Combination of diagnostic laparoscopy and intraoperative indocyanine green fluorescence angiography for the early detection of intestinal ischemia not detectable at CT scan

Alemanno, Giovanni; Somigli, Riccardo; Prosperi, Paolo; Bergamini, Carlo; Maltinti, Gherardo; Giordano, Alessio; Valeri, Andrea

doi:10.1016/j.ijscr.2016.07.016

Cited by 30 publications

(16 citation statements)

References 9 publications

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“…[1] Treatment options include methods ranging from radiological intervention to surgical methods. [21] Early diagnosis and appropriate treatment intervention reduce mortality. Among surgical options used in the present study, the most preferred method was segmental small intestine resection.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors and Evaluation through Mannheim Peritonitis Index and Platelet-to-Lymphocyte Ratio in Acute Mesenteric Ischemia

Yılmaz

Cartı²

2017

Ulus Travma Acil Cerrahi Derg

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Section: Discussionmentioning

confidence: 99%

Prognostic Factors and Evaluation through Mannheim Peritonitis Index and Platelet-to-Lymphocyte Ratio in Acute Mesenteric Ischemia

Yılmaz

Cartı²

2017

Ulus Travma Acil Cerrahi Derg

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“…The studies were often done on animal models [ 8 , 9 ]. Some rare series described its relevance to determinate the viability of bowel and to identify the limits of bad perfused segments in patients with ischemic disease [ 10 ], but included only a small number of cases [ 6 , 11 – 13 ].…”

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confidence: 99%

Does near-infrared (NIR) fluorescence angiography modify operative strategy during emergency procedures?

et al. 2018

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IntroductionBowel viability can be difficult to evaluate during emergency surgery. Near-infrared (NIR) fluorescence angiography allows an intraoperative assessment of organ perfusion during elective surgery and might help to evaluate intestinal perfusion during emergency procedures. The aim of this study was to assess if NIR modified operative strategy during emergency surgery.Materials and methodsFrom July 2014 to December 2015, we prospectively evaluated all consecutive patients, who had NIR assessment during emergency surgery. Primary endpoint was the modification of operative strategy after the assessment with NIR. Secondary endpoints were general post-operative outcomes, including reoperation rate.ResultsFifty-six patients were included in the study. Mean age was 64 ± 17 years. An exploratory laparoscopy was performed in 39% (n = 22) and an open surgery in 61% of cases (n = 34). Conversion rate to open surgery was 41% (n = 9). 32 patients had a bowel resection. In 32% of the cases (n = 18), the result of the NIR test led to a modification of the operative strategy. Among them, 33% (n = 6) had a larger resection or a resection, which was initially not planned. The other 12 patients (67%) had finally no resection, which was initially thought to be performed. Importantly, none of those patients needed a reoperation for ischemia. Mean time for performing NIR test was 167 s (± 121). Overall reoperation rate was 16.1% (n = 9). Two patients had an anastomotic leak. Eight patients (14.3%) died within the first 30 post-operative days; however, none of them presented a bowel ischemia or an anastomotic leak.ConclusionNIR is an easy and short procedure, which can be performed during emergency surgery to assess bowel perfusion. It may help the surgeon to preserve intestinal length or to define the exact limits of resection. Overall, we report a modification of operative strategy in up to one-third of evaluated patients.Electronic supplementary materialThe online version of this article (10.1007/s00464-018-6226-9) contains supplementary material, which is available to authorized users.

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“…In a case report of ileocolic resection for ischemia complicating an aortic repair, authors visualized ascending colon hypoperfusion with FA. While macroscopically the colonic serosa appeared intact from a clinical viewpoint, the mucosa was completely ischemic in the resected specimen [24].…”

Section: Discussionmentioning

confidence: 96%

“…The first affected area and the initial site of injury caused by impaired blood flow is the mucosal bowel surface [17]. The mucosa and submucosa receive 70% of the mesenteric blood flow, whereas 30% goes to the muscularis and serosal layers [24,25]. Consequently, during periods of intestinal ischemia, the mucosa reacts before the serosa, and mucosal necrosis appears within 3h, while full-thickness necrosis develops within 6h [24].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous computer-assisted assessment of mucosal and serosal perfusion in a model of segmental colonic ischemia

et al. 2019

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Background Fluorescence-based enhanced reality (FLER) enables the quantification of fluorescence signal dynamics, which can be superimposed onto real-time laparoscopic images by using a virtual perfusion cartogram. The current practice of perfusion assessment relies on visualizing the bowel serosa. The aim of this experimental study was to quantify potential differences in mucosal and serosal perfusion levels in an ischemic colon segment. Methods An ischemic colon segment was created in 12 pigs. Simultaneous quantitative mucosal and serosal fluorescence imaging was obtained via intravenous indocyanine green injection (0.2mg/kg), using 2 near-infrared camera systems, and computer-assisted FLER analysis. Lactate levels were measured in capillary blood of the colonic wall at 7 regions of interest (ROIs) as determined with FLER perfusion cartography: the ischemic zone (I), the proximal and distal vascularized areas (PV, DV), and the 50% perfusion threshold proximally and distally at the mucosal and serosal side (P50M, P50S, D50M, D50S). Results The mean ischemic zone as measured (mm) for the mucosal side was significantly larger than the serosal one (56.3±21.3 vs. 40.8±14.9, p=0.001) with significantly lower lactate values at the mucosal ROIs. There was a significant weak inverse correlation between lactate and slope values for the defined ROIs (r=-0.2452, p=0.0246). Conclusions Mucosal ischemic zones were larger than serosal zones. These results suggest that an assessment of bowel perfusion from the serosal side only can underestimate the extent of ischemia. Further studies are required to predict the optimal resection margin and anastomotic site.

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Combination of diagnostic laparoscopy and intraoperative indocyanine green fluorescence angiography for the early detection of intestinal ischemia not detectable at CT scan

Cited by 30 publications

References 9 publications

Prognostic Factors and Evaluation through Mannheim Peritonitis Index and Platelet-to-Lymphocyte Ratio in Acute Mesenteric Ischemia

Prognostic Factors and Evaluation through Mannheim Peritonitis Index and Platelet-to-Lymphocyte Ratio in Acute Mesenteric Ischemia

Does near-infrared (NIR) fluorescence angiography modify operative strategy during emergency procedures?

Simultaneous computer-assisted assessment of mucosal and serosal perfusion in a model of segmental colonic ischemia

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