When should indocyanine green be assessed in colorectal surgery, and at what distance from the tissue? Quantitative measurement using the SERGREEN program

Serra‐Aracil, Xavier; Lucas-Guerrero, Victoria; García-Nalda, Albert; Mora-López, Laura; Pallisera‐Lloveras, Anna; Serracant, Anna; Navarro‐Soto, Salvador

doi:10.1007/s00464-022-09343-2

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…Most of the commercialized systems are in auto-settings, limiting the possibility of comparing intra-patient and inter-patient data. Furthermore, several studies have suggested that fluorescence intensity changes with the distance of the camera from the structure or organ of interest [60,61]. For example, Serra-Aracil et al [60] showed a significant correlation between the distance from the desired anatomy with the measured fluorescence intensity in a prospective study of colorectal surgery.…”

Section: Discussionmentioning

confidence: 99%

Quantification of Indocyanine Green Fluorescence Imaging in General, Visceral and Transplant Surgery

Pollmann

Juratli

Roushansarai

et al. 2023

JCM

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Near-infrared (NIR) imaging with indocyanine green (ICG) has proven to be useful in general, visceral, and transplant surgery. However, most studies have performed only qualitative assessments. Therefore, a systematic overview of all studies performing quantitative indocyanine green evaluation in general, visceral, and transplant surgeries should be conducted. Free term and medical subject heading (MeSH) term searches were performed in the Medline and Cochrane databases until October 2022. The main categories of ICG quantification were esophageal surgery (24.6%), reconstructive surgery (24.6%), and colorectal surgery (21.3%). Concordantly, anastomotic leak (41%) was the main endpoint, followed by the assessment of flap perfusion (23%) and the identification of structures and organs (14.8%). Most studies examined open surgery (67.6%) or laparoscopic surgery (23.1%). The analysis was mainly carried out using manufacturer software (44.3%) and open-source software (15.6%). The most frequently analyzed parameter was intensity over time for blood flow assessment, followed by intensity alone or intensity-to-background ratios for structure and organ identification. Intraoperative ICG quantification could become more important with the increasing impact of robotic surgery and machine learning algorithms for image and video analysis.

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Section: Discussionmentioning

confidence: 99%

Quantification of Indocyanine Green Fluorescence Imaging in General, Visceral and Transplant Surgery

Pollmann

Juratli

Roushansarai

et al. 2023

JCM

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“…One of the main drawbacks of this method is the fact that assessment is subjective. Therefore, recent studies [ 16 , 17 , 18 , 19 ] have tried to address this issue with software assessing the ICG saturation. One study [ 16 ] reported the optimal distance of the camera from the colon to assess perfusion (5 cm) and the optimal time for assessment (1.5–3.5 min after intravenous infusion), indicating some progress in this area.…”

Section: Current Uses Of Icg In Colorectal Surgerymentioning

confidence: 99%

“…Therefore, recent studies [ 16 , 17 , 18 , 19 ] have tried to address this issue with software assessing the ICG saturation. One study [ 16 ] reported the optimal distance of the camera from the colon to assess perfusion (5 cm) and the optimal time for assessment (1.5–3.5 min after intravenous infusion), indicating some progress in this area. Still, more research is required to identify the optimal software for validated, quantifiable, and reproducible perfusion assessment.…”

Section: Current Uses Of Icg In Colorectal Surgerymentioning

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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“…First, the fluorescence intensity is highly influenced by external factors, such as the camera angle and distance to the object, background light, equipment used, and ICG concentration in the blood. Fluorescence intensity is inversely correlated with the distance between the camera and the tissue and is very sensitive to slight changes in this distance; thus, the slightest jolt of the handheld camera