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Surgical Endoscopy

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Open Access 01-07-2016

Indocyanine green-enhanced fluorescence to assess bowel perfusion during laparoscopic colorectal resection

Authors: Luigi Boni, Giulia David, Gianlorenzo Dionigi, Stefano Rausei, Elisa Cassinotti, Abe Fingerhut

Published in: Surgical Endoscopy | Issue 7/2016

Abstract

Aims

Anastomotic leakage after colorectal surgery is a severe complication. One possible cause of anastomotic leakage is insufficient vascular supply. The aim of this study was to evaluate the feasibility and the usefulness of intraoperative assessment of vascular anastomotic perfusion in colorectal surgery using indocyanine green (ICG)-enhanced fluorescence.

Methods

Between May 2013 and October 2014, all anastomosis and resection margins in colorectal surgery were investigated using fluorescence angiography (KARL STORZ GmbH & Co. KG, Tuttlingen, Germany) intraoperatively to assess colonic perfusion prior to and after completion of the anastomosis, both in right and left colectomies.

Results

A total of 107 patients undergoing colorectal laparoscopic resections were enrolled: 40 right colectomies, 10 splenic flexure segmental resections, 35 left colectomies, and 22 anterior resections. In 90 % of cases, the indication for surgery was cancer and high ligation of vessels was performed. Based on the fluorescence intensity, the surgical team judged the distal part of the proximal bowel to be anastomosed insufficiently perfused in 4/107 patients (two anterior, one sigmoid and one segmental splenic flexure resections for cancer), and consequently, further proximal “re-resection” up to a “fluorescent” portion was performed. None of these patients had a clinical leak. The overall morbidity rate was 30 %; one patient undergoing right colectomy had an anastomotic leakage, apparently unrelated to ischemia; there were no clinical evident anastomotic leakages in colorectal resections including all low anterior resections.

Conclusions

ICG-enhanced fluorescent angiography provides useful intraoperative information about the vascular perfusion during colorectal surgery and may lead to change the site of resection and/or anastomosis, possibly affecting the anastomotic leak rate. Larger further randomized prospective trials are needed to validate this new technique.

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Title: Indocyanine green-enhanced fluorescence to assess bowel perfusion during laparoscopic colorectal resection
Authors: Luigi Boni
Giulia David
Gianlorenzo Dionigi
Stefano Rausei
Elisa Cassinotti
Abe Fingerhut
Publication date: 01-07-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4540-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Indocyanine green-enhanced fluorescence to assess bowel perfusion during laparoscopic colorectal resection

Abstract

Aims

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Aims

Methods

Results

Conclusions

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