Laparoscopic Gastric Bypass Conversion to SADI-S with Use of Indocyanine Green Fluoroscopy

Garofalo, Fabio; Mongelli, Francesco; Cristaudi, Alessandra; Regina, Davide La; Podetta, Michele; Marengo, Michele; Popeskou, Sotirios Georgios

doi:10.1007/s11695-022-05929-w

Cited by 3 publications

(6 citation statements)

References 6 publications

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“…In our series, no ICG-related complications were recorded, and also the intraoperative time dedicated to the test was low (a few minutes). The safety and feasibility demonstrated in our study were also reported by many articles in the literature 15 – 18 , 25 , 26 .…”

Section: Discussionsupporting

confidence: 86%

“…The authors scored the ICG-tested vascular supply and found that in two out of four conversional cases (from SG to GB) a change of the surgical strategy was deemed necessary. Garofalo et al 15 published a video report assessing the safety and feasibility of ICG use during a two-step conversion from GB to single anastomosis duodeno–ileal bypass with sleeve gastrectomy. The authors found that, although ICG was useful to assess the blood supply, no change in the surgical strategy was necessary.…”

Section: Discussionmentioning

confidence: 99%

“…Recent works in colorectal surgery have postulated that the use of indocyanine green may lead to a change in choosing the optimal site for anastomosis, thus reducing the rate of anastomotic leakage 14 . However, the use of indocyanine green in bariatric surgery has never been considered mandatory or necessary like in colorectal surgery, as the blood supply of the stomach is generally adequate 10 , 11 , 15 . Few studies have assessed the usefulness of ICG fluorescence in primary or reoperative bariatric surgery 11 , 16 – 18 .…”

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confidence: 99%

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Assessment of gastric pouch blood supply with indocyanine green fluorescence in conversional and revisional bariatric surgery: a prospective comparative study

Mongelli

Garofalo

Giacopelli

et al. 2023

Sci Rep

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Our study aimed to evaluate the usefulness of indocyanine green (ICG) angiography during conversional or revisional bariatric surgery. We prospectively enrolled all patients scheduled for reoperative bariatric surgery with gastric pouch resizing and ICG assessment and we compared them with a retrospective series of similar patients who did not receive ICG. The primary outcome was the rate of intraoperative change in the surgical strategy due to the ICG test. We included 32 prospective patients receiving intraoperatively an ICG perfusion test and 48 propensity score-matched controls. The mean age was 50.7 ± 9.7 years, 67 (83.7%) patients were female, and the mean BMI was 36.8 ± 5.3 kg/m2. The patient characteristics were similar in both groups. The ICG angiography was successfully conducted in all patients, and no change of the surgical strategy was necessary. Postoperative complications were similar in both groups (6.2% vs. 8.3%, p = 0.846), as well as operative time (125 ± 43 vs. 133 ± 47 min, p = 0.454) and length of hospital stay (2.8 ± 1.0 vs. 3.3 ± 2.2 days, p = 0.213). Our study suggested that ICG fluorescence angiography might not have been useful for assessing the blood supply of the gastric pouch in patients who underwent reoperative bariatric surgery. Therefore, it remains uncertain whether the application of this technique is indicated.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Assessment of gastric pouch blood supply with indocyanine green fluorescence in conversional and revisional bariatric surgery: a prospective comparative study

Mongelli

Garofalo

Giacopelli

et al. 2023

Sci Rep

Self Cite

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“…Only four publications present the results of over 50 patients [ 18 , 19 , 27 , 28 ], and the largest study group includes 95 patients [ 27 ]. Five studies were case reports that examined one patient each [ 23 – 26 , 29 ]. The most commonly described application of fluorescence is the assessment of tissue blood supply during MBS, which was reported in nine studies [ 18 – 26 ].…”

Section: Resultsmentioning

confidence: 99%

Fluorescence use in minimally invasive metabolic and bariatric surgery — a systematic review of the literature

