Use of fluorescence imaging and indocyanine green during colorectal surgery: Results of an intercontinental Delphi survey

Wexner, Steven D.; Abu-Gazala, Mahmoud; Boni, Luigi; Buxey, Kenneth; Cahill, Ronan; Carus, Thomas; Chadi, Sami A.; Chand, Manish; Cunningham, Chris; Emile, Sameh Hany; Fingerhut, Abe; Foo, Chi Chung; Hompes, Roel; Ioannidis, Argyrios; Keller, Deborah S.; Knol, Joep; Lacy, Antonio M.; Lacy, F. Borja de; Liberale, Gabriel; Martz, Joseph; Mizrahi, Ido; Montroni, Isacco; Mortensen, N. J. McC.; Rafferty, Janice F.; Rickles, Aaron S.; Ris, Frédéric; Safar, Bashar; Sherwinter, Danny A.; Sileri, Pierpaolo; Stamos, Michael J.; Starker, Paul M.; Bos, Jacqueline van den; Watanabe, Jun; Wolf, Joshua H.; Yellinek, Shlomo; Zmora, Oded; White, Kevin P.; Dip, Fernando; Rosenthal, Raúl J.

doi:10.1016/j.surg.2022.04.016

Cited by 12 publications

(9 citation statements)

References 36 publications

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“…Hopefully, the results of the AVOID study will provide the evidence needed to dissolve any ensuing skepticism on this modality [ 15 ]. A recently published Delphi consensus of international experts on the use of ICG further supported the use of ICG for anastomotic perfusion assessment (100% consensus reached), as well as issues such as timing and dosage of ICG for perfusion assessment during colorectal surgery [ 108 , 109 ]. The other ICG applications for perfusion assessment, including for gracilis and advancement flaps, although promising, require further research in order to be routinely implemented into daily practice.…”

Section: Discussion and Future Perspectivesmentioning

confidence: 99%

“…The available studies show promising results with potential practice-changing applications of this technique including lymph node evaluation. The prematurity and contradictive nature of the available data is also reflected in the recent Delphi survey: while experts agreed that ICG lymphangiography might increase the lymph node yield, they debated whether the routine use of ICG is needed in cancer surgery for lymph node evaluation or whether it will impact the resection plan [ 108 , 109 ]. Furthermore, the use of ICG for the intraoperative visualization of colorectal peritoneal and liver metastases seems revolutionary, yet more research is needed for the quantification of ICG signal as well as safely defining the boundary where fluorescence ceases and healthy tissue ensues.…”

Section: Discussion and Future Perspectivesmentioning

confidence: 99%

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Indocyanine Green Fluorescence Guided Surgery in Colorectal Surgery

Garoufalia

Wexner

2023

JCM

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Background: Indocyanine green (ICG) imaging has been increasingly used for intraoperative guidance in colorectal surgery over the past decade. The aim of this study was to review and organize, according to different type of use, all available literature on ICG guided colorectal surgery and highlight areas in need of further research and discuss future perspectives. Methods: PubMed, Scopus, and Google Scholar databases were searched systematically through November 2022 for all available studies on fluorescence-guided surgery in colorectal surgery. Results: Available studies described ICG use in colorectal surgery for perfusion assessment, ureteral and urethral assessment, lymphatic mapping, and hepatic and peritoneal metastases assessment. Although the level of evidence is low, results are promising, especially in the role of ICG in reducing anastomotic leaks. Conclusions: ICG imaging is a safe and relatively cheap imaging modality in colorectal surgery, especially for perfusion assessment. Work is underway regarding its use in lymphatic mapping, ureter identification, and the assessment of intraperitoneal metastatic disease.

