Antonio Gangemi

Background Indocyanine green fluorescence (ICG‐F) stains hepatic tumours and delineates vascular and biliary structures in real‐time. We detail the efficacy of ICG‐F in robotic hepatobiliary surgery. Methods PubMed, EMBASE, Web of Science, and Cochrane Central were searched for original articles and meta‐analyses detailing the outcomes of ICG‐F in robotic hepatobiliary surgery. Results 214 abstracts were reviewed; 16 studies are presented. One single‐institution study reported ICG‐F in robotic right hepatectomy reduced postoperative bile leakage (0% vs. 12%, p = 0.023), R1 resection (0% vs. 16%, p = 0.019), and readmission ( p = 0.023) without prolonging operative time (288 vs. 272 min, p = 0.778). Improved visualisation aided in attainment of R0 resection in partial hepatectomies and radical gallbladder adenocarcinoma resections. Fewer ICG‐F‐aided robotic cholecystectomies were converted to open procedure compared to laparoscopic cholecystectomies (2.1% vs. 8.9%, p = 0.03; 0.15% vs. 2.6%, p < 0.001). Conclusions ICG‐F improves clinical outcomes in robotic hepatobiliary surgery without prolonging operative time. There is an opportunity to standardise ICG administration protocols, especially for hepatectomies.