LC has been widely accepted as an effective surgical treatment for cholecystitis and cholelithiasis. However, BDI is the most severe complication of LC and the incidence still occurs in 0.3%−1.5% of cases [1,2].

The accessory bile duct is a type of anatomical variants of the biliary tree that leads to misidentification in surgery. Goor and Ebert have defined the communicating accessory bile duct as that intercommunicate between major biliary channels but do not drain individual segments of liver [3], and its actual prevalence is ambiguous0. The partial cholecystectomy was performed approximately 0.4% of cases especially in emergency settings [4]. Surgical treatment is indicated in symptomatic recurrent cholelithiasis. The laparoscopic resection of residual gallbladder is a challenging procedure due to the uncertain local anatomy and severe adhesions. Severe inflammation made it difficult to identify in Calot's triangle and increased the chance of BDI [4]. So, a thorough understanding of the biliary tract anatomy is important for preventing the surgical complications. Traditionally, IOC was used to prevent BDI in patients with acute cholecystitis efficiently [5]. However, it was limited by complicated process, prolonged operative time and the radiation exposure involved. In addition, the MRCP was used for preoperative evaluation of LC in identifying the accessory bile duct. But it was still not routinely performed in many institutions [6]. But these are not reducing the incidence of BDI efficiently of LC and a tool that could identify the biliary tract in real-time intraoperative is required. A tool that could identify the biliary tract in real-time intraoperative is required. Then the fluorescence cholangiography with ICG came out and had been studied [7].

ICG fluorescence cholangiography could provide the real-time imaging to identify the biliary tract efficiently in LC [8]. Ishizawa et al. first reported the use of ICG fluorescent cholangiography to identity the bile duct with near-infrared light [7]. Subsequently, some studies showed that the security and superiority of using ICG fluorescence cholangiography to identify the extrahepatic bile ducts and the artery than traditional LC [9,10]. Especially, it has the ability to detect the biliary anomalies intraoperative [11].

In this paper, we herein reported a patient diagnosed as residual gallbladder stone with an accessory bile duct. The patient received laparoscopic surgery guided by ICG fluorescence and IOC without BDI.