Near-infrared fluorescence angiography for intra-operative assessment of pedicled omentoplasty for filling of a pelvic cavity: a pilot study

Slooter, M D; Blok, Robin D.; Wisselink, D D; Buskens, Christianne J.; Bemelman, Willem A.; Tanis, Pieter J.; Hompes, Roel

doi:10.1007/s10151-019-02048-0

Cited by 8 publications

(10 citation statements)

References 15 publications

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“…The percentage of intra-operative detection of partial omental ischaemia by conventional assessment (17% and 12% in the two cohorts, respectively) corresponds to reported rates in the literature [14]. In the cohort with FA, resection of ischaemic parts of the omentoplasty was performed according to FA findings in an additional 78%, which is in line with the observation from a previous pilot study [8].…”

Section: Discussionsupporting

confidence: 88%

“…After conventional white light assessment of omental perfusion, the decision was made whether or not there was a need for partial omental resection due to ischaemia. From April 2018 onwards, FA was subsequently performed as previously described [8]. FA interpretation was based on the near infrared image (standard setting) and was a consensus between two colorectal surgeons.…”

Section: Methodsmentioning

confidence: 99%

“…In a pilot study, the use of intra-operative fluorescence angiography (FA) using indocyanine green was found to potentially contribute to the diagnosis of omental ischaemia in patients who were treated by salvage surgery and a pedicled omentoplasty [8,9]. However, the effect on clinical outcomes of the prophylactic resection of poorly perfused omental areas as interpreted by FA is still unknown.…”

Section: Introductionmentioning

confidence: 99%

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Optimizing omentoplasty for management of chronic pelvic sepsis by intra‐operative fluorescence angiography: a comparative cohort study

et al. 2020

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Aim Pelviperineal wound complications frequently occur after salvage surgery for chronic pelvic sepsis despite using an omentoplasty. Sufficient perfusion of the omentoplasty following mobilization is essential for proper healing. This study investigated the impact on short-term clinical outcomes of fluorescence angiography (FA) using indocyanine green for assessment of omental perfusion in patients undergoing salvage surgery. Method This was a comparative cohort study including consecutive patients who underwent combined abdominal and transanal minimally invasive salvage surgery with omentoplasty at a national referral centre for chronic pelvic sepsis between December 2014 and August 2019. The historical and interventional cohorts were defined based on the date of introduction of FA in April 2018. The primary outcome was pelviperineal non-healing, defined by the presence of any degree of pelviperineal infection at the final postoperative evaluation. Results Eighty-eight patients underwent salvage surgery with omentoplasty for chronic pelvic sepsis, of whom 52 did not have FA and 36 did have FA. The underlying primary disease was Crohn's disease (n = 50) or rec-tal cancer (n = 38), with even distribution among the cohorts (P = 0.811). FA led to a change in management in 28/36 (78%) patients. After a median of 89 days, pelviperineal non-healing was observed in 22/ 52 (42%) patients in the cohort without FA and in 8/ 36 (22%) patients in the cohort with FA (P = 0.051). Omental necrosis was found during reoperation in 3/ 52 and 0/36 patients, respectively (P = 0.266). Conclusion After introduction of FA to assess perfusion of the omentoplasty, halving of the pelviperineal nonhealing rate was observed in patients undergoing salvage surgery for chronic pelvic sepsis.

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Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimizing omentoplasty for management of chronic pelvic sepsis by intra‐operative fluorescence angiography: a comparative cohort study

et al. 2020

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“…A meta-analysis of 1894 patients showed that omentoplasty did not reduce the risk of postoperative presacral abscesses or perineal complications [93]. ICG fluorescence angiography of the transferred omentum was recently assessed in a pilot study [94]. Remarkably, ICG fluorescence angiography led to a change in surgical management in 80% of the patients.…”

Section: Omentoplastic Perfusionmentioning

confidence: 99%

Fluorescence-guided surgery in colorectal cancer; A review on clinical results and future perspectives

Galema

Meijer

Lauwerends

et al. 2022

European Journal of Surgical Oncology

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Background: Colorectal cancer is the fourth most diagnosed malignancy worldwide and surgery is one of the cornerstones of the treatment strategy. Near-infrared (NIR) fluorescence imaging is a new and upcoming technique, which uses an NIR fluorescent agent combined with a specialised camera that can detect light in the NIR range. It aims for more precise surgery with improved oncological outcomes and a reduction in complications by improving discrimination between different structures. Methods: A systematic search was conducted in the Embase, Medline and Cochrane databases with search terms corresponding to 'fluorescence-guided surgery', 'colorectal surgery', and 'colorectal cancer' to identify all relevant trials. Results: The following clinical applications of fluorescence guided surgery for colorectal cancer were identified and discussed: (1) tumour imaging, (2) sentinel lymph node imaging, (3) imaging of distant metastases, (4) imaging of vital structures, (5) imaging of perfusion. Both experimental and FDA/EMA approved fluorescent agents are debated. Furthermore, promising future modalities are discussed. Conclusion: Fluorescence-guided surgery for colorectal cancer is a rapidly evolving field. The first studies show additional value of this technique regarding change in surgical management. Future trials should focus on patient related outcomes such as complication rates, disease free survival, and overall survival.

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“…Omentoplasty is a well-known method to fill the pelvic cavity after APR or in case of complications after rectal cancer surgery. A pilot study of the intraoperative value of NIR fluorescence imaging with ICG to assess omental perfusion after the creation of a pedicled omentoplasty found that a change in decision making occurred in 80% of the cases[ 110 ], and a positive impact on the nonhealing rates of patients undergoing salvage surgery for chronic pelvic sepsis was also observed[ 111 ].…”

Section: Other Usesmentioning

confidence: 99%

Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art

Peltrini¹,

Podda²,

Castiglioni³

et al. 2021

WJG

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Indocyanine green (ICG) fluorescence imaging is widely used in abdominal surgery. The implementation of minimally invasive rectal surgery using new methods like robotics or a transanal approach required improvement of optical systems. In that setting, ICG fluorescence optimizes intraoperative vision of anatomical structures by improving blood and lymphatic flow. The purpose of this review was to summarize all potential applications of this upcoming technology in rectal cancer surgery. Each type of use has been separately addressed and the evidence was investigated. During rectal resection, ICG fluorescence angiography is mainly used to evaluate the perfusion of the colonic stump in order to reduce the risk of anastomotic leaks. In addition, ICG fluorescence imaging allows easy visualization of organs such as the ureter or urethra to protect them from injury. This intraoperative technology is a valuable tool for conducting lymph node dissection along the iliac lymphatic chain or to better identifying the rectal dissection planes when a transanal approach is performed. This is an overview of the applications of ICG fluorescence imaging in current surgical practice and a synthesis of the results obtained from the literature. Although further studies are need to investigate the real clinical benefits, these findings may enhance use of ICG fluorescence in current clinical practice and stimulate future research on new applications.

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Near-infrared fluorescence angiography for intra-operative assessment of pedicled omentoplasty for filling of a pelvic cavity: a pilot study

Cited by 8 publications

References 15 publications

Optimizing omentoplasty for management of chronic pelvic sepsis by intra‐operative fluorescence angiography: a comparative cohort study

Optimizing omentoplasty for management of chronic pelvic sepsis by intra‐operative fluorescence angiography: a comparative cohort study

Fluorescence-guided surgery in colorectal cancer; A review on clinical results and future perspectives

Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art

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