The main goals of IOC are to identify bile duct stones, clarify biliary anatomy, and prevent bile duct injuries. Indications for IOC during laparoscopic cholecystectomy may include jaundice or a history of jaundice, a history of pancreatitis particularly related to gallstone pancreatitis, elevated liver function tests, a common bile duct larger than 5-7mm in diameter, a cystic duct larger than 3mm in diameter, multiple small gallbladder stones, unclear anatomy, common bile duct stones visualized on preoperative ultrasound, possible bile duct injury or leak, and a short cystic duct.

The SAGES guidelines for the clinical application of laparoscopic biliary tract surgery recommended that IOC may decrease the risk of bile duct injury when used routinely and can allow access to the biliary tree for therapeutic intervention (Level II evidence, grade B recommendation). In a more recent guideline from the European Association for Endoscopic Surgery (EAES) regarding the prevention and treatment of bile duct injuries during laparoscopic cholecystectomy, the authors commented that the routine use of IOC remained controversial and that routine IOC could not be recommend based on the available literature. This guideline, however, indicated that IOC allows forearly identification of bile duct injuries as long as they are correctly interpreted.

Recommendation
Surgeons should use IOC liberally, be familiar with its indications, and become facile with the technique and interpretation of cholangiogram images. While IOC may decrease the risk of bile duct injury its routine use remains controversial; further high quality evidence is needed before routine IOC can be recommended. (Quality of evidence: +++, weak)