Indocyanine green perfusion assessment of the gastric conduit in minimally invasive Ivor Lewis esophagectomy

Pather, Keouna; Deladisma, Adeline M.; Guerrier, Christina; Kriley, Isaac; Awad, Ziad T.

doi:10.1007/s00464-021-08346-9

Cited by 6 publications

(6 citation statements)

References 22 publications

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“…Blood flow of the gastric tube was measured to be 67% of the measure just after laparotomy was performed, compared to the non-PET group, where the respective value of blood flow was 33%. Similar outcomes were noticed regarding the anastomotic leakage rate among the two groups [39]. Nowadays, the idea of ischemic preconditioning has been extended apart from preoperative embolization also to pre-operative laparoscopic ligation of the left gastric and left gastroepiploic arteries during the staging laparoscopy in type II junction tumors [16].…”

Section: Ischemic Preconditioning Of the Stomachsupporting

confidence: 65%

“…This may lead to insufficient arterial supply or venous congestion at the anastomotic site, leading consequently to anastomotic complications, such as anastomotic leakage, benign stricture, and graft necrosis [38]. Esophagogastric anastomotic strength and, thus anastomotic complications after esophagectomy depend mainly on the preservation of the right gastric and right gastroepiploic arteries, which provide adequate perfusion to gastric conduit [39]. In addition, the tip of the gastric conduit is the most vulnerable site of ischemia due to insufficient perfusion by the gastroduodenal artery.…”

Section: Gastric Conduit Perfusion Evaluation-intraoperative Fluoresc...mentioning

confidence: 99%

“…The authors conclude that non-perfusion was independently associated with anastomotic leak postoperatively. However, anastomotic leakage remains a multifactorial complication, and ICG-FA should be used as a tool for recognizing high-risk patients, parallel to patient preoperative optimization [39].…”

Section: Gastric Conduit Perfusion Evaluation-intraoperative Fluoresc...mentioning

confidence: 99%

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Prevention of Anastomotic Leak in Minimally Invasive Esophagectomy: The Role of Anastomotic Technique and Adjuvant Surgical Strategies

Kotidis¹,

Anestiadou²

2024

Current Concepts and Controversies in Laparoscopic Surgery

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Ivor-Lewis esophagectomy is followed by a considerable anastomotic leakage rate, which is a potentially fatal complication, followed by increased morbidity and mortality. The emergence of minimally invasive surgery led to a wide variety of anastomotic techniques, three of which are mainly preferred. Hand-sewn anastomoses can be performed in an end-to-end or end-to-side manner, while stapled end-to-end or end-to-side anastomoses are conducted either as circular-stapled anastomoses using a transorally inserted anvil (Orvil™) or as hand-sewn purse-string stapled anastomoses. In addition, side-to-side esophagogastrostomy with a linear stapler is presented as a promising technique. Hybrid techniques are also reported. No consensus has been achieved upon optimal technique and the decision relies on surgeon preference and skills, cost, and length of the available conduit. Furthermore, numerous techniques have been proposed to prevent anastomotic leakage (AL), including appropriate submucosa apposition, omentoplasty of the anastomosis, wide gastric and duodenal mobilization, sufficient esophageal hiatus enlargement, gentle conduit manipulation, reinforcement of staple line, intraoperative fluorescence angiography, as well as preoperative ligation of the left gastric artery. This chapter aims to provide a critical appraisal of the various anastomotic techniques and the tips and tricks described for reducing the anastomotic leak rate during minimally invasive Ivor-Lewis esophagectomy.

