Intraluminal indocyanine green for intraoperative staple line leak testing in bariatric surgery

Kalmar, Christopher L.; Reed, Christopher M.; Peery, Curtis; Salzberg, Arnold D.

doi:10.1007/s00464-020-07606-4

Cited by 19 publications

(16 citation statements)

References 19 publications

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“…55 The use of intraluminal ICG-FI versus gastroscopy-air leak test-for intraoperative detection of leaks in bariatric surgery was assessed showing only one false-negative case among 59 patients in the ICG-FI group for a sensitivity of 100% and a specificity of 98.28%. 56 These results were comparable with the gastroscopy group, which had three false negatives and 193 true negatives in 196 patients. 56 In another study, 95 patients undergoing robotic gastric bypass were tested with air and a blend of methylene blue and ICG to detect anastomotic leaks intraoperatively.…”

Section: Bariatric and Metabolic Surgerysupporting

confidence: 53%

“…56 These results were comparable with the gastroscopy group, which had three false negatives and 193 true negatives in 196 patients. 56 In another study, 95 patients undergoing robotic gastric bypass were tested with air and a blend of methylene blue and ICG to detect anastomotic leaks intraoperatively. 57 Remarkably, there were no leaks identified with either air or methylene blue; however, four patients were found to have a leak with ICG in the same cohort of patients.…”

Section: Bariatric and Metabolic Surgerysupporting

confidence: 53%

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Indocyanine Green Use in the Minimally Invasive Gastrointestinal Surgery

Ferri

Szomstein

2021

Digestive Disease Interventions

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Indocyanine green (ICG) is a fluorescent dye that has been used in some medical specialties already for almost 60 years and has gained popularity in recent years due to the clinical applications recently proposed in the surgical field. This review article details the current use of the ICG in the minimally invasive gastrointestinal surgery. There is abundant evidence validating the usefulness of ICG fluorescence angiography in the gastrointestinal surgery, leading to a decrease of complications. Other uses, such as its lymphographic use for sentinel lymph node mapping or detection of metastatic lymph nodes, need further investigation to prove its benefit. The heterogeneity and subjective nature of the data remain the greatest challenge when analyzing the possible effects ICG can bring to the gastrointestinal surgery.

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Section: Bariatric and Metabolic Surgerysupporting

confidence: 53%

Section: Bariatric and Metabolic Surgerysupporting

confidence: 53%

Indocyanine Green Use in the Minimally Invasive Gastrointestinal Surgery

Ferri

Szomstein

2021

Digestive Disease Interventions

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“…Some authors have recently used the intraluminal or intravenous administration of ICG to evaluate real-time tissue perfusion and to assess the integrity of the staple line during bariatric surgery, without, however, achieving definitive results yet ( 22 – 24 , 27 , 61 ).…”

Section: Discussionmentioning

confidence: 99%

“…Finally, another use of ICG described in the literature is the intraluminal gastric injection ( 61 ). Kalmar et al performed intraoperative leak test using the intraluminal ICG method in 59 patients and the gastroscopy method in 196 patients who underwent bariatric surgery, proving that intraluminal ICG is an alternative for intraoperative detection of leak with comparable specificity to intraoperative endoscopy ( 61 ).…”

Section: Discussionmentioning

confidence: 99%

“…Kalmar et al performed intraoperative leak test using the intraluminal ICG method in 59 patients and the gastroscopy method in 196 patients who underwent bariatric surgery, proving that intraluminal ICG is an alternative for intraoperative detection of leak with comparable specificity to intraoperative endoscopy ( 61 ). The advantage of the intraluminal ICG, in comparison to intraoperative endoscopy, is that it does not require an experienced endoscopist, any personnel and material cost to resterilize the equipment and not increasing the operative time ( 61 ). It is a similar test with a reported lower false negative rate than the methylene blue test, although there are no comparative studies in the literature ( 21 , 61 , 62 ).…”

Section: Discussionmentioning

confidence: 99%

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Indocyanine Green Fluorescence Angiography During Laparoscopic Bariatric Surgery: A Pilot Study

et al. 2022

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AimsIndocyanine green (ICG) fluorescence angiography (FA) is used for several purposes in general surgery, but its use in bariatric surgery is still debated. The objective of the present pilot study is to evaluate the intraoperative utility of ICG-FA during bariatric surgery in order to focus future research on a reliable tool to reduce the postoperative leak rate.MethodsThirteen patients (4 men, 30.8%, 9 women, 69.2%) with median age of 52 years (confidence interval, CI, 95% 46.2–58.7 years) and preoperative median body mass index of 42.6 kg/m2 (CI, 95% 36 to 49.3 kg/m2) underwent bariatric surgery with ICG-FA in our center. Three mL of ICG diluted with 10 cc sterile water were intravenously injected after gastric tube creation during laparoscopic sleeve gastrectomy (LSG) and after the gastric pouch and gastro-jejunal anastomosis creation during laparoscopic gastric by-pass (LGB). For the ICG-FA, Karl Storz Image 1S D-Light system (Karl Storz Endoscope GmbH & C. K., Tuttlingen, Germany) placed at a fixed distance of 5 cm from the structures of interest and zoomed vision modality were used to identify the vascular supply. The perfusion pattern was assessed by the surgical team according to a score. The score ranged from 1 (poor vascularization) to 5 (excellent vascularization) based on the intensity and timing of fluorescence of the vascularized structures.ResultsFom January 2021 to February 2022, six patients underwent LSG (46.2%), three patients underwent LGB (23.1%), and four patients underwent re-do LGB after LSG (30.8%). No adverse effects to ICG were observed. In 11 patients (84.6%) ICG-FA score was 5. During two laparoscopic re-do LGB, the vascular supply was not satisfactory (score 2/5) and the surgical strategy was changed based on ICG-FA (15.4%). At a median follow-up of five months postoperatively, leaks did not occur in any case.ConclusionsICG-FA during bariatric surgery is a safe, feasible and promising procedure. It could help to reduce the ischemic leak rate, even if standardization of the procedure and objective fluorescence quantification are still missing. Further prospective studies with a larger sample of patients are required to draw definitive conclusions.

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