A Narrative Review of the Usefulness of Indocyanine Green Fluorescence Angiography for Perfusion Assessment in Colorectal Surgery

Abstract

Anastomotic leakage is one of the most dreaded complications of colorectal surgery and is strongly associated with tissue perfusion. Indocyanine green fluorescence angiography (ICG-FA) using indocyanine green and near-infrared systems is an innovative technique that allows the visualization of anastomotic perfusion. Based on this information on tissue perfusion status, surgeons will be able to clearly identify colorectal segments with good blood flow for safer colorectal anastomosis. The results of several clinical trials indicate that ICG-FA may reduce the risk of AL in colorectal resection; however, the level of evidence is not high, as several other studies have failed to demonstrate a reduction in the risk of AL. Several large-scale RCTs are currently underway, and their results will determine whether ICG-FA is, indeed, useful. The major limitation of the current ICG-FA evaluation method, however, is that it is subjective and based on visual assessment by the surgeon. To complement this, the utility of objective evaluation methods for fluorescence using quantitative parameters is being investigated. Promising results have been reported from several clinical trials, but all trials are preliminary owing to their small sample size and lack of standardized protocols for quantitative evaluation. Therefore, appropriately standardized, high-quality, large-scale studies are warranted.

Indocyanine green near-infrared imaging-guided lymph node dissection during oesophageal cancer surgery: A single-centre experience

“…Compared with previous research, the injection of ICG did not increase the rate of postoperative complications ( 26 ). Iwamoto, M. et al ( 27 ) found that ICG could reduce the risk of complications such as anastomotic leakage in colorectal resection and Tokumaru, S. also reported that no complications were found using ICG and this method can be a powerful tool to avoid thoracic duct injury during esophageal cancer surgery ( 28 ).…”

ICG-augmented hyperspectral imaging for visualization of intestinal perfusion compared to conventional ICG fluorescence imaging: an experimental study

“…Examples of gradual evaluations are usually addressing the quantification of relatively decreased perfusion levels for example in gastrointestinal organs. For these cases ICG could not convince in the past, mainly due to a lack of standardized application as well as a lack of standardized evaluation without objectively quantifiably reference values 21 , 37 . For example there are no ICG intensity values known below which the gastrointestinal organ wall will perish over time.…”

Historical and modern intraoperative methods for determining the viability of the anastomosed ends of the colon

“…Основной механизм этих методов -внутривенное введение люминесцентного препарата и распределение его в кишечнике, при этом кишечник освещают ультрафиолетовой лампой. При перфузионной флюориметрии подсвеченные флуоресцеином натрия участки жизнеспособного кишечника окрашиваются в ярко-зелёный цвет, некротизированный или ишемизированный участок кишечника не окрашивается в отражённом ультрафиолетовом свете, который можно использовать при лапаротомии с лампой Вуда или лапароскопии с ультрафиолетовой подсветкой [45,46]. В серии работ, посвящённых флюоресцентным исследованиям, включающим больных раком ободочной кишки, показано, что все метастатические узлы были выявлены с помощью индоцианинового зелёного красителя и что можно получить таким образом достоверные сведения о лимфогенном распространении этих опухолей [47][48][49].…”