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Section: Discussion and Future Perspectivesmentioning

confidence: 99%

Section: Discussion and Future Perspectivesmentioning

confidence: 99%

Indocyanine Green Fluorescence Guided Surgery in Colorectal Surgery

Garoufalia

Wexner

2023

JCM

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“…Therefore, the identification of the region of potentially involved D3 lymph nodes is crucial for effective oncological surgery. Previous studies have demonstrated that FLNM could be beneficial for adequate D3 lymph node dissection in colorectal cancer [8][9][10][11][12][13][14][15]21]. Therefore, FLNM may play a role in optimal D3 lymph node dissection during laparoscopic surgery for locally advanced colon cancers.…”

Section: Discussionmentioning

confidence: 99%

“…Fluorescence lymph node mapping allows realtime visualization of lymph nodes and the lymphatic drainage pathways during surgery. However, some studies have evaluated the feasibility of FLNM for right-sided colon cancer, and there is insufficient evidence regarding its role in achieving adequate lymph node dissection [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG for Laparoscopic Right Hemicolectomy: A Prospective Case–Control Study

Son,

Yun,

Lee

et al. 2023

Cancers

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Background: The distinction between D3 lymph nodes and actual lymphatic pathways in primary tumors can be difficult during surgery, making it challenging to confirm the completeness of D3 lymph node dissection. Fluorescence lymph node mapping (FLNM) is a promising method for lymph node visualization. Purpose: This study aimed to assess whether FLNM enhances the effectiveness of D3 lymph node dissection in patients with right-sided colon cancer. Methods: Endoscopic submucosal indocyanine green injection were performed on the distal margin of the colon cancer. In an FLNM group, the lymphatic drainage pathway and distribution of D3 lymph nodes were explored. Pathological evaluations were conducted for the fluorescent D3 and non-fluorescent D3 lymph nodes. Results: The FLNM group showed a significantly higher number of harvested lymph nodes in the D3 area. In stage III patients, the proportion of D3 lymph node metastasis was significantly higher in the FLNM group. The harvested D3 lymph node count showed a proportional correlation with a metastatic lymph node count of up to 15. Conclusion: FLNM could be considered a promising new strategy to potentially increase harvested D3 lymph node counts in colon cancer surgery.

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“…A randomised prospective comparative study, using as control group patients who have been preoperatively marked with India Ink, would be necessary in order to demonstrate whether the benefits of this technique are significant for tumor localisation and possible adverse events. In addition, more studies are required to also verify the optimal dosage of the fluorophores, as shown recently by an intercontinental experts Delphi consensus study ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Preoperative tumor marking with indocyanine green prior of robotic colorectal resections

et al. 2022

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This prospective case-series study aimed to assess the usefulness of preoperative colonoscopic marking of colorectal tumors using Indocyanine Green (ICG) fluorescence in patients that underwent robotic surgical colorectal resections. Consecutive patients that were eligible for colorectal resection with intent to cure in a single hospital (Athens Medical Center), from February 2022 to June 2022, were included. ICG solution was injected into the submucosal layer at 2 opposite sites (180 degrees apart) distal to the tumor, without submucosal elevation. Identification of the tumor marking was then performed after switching to near-infrared (NIR) fluorescence mode. During the robotic procedure, qualitative evaluation of fluorescence was performed by the surgical team (primary surgeon, first assistant, second assistant, research fellow). All 10 patients underwent robotic surgical approach and operations included right-sided colectomy (n = 1), left-sided colectomy (n = 6) and low anterior resection (n = 3). Visualisation of this dye with near-infrared light was very clear with bright intensity in all patients when the marking was performed one day prior of surgery. Preoperative tumor marking with ICG was identified intraoperatively in all cases and the techinque was easily reproducible.

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Use of fluorescence imaging and indocyanine green during colorectal surgery: Results of an intercontinental Delphi survey

Cited by 12 publications

References 36 publications

Indocyanine Green Fluorescence Guided Surgery in Colorectal Surgery

Indocyanine Green Fluorescence Guided Surgery in Colorectal Surgery

Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG for Laparoscopic Right Hemicolectomy: A Prospective Case–Control Study

Preoperative tumor marking with indocyanine green prior of robotic colorectal resections

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