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Open Access 01-09-2021 | Laparoscopy

Preoperative endoscopic marking of the gastrointestinal tract using fluorescence imaging: submucosal indocyanine green tattooing versus a novel fluorescent over-the-scope clip in a survival experimental study

Authors: Manuel Barberio, Margherita Pizzicannella, Andrea Spota, Anila Hoskere Ashoka, Vincent Agnus, Mahdi Al Taher, Boris Jansen-Winkeln, Ines Gockel, Jacques Marescaux, Lee Swanström, Seong-Ho Kong, Eric Felli, Andrey Klymchenko, Michele Diana

Published in: Surgical Endoscopy | Issue 9/2021

Abstract

Background

Intraoperative localization of endoluminal lesions is can be difficult during laparoscopy. Preoperative endoscopic marking is therefore necessary. Current methods include submucosal tattooing using visible dyes, which in case of transmural injection can impair surgical dissection. Tattooing using indocyanine green (ICG) coupled to intraoperative near-infrared (NIR) laparoscopy has been described. ICG is only visible under NIR-light, therefore, it doesn’t impair the surgical workflow under white light even if there is spillage. However, ICG tattoos have rapid diffusion and short longevity. We propose fluorescent over-the-scope clips (FOSC), using a novel biocompatible fluorescent paint, as durable lesion marking.

Methods

In six pigs, gastric and colonic endoscopic tattoos using 0.05 mg/mL of ICG and markings using the fluorescent OSC were performed (T0). Simultaneously, NIR laparoscopy was executed. Follow-up laparoscopies were conducted at postoperative day (POD) 4–6 (T1) and POD 11–12 (T2). During laparoscopy, fluorescence intensity was assessed. In one human cadaver, FOSC was used to mark a site on the stomach and on the sigmoid colon, respectively. Intraoperative detection during NIR laparoscopy was assessed.

Results

Gastric and colonic ICG tattooing and OSC markings were easily visible using NIR laparoscopy on T0. All FOSC were visible at T1 and T2 in both stomach and colon, whereas the ICG tattooing at T1 was only visible in the stomach of 2 animals and in the colon of 3 animals. At T2, tattoos were not visible in any animal. FOSC were still visible in both stomach and colon of the human cadaver at 10 days.

Conclusion

Endoscopic marking using FOSC can be an efficient and durable alternative to standard methods.

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Title: Preoperative endoscopic marking of the gastrointestinal tract using fluorescence imaging: submucosal indocyanine green tattooing versus a novel fluorescent over-the-scope clip in a survival experimental study
Authors: Manuel Barberio
Margherita Pizzicannella
Andrea Spota
Anila Hoskere Ashoka
Vincent Agnus
Mahdi Al Taher
Boris Jansen-Winkeln
Ines Gockel
Jacques Marescaux
Lee Swanström
Seong-Ho Kong
Eric Felli
Andrey Klymchenko
Michele Diana
Publication date: 01-09-2021
Publisher: Springer US
Keyword: Laparoscopy
Published in: Surgical Endoscopy / Issue 9/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07999-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preoperative endoscopic marking of the gastrointestinal tract using fluorescence imaging: submucosal indocyanine green tattooing versus a novel fluorescent over-the-scope clip in a survival experimental study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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