Abstract:ObjectiveTo study the role of indocyanine green （ICG） fluorescence imaging in biliary tract recognition during laparoscopic difficult biliary tract surgery. MethodsThe clinical data of 54 patients with laparoscopic difficult biliary surgery admitted to The Second Affiliated Hospital of Kunming Medical University from August 2019 to August 2022 were retrospectively collected. All patients had extrahepatic bile duct stones and had a history of upper abdominal surgery. Among them, 25 patients underwent ICG fluorescence imaging surgery （fluorescence imaging group） and 29 patients underwent conventional laparoscopic surgery （conventional surgery group）. The intraoperative and postoperative conditions of two groups were compared. ResultsCompared with the conventional surgery group, the operation time ［（110.68±19.03）min vs（147.83±28.59）min］, the time to find bile duct ［（30.92±9.72）min vs（56.52±18.84）min］, and the amount of bleeding ［（43.61±30.67）mL vs（87.93±15.67）mL）］ were significantly reduced （P＜0.05）, the time of exhaust, extubation, hospitalization and total cost of hospitalization were significantly reduced （P＜0.05） in the fluorescence imaging group. There was no statistically significant difference total complications rate between fluorescence imaging group and conventional surgery group （4.00% vs 27.59%, χ2=3.814, P＞0.05）. ConclusionICG fluorescence imaging technology can display the biliary system in real time during operation. Compared with conventional laparoscopic surgery, it can reduce the time to find bile ducts, reduce the amount of bleeding, shorten the operation time, improve the safety of surgery, and reduce the burden of patients. It has good clinical application value.