Evaluation of intestinal perfusion by ICG fluorescence imaging in laparoscopic colorectal surgery with DST anastomosis

Kawada, Kenji; Hasegawa, Suguru; Wada, Tetsuyuki; Takahashi, Ryo; Hisamori, Shigeo; Hida, Koya; Sakai, Yoshiharu

doi:10.1007/s00464-016-5064-x

Cited by 101 publications

(70 citation statements)

References 33 publications

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“…Blood supply to the anastomosis is also thought to be an important factor for AL, and decreased blood flow is a risk factor 22,23) . Since it has been reported that realtime assessment of blood flow around an anastomosis with indocyanine green is acceptable 24) , further study to objectively evaluate the blood flow is necessary.…”

Section: Discussionmentioning

confidence: 99%

Higher modified Glasgow Prognostic Score and multiple stapler firings for rectal transection are risk factors for anastomotic leakage after low anterior resection in rectal cancer

Sakamoto

Ohki

Kikuchi

et al. 2020

FJMS

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Objective : Anastomotic leakage (AL) is one of the most devastating complications of rectal cancer surgery. Not only does AL result in reduced quality of life, extended hospitalization and impaired defecatory function, it also has a high local recurrence rate. In this study, we investigated risk factors for AL as it may help to decrease its occurrence and improve patient outcomes. Methods : This study was a retrospective, singleinstitution study of rectal cancer patients who underwent elective low anterior resection between April 2002 and February 2018 at Fukushima Medical University Hospital. Patients were divided into two groups according to the presence of AL. Patient-, tumor-, and surgeryrelated variables were examined using univariate and multivariate analyses. Results : One hundred sixtyone patients, average age 63.5±11.5 years, were enrolled in the study. The overall AL rate was 6.8% (11/161). In the univariate analysis, modified Glasgow Prognostic Score (mGPS)=2 (p=0.003), use of multiple staplers (≥3 firings) for rectal transection (p=0.001) and intraoperative bleeding (≥250 g) were significantly associated with AL incidence. Multivariate analysis identified that mGPS = 2 (odds ratio [OR] : 19.6, 95% confidence interval [CI] : 2.96-125.00, p=0.002) and multiple firings (OR : 18.19, CI : 2.31-111.11, p=0.002) were independent risk factors for AL. Conclusion : Higher mGPS score and multiple firings were independent risk factors for AL.

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Section: Discussionmentioning

confidence: 99%

Higher modified Glasgow Prognostic Score and multiple stapler firings for rectal transection are risk factors for anastomotic leakage after low anterior resection in rectal cancer

Sakamoto

Ohki

Kikuchi

et al. 2020

FJMS

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“…by blood flow evaluation in the anastomosis site by ICG fluorescence imaging in colorectal cancer. 9,10 We also reported the effectiveness of predicting AL in colorectal cancer surgery with a quantitative laparoscopic ICG fluorescence imaging for the first time. In that report, T0, the time from the administration of ICG to first observation of fluorescence, might be a useful parameter for prediction AL.…”

Section: Introductionmentioning

confidence: 97%

Quantitative Indocyanine Green Fluorescence Imaging Used to Predict Anastomotic Leakage Focused on Rectal Stump During Laparoscopic Anterior Resection

Iwamoto

Matsuda

Hayami

et al. 2020

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: Anastomotic leakage (AL) is arguably the most troublesome complication of anterior resection (AR). In recent years, however, indocyanine green (ICG) fluorescence imaging has been recently used to evaluate blood flow in the anastomosis site, and it has been suggested that AL may be predicted. We reported the effectiveness of predicting AL in colorectal cancer surgery by observing a quantitative laparoscopic ICG fluorescence imaging for the first time. The purpose of this study was to predict the risk of postoperative AL by quantitative laparoscopic ICG fluorescence imaging focused on the rectal stamp, which is one of the major causes of AL in AR, and to construct diverting stoma (DS) only in appropriate cases. Methods: We studied the 25 patients who underwent elective laparoscopic AR for rectal cancer at our hospital between July 2016 and June 2017. Before enforcing double-stapling technique anastomosis, we injected ICG intravenously, and laparoscopically evaluated blood flow on the rectal stump. We analyzed quantitatively the relationship between various parameters and AL. Results: Median T0, from when the ICG was injected intravenously and the ICG disappeared from the injection route to the rise of the histogram of intensity, in AL group was significantly longer than that in non-AL group (P = .03). There were no other significant differences between AL and non-AL groups. Conclusions: T0 was longer in patients with AL than in those without. If prolonged T0 can be recognized intraoperatively, it will be possible to construct DS for appropriate patients only.