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Section: Ischemic Preconditioning Of the Stomachsupporting

confidence: 65%

Section: Gastric Conduit Perfusion Evaluation-intraoperative Fluoresc...mentioning

confidence: 99%

Section: Gastric Conduit Perfusion Evaluation-intraoperative Fluoresc...mentioning

confidence: 99%

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Prevention of Anastomotic Leak in Minimally Invasive Esophagectomy: The Role of Anastomotic Technique and Adjuvant Surgical Strategies

Kotidis¹,

Anestiadou²

2024

Current Concepts and Controversies in Laparoscopic Surgery

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“…In order to avoid the complications related to the viability of the graft in the rst cases, its preparation was done extracorporeal by externalization through an epigastric mini-laparotomy, being recommended in the period of the learning curve [16]. In order to reduce complications related to viabily of the gastric conduit use of indocyanine green is recommended to asses intraoperatively the perfusion of the stomach [17].…”

Section: Discussionmentioning

confidence: 99%

Early experience in minimally invasive esophagectomy for treatment of thoracic esophageal cancer

Achim

Constantin

Mossen

et al. 2022

Preprint

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Introduction: Minimally invasive esophagectomy (MIE) has gained popularity in the surgical treatment of esophageal cancer over the past three decades. By introducing minimally invasive techniques, esophageal oncological surgery has advanced in terms of safety, radicality, functional preservation and quality of life post-esophagectomy of the patients. Material and Method: We present the experience of the Center of Excellence in Esophageal Surgery at Sf. Maria Clinical Hospital regarding total (MIE) through total 3D HD thoraco-laparoscopic modified McKeown triple approach. In between January 2015 - December 2021, 24 patients (M) were treated for thoracic esophageal cancer. The average age of patients was 57 years. Most of the esophageal tumors were midthoracic (62.5%), 83.3% were squamous carcinomas and half were moderately differentiated. Most of the esophageal tumors were locally advanced tumors (cT3N1 – 58.3%), 18 patients were staged III. 70.8% of patients received neoadjuvant chemo radiotherapy. Results: Thoracoscopic esophageal mobilizations were successful in all 24 patients, no conversion to thoracotomy. Laparoscopic gastric mobilizations were successful in all 24 patients, conversion to open technique was performed in 7 patients for creation extracoporeally of the gastric conduit through an epigastric minilaparotomy. The esophageal substitute was represented by the gastric conduit. The intraoperative blood loss was minimal. The average duration of surgical interventions was 360 minutes. All the surgical interventions were considered with curative intention (R0). The rate of intraoperative complications was 20.8%. The rate of early postoperative complications was 66%. Distribution of postoperative complications according to the Clavien-Dindo Classification (0-33.3%, 1-16.6%, 2-4.1%, 3a-12.5%, 3b-8.3%, 4a-0%, 4b-8.3%, 5-16.6%) highlighted a rate of 33.3% of major complications. The advantages of MIE observed in the studied group in the postoperative period were: reduced postoperative pain, improved comfort and early mobilization of the patients. Conclusions: The early outcomes of using the minimally invasive approach in the treatment of esophageal cancer in our clinic include the reduction of perioperative morbidity, the duration of hospitalization and a faster recovery.

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“…However, no high-quality evidence has been published yet proving the additional value of ICG-FA to prevent these anastomotic complications [8,9]. Evidence that ICG-FA reduces the risk of anastomotic leakage of the gastric conduit is also scarce [10,11]. This might be due to the subjective interpretation of the fluorescence signal, which depends on the 'real-time' interpretation of the surgeon.…”

Section: Introductionmentioning

confidence: 99%

A quantitative assessment of perfusion of the gastric conduit after oesophagectomy using near-infrared fluorescence with indocyanine green

Galema¹,

Faber²,

Tange³

et al. 2023

European Journal of Surgical Oncology

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Indocyanine green perfusion assessment of the gastric conduit in minimally invasive Ivor Lewis esophagectomy

Cited by 6 publications

References 22 publications

Prevention of Anastomotic Leak in Minimally Invasive Esophagectomy: The Role of Anastomotic Technique and Adjuvant Surgical Strategies

Prevention of Anastomotic Leak in Minimally Invasive Esophagectomy: The Role of Anastomotic Technique and Adjuvant Surgical Strategies

Early experience in minimally invasive esophagectomy for treatment of thoracic esophageal cancer

A quantitative assessment of perfusion of the gastric conduit after oesophagectomy using near-infrared fluorescence with indocyanine green

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