Wityk

Dowgiałło-Gornowicz

Feszak

et al. 2023

Langenbecks Arch Surg

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Purpose This review aims to explore and summarise current knowledge of indocyanine green (ICG) fluorescence application in metabolic and bariatric surgery (MBS) and assess its potential in improving patient safety. Methods The review was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Evidence from PubMed, ScienceDirect and Ovid MEDLINE databases was independently screened in October 2022. The primary information and outcomes were the type of fluorescence application with potential patient benefit and the complication rate. The secondary outcomes consisted of the kind of dye, the application protocol, and the equipment used. Results Thirteen publications were included, with six prospective observational studies, five case reports and two retrospective cohort studies and involved a total of 424 patients. The publications were categorized into four groups based on the method of fluorescence application. Sixty-six percent of the cases used fluorescence for LSG, 32.3% used it for RYGB, 1.2% for revisional surgery, 0.2% during removal of an adjustable gastric band, and 0.2% for LSG combined with Rossetti fundoplication. ICG was used on its own in the majority of studies, although in one case, it was used in combination with methylene blue. ICG administration protocols varied significantly. Complications occurred in three patients (0.71%): leaks were diagnosed in two cases, and one patient required a blood transfusion. Conclusion The most popular type of use is intraoperative assessment of the blood supply. ICG application may reduce the risk of complications, with potential benefits in detecting ischemia and leaks, searching for bleeding in areas inaccessible to endoscopy, and non-invasive hepatopathy evaluation.

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“…It should be also noted that, thus far, indocyanine green (ICG) angiography is not supported by the Hugo™ RAS system. ICG angiography can be useful in cases of doubtful perfusion of the gastric pouch and anastomoses, especially in revisional surgery, where the technical advantages of the robotic platform can be decisive, but thus far the Hugo™ RAS system does not support it, which is a temporary limitation of the platform ( 32 – 34 ). Another limitation of the Hugo™ platform is the lack of robotic staplers that would allow to complete a totally robotic procedure.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Roux-en-Y Gastric Bypass with the novel robotic platform HUGO™ RAS

et al. 2023

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IntroductionRobotic assisted surgery is a rapidly developing field of minimally invasive bariatric surgery in the last 20 years. Its wide diffusion has led to the development and standardization of robotic assisted approaches for bariatric operations. In this study, we present the first four Roux-en-Y Gastric Bypass (RYGB) operations performed with the new Hugo™ RAS system (Medtronic, Minneapolis, MN, USA).MethodsIn January and February 2023, 4 consecutive patients scheduled for minimal invasive Roux-en-Y-Bypass were selected and underwent the procedure robotic-assisted with the new platform. No exclusion criteria were applied.ResultsFour patients, two females and two males, underwent RYGB with a median BMI of 40 Kg/m2 (range: 36–46) and diabetes mellitus in two cases. The median docking time was 8 min (range: 7–8.5) and the median console time was 127.5 min (range: 95–150). A description of the operating theatre, robotic arms and docking setup is provided. Procedures were performed without intraoperative complications and no conversion to laparoscopy or open surgery was noted. No additional ports were needed to be placed. System's function and docking were uneventful. No early post-operative complications were observed.ConclusionsBased on our initial experience, RYGB with the Hugo™ RAS system is feasible. This study provides the configurations necessary to perform RYGB with the Hugo™ RAS system as well as general information and insights from our preliminary experience.

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Laparoscopic Gastric Bypass Conversion to SADI-S with Use of Indocyanine Green Fluoroscopy

Cited by 3 publications

References 6 publications

Assessment of gastric pouch blood supply with indocyanine green fluorescence in conversional and revisional bariatric surgery: a prospective comparative study

Assessment of gastric pouch blood supply with indocyanine green fluorescence in conversional and revisional bariatric surgery: a prospective comparative study

Fluorescence use in minimally invasive metabolic and bariatric surgery — a systematic review of the literature

Feasibility of Roux-en-Y Gastric Bypass with the novel robotic platform HUGO™ RAS

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