Fluorescence angiography with indocyanine green (ICG) to evaluate anastomosis in colorectal surgery: where does it have more value?

Morales-Conde, Salvador; Alarcón, Isaías; Yang, Tao; Licardie, Eugenio; Camacho, V; Castillo, Fátima Aguilar del; Balla, Andrea

doi:10.1007/s00464-019-07159-1

Cited by 38 publications

(25 citation statements)

References 34 publications

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“…In the literature the strategy change was reported between 2.5 and 20% [25]. Morales-Conde concluded a maximum impact for ICG-FA on the left-sided resections, where he noted significantly more strategy changes [26]. Summing up our left-sided resections, the strategy was changed in 17.4% (34 of 196 patients).…”

Section: Discussionmentioning

confidence: 74%

“…Compared to our right-sided resections with a strategy change in 13.2% (10 of 76 patients), we could only show a slight tendency. Further, we performed an ileocolic hand-sewn isoperistaltic side-to-side anastomosis in our right hemicolectomies, in the literature Morales performed a stapled one [26].…”

Section: Discussionmentioning

confidence: 99%

“…After the first phase of flooding and intensity rise, in the long run, even a minor perfused descending colon lights up intensely green, and this information is finally useless for the determination of our transection line. The impact of ICG-FA, especially on the left-sided resection [26], might be due to the delicate situation of the perfusion by only one small marginal artery (Drummond) in the descending colon, which is part of the anastomosis. Even though we could not show a significant effect on LAR, in right hemicolectomies, the effect of ICG-FA was significant.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative fluorescence angiography with indocyanine green: retrospective evaluation and detailed analysis of our single-center 5-year experience focused on colorectal surgery

Marquardt

Kalev

Schiedeck

2020

Innovative Surgical Sciences

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ObjectivesAssessing bowel perfusion with indocyanine green fluorescence angiography (ICG-FA) shows positive effects on anastomotic healing in colorectal surgery.MethodsA retrospective evaluation of 296 colorectal resections where we performed ICG-FA was undertaken from January 2014 until December 2018. Perfusion of the bowel ends measured with ICG-FA was compared to the visual assessment before and after performing the anastomosis. According to the observations, the operative strategy was confirmed or changed. Sixty-seven low anterior rectal resections (LARs) and 76 right hemicolectomies were evaluated statistically, as ICG-FA was logistically not available for every patient in our service and thus a control group for comparison resulted.ResultsThe operative strategy based on the ICG-FA results was changed in 48 patients (16.2%), from which only one developed an anastomotic leakage (AL) (2.1%). The overall AL rate was calculated as 5.4%. Within the 67 patients with LAR, the strategy was changed in 11 patients (16.4%). No leakage was seen in those. In total three AL happened (4.5%), which was three times lower than the AL rate of 13.6% in the control group but statistically not significant. From the 76 right hemicolectomies a strategy change was undertaken in 10 patients (13.2%), from which only one developed an AL. This was the only AL reported in the whole group (1.3%), which was six times lower than the leakage rate of the control group (8.1%). This difference was statistically significant (p=0.032).ConclusionsBased on the positive impact by ICG-FA on the AL rate, we established the ICG-FA into our clinical routine. Although randomized studies are still missing, ICG-FA can raise patient safety, with only about 10 min longer operating time and almost no additional risk for the patients.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intraoperative fluorescence angiography with indocyanine green: retrospective evaluation and detailed analysis of our single-center 5-year experience focused on colorectal surgery

Marquardt

Kalev

Schiedeck

2020

Innovative Surgical Sciences

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“…ICG fluorescence angiography leads to significantly increased changes in the resection line and is a promising optical imaging technique to reduce anastomotic leakage [23]. This procedure was considered to be a standard method; however, it was overtaken by a new technology, namely, ICG FI.…”

Section: Discussionmentioning

confidence: 99%

Ultimate Stomaless Technique of Two-Stage Operation for Lower Rectal Cancer Performed on a Patient with a High Body Mass Index: The Reborn Operation (Novel Pull-Through Method)

Nitta

Tanaka

Kataoka

et al. 2020

Case Rep Gastroenterol

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KeywordsLower rectal cancer · High body mass index · Indocyanine green fluorescence imaging · Stomaless surgery · Pull-through procedure Abstract A 58-year-old Japanese man, with a body mass index of 41.7 kg/m 2 (height: 179.8 cm; weight: 133.8 kg), underwent a laparoscopic pull-through procedure with delayed coloanal anastomosis performed in two surgical stages for lower rectal cancer. This method was selected because the volume of the abdominal wall was fairly thick and it would have been impossible to perform diverting ileostomy and colostomy, which are routinely conducted. First, a colonic pull-through segment of about 10 cm was left outside the anal canal without any tension and was fixed by sutures under indocyanine green fluorescence imaging (ICG FI). The second surgical stage was performed 10 days after the first operation under general anesthesia. Final coloanal anastomosis was performed with near-infrared light without diverting the stoma under ICG FI. The patient demonstrated a good postoperative course and was discharged from our hospital in remission 15 days after the latest operation. We could inspect the coloanal flow of the anastomosis under ICG FI before the reconstruction. This procedure was considered to be a Case Nitta et al.: The Reborn Operation: Novel Pull-Through Technique 249 standard method, but it was overtaken by new technology, ICG FI. This procedure is an ultimate stomaless surgery for ultralow rectal cancer that can be performed in selected cases, such as in patients with a high body mass index and with hope for stomaless operation.

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“…Morales Conde et al published in 2019 a prospective, monocentric study [20], that included 192 patients who were divided into 4 groups. Group A consisted of 67 patients undergoing right hemicolectomy, group B 9 patients undergoing segmental resection of the splenic angle, Group C with 81 patients undergoing left hemicolectomy, and group D with 35 patients undergoing anterior rectal resection.…”

Section: Evolution Of Icg In Colorectal Cancer and Literature Experiencementioning

confidence: 99%

Indocyanine Green Fluorescence in Colorectal Cancer

Vargas¹,

Ginestà²

2021

Colorectal Cancer

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Fluorescence vision using indocyanine green is a surgical tool with increasing applications in colorectal cancer surgery. This tool has received acceptance in several disciplines as a potential method to improve visualization of the surgical field, improve lymph node resection and decrease the incidence of anastomotic leaks (ALs). In colorectal surgery specifically, some studies have shown that intraoperative fluorescence imaging is a safe and feasible method to evaluate anastomotic perfusion, and its use could affect the incidence of anastomotic leaks. Currently, controlled trials are carried out to validate these conclusions, as well as new indications for indocyanine green such as detection and guidance in the management of hepatic colorectal metastases, visualization of ureters and even as tumor marking and improvement the lymph node harvest of early tumors. These advances could offer great value to surgeons and patients, by improving the accuracy and results of cancer resections.

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Fluorescence angiography with indocyanine green (ICG) to evaluate anastomosis in colorectal surgery: where does it have more value?

Cited by 38 publications

References 34 publications

Intraoperative fluorescence angiography with indocyanine green: retrospective evaluation and detailed analysis of our single-center 5-year experience focused on colorectal surgery

Intraoperative fluorescence angiography with indocyanine green: retrospective evaluation and detailed analysis of our single-center 5-year experience focused on colorectal surgery

Ultimate Stomaless Technique of Two-Stage Operation for Lower Rectal Cancer Performed on a Patient with a High Body Mass Index: The Reborn Operation (Novel Pull-Through Method)

Indocyanine Green Fluorescence in Colorectal Cancer

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