approach was well-tolerated and provided high-quality imaging without complications.

Department of Paediatric Surgery 2nd Faculty of Medicine Charles University and Motol University Hospital Charles University 5 Uvalu 84 Praha 5 150 06 Prague Czech Republic

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