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“…Využívá se běžně v jiných indikacích, např. k hodnocení jaterních funkcí, k angiografii v očním lékařství, ke stanovení prokrvení tkání, hledání spá dových lymfatických uzlin [23,24,28]. Neměla by být použita u pacientů s aler gií na jod.…”

Section: Obr 2 Foto Z Operace -Otevření Dutiny Břišní a Patrná Mléčunclassified

The Use of Indocyanin Green for Peroperative Diagnostic of Chylous Ascites and Autologous Tissue Glue (Vivostat) for the Treatment

Zetelová¹,

Rovný²,

Kala³

et al. 2020

Klin Onkol

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Chirurgická klinika LF MU a FN Brno 2 Gynekologická klinika FN BrnoSouhrn Východiska: Chylózní ascites neboli chyloperitoneum může vzniknout peroperačním poraně ním lymfatických cest, lymfa je následně kumulována v dutině břišní. Incidence chylózního ascitu se liší podle typu operace a rozsahu lymfadenektomie. První volbou léčby je konzer vativní postup -totální parenterální výživa nebo event. přísná nízkotučná dieta. Pokud tento postup selže, je indikována operační revize. Ta je však často obtížná pro pooperačně změněný terén a chronickou přítomnost patologického sekretu v dutině břišní. V identifikaci zdroje lymfy může pomoci aplikace tukové emulze nebo indocyaninové zeleně (indocyanin green -ICG) do oblasti drenáže lymfatických cest. ICG se v dnešní době využívá v různých klinických indika cích, např. k hodnocení jaterních funkcí, k angiografii v očním lékařství, ke stanovení prokrvení tkání, prokrvení štěpů v plastické chirurgii, hledání spádových lymfatických uzlin při onkologic kých výkonech. Výhodou ICG lymfografie je možnost pozorování místa leaku v reálném čase přímo na operačním sále. Případ: Polymorbidní 66letá pacientka po radikální onkogynekolo gické operaci s aortopelvickou lymfadenektomií se pooperačně komplikovala perzistentním, vysokoobjemovým chylózním ascitem nereagujícím na konzervativní léčbu. Provedli jsme tedy operační revizi dutiny břišní a úspěšné ošetření zdroje chylózního leaku za pomoci ICG per operační lymfografie a s následnou aplikací autologního tkáňového lepidla Vivostat na oblast ošetřené léze. Závěr: Vysokoobjemový refrakterní chylózní ascites je méně častá pooperační komplikace s významným dopadem na kvalitu života, nutriční stav nemocného i další pro gnózu pacienta. Léčba je přísně individuální. První volbou by měl být konzervativní postup. Tam, kde selže, je indikována obtížná operační revize. V dnešní době však chirurgovi mohou po moci moderní technologie, jako je např. fluorescenčně navigovaná chirurgie či ošetření zdroje autologními tkáňovými lepidly.

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Evaluation of intestinal perfusion by ICG fluorescence imaging in laparoscopic colorectal surgery with DST anastomosis

Abstract: ICG fluorescence imaging is useful for determining the transection line in laparoscopic colorectal surgery with DST anastomosis. Anticoagulation therapy and preoperative chemotherapy are important risk factors for poor intestinal perfusion.

Cited by 101 publications

References 33 publications

Higher modified Glasgow Prognostic Score and multiple stapler firings for rectal transection are risk factors for anastomotic leakage after low anterior resection in rectal cancer

Higher modified Glasgow Prognostic Score and multiple stapler firings for rectal transection are risk factors for anastomotic leakage after low anterior resection in rectal cancer

Quantitative Indocyanine Green Fluorescence Imaging Used to Predict Anastomotic Leakage Focused on Rectal Stump During Laparoscopic Anterior Resection

The Use of Indocyanin Green for Peroperative Diagnostic of Chylous Ascites and Autologous Tissue Glue (Vivostat) for the Treatment

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