Visualization of blood supply route to the reconstructed stomach by indocyanine green fluorescence imaging during esophagectomy

Abstract

BackgroundEnsuring an adequate blood supply is essential to the safe performance of an anastomosis during esophagectomy and the prevention of anastomotic leakage. Recently, indocyanine green (ICG) fluorescence imaging has been used to visualize the blood supply when anastomosis is performed in vascular surgery. We used ICG fluorescence imaging to visualize the blood supply for reconstruction during esophagectomy.MethodsSince January 2009, we have performed ICG fluorescence imaging in 33 patients with thoracic esophageal cancer who underwent thoracic esophagectomy. After pulling up the reconstructed stomach, 2.5 mg of ICG was injected as a bolus. ICG fluorescence imaging was performed with a near-infrared camera, and the images were recorded.ResultsICG fluorescence was easily detected in all patients 1 min after injection. Vascular networks were well visualized in the gastric wall and omentum. The blood supply route was located in the greater omentum beside the splenic hilum in 22 (66.7%) of the 33 patients.ConclusionsICG fluorescence can be used to evaluate the blood supply to the reconstructed stomach in patients undergoing esophagectomy for esophageal cancer. On ICG fluorescence imaging, the splenic hiatal vessels were the major blood supply for the anastomosis in most patients.

The Risk Factors for Refractory Fistula after Esophagectomy with Gastric Tube Reconstruction in Patients with Esophageal Cancer

“…Zehetner et al [18] suggested that disease processes that compromise anastomotic perfusion are major predictors of AL. Rino et al [19] suggested that ICG fluorescence can be used to evaluate the blood supply to the reconstructed stomach in patients undergoing esophagectomy for esophageal cancer. It was mentioned that preservation of the splenic hiatal route would maintain blood flow to the top of the reconstructed stomach.…”

Current Trends and Emerging Future of Indocyanine Green Usage in Surgery and Oncology: An Update

“…Other examples of NIR-guided reconstruction are described for breast and esophageal cancer. [72][73][74][75] ECONOMIC CONSIDERATIONS NIR guidance has the potential of reducing healthcare expenditure if improved outcomes warrant replacement of current technologies at a reduced unit cost. Lymphoscintigraphy is the standard for detecting nodal metastasis, but it is invasive, false-negatives exceed 5 %, radiation is detected, and it is costly and time consuming.…”

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“…Many techniques have been described to assess blood supply to the digestive graft (gastric, jejunal, and colon) [47]. However handheld Doppler ultrasound and Fluorescence Imaging System (SPY system) are the most used to evaluate graft perfusion intraoperatively.…”

“…These two techniques are easily used in the operating room and their reported sensitivity was up to 60% [48]. Murawa and colleagues [48] published the first use of the SPY system to assess the gastric graft and several other studies [47,49,50] suggested the utility of using this technique. The SPY system may be particularly useful with considerable contribution when a complex esophageal reconstruction is considered to assess the adequacy of supercharged graft blood supply.…”

“…Therefore information given by intraoperative assessments can be used to guide intraoperative decision making. As recommended by authors [47,48,49,50], these tools are used in conjunction with clinical acumen to decide whether the conduit blood supply is suitable or whether another conduit must be sought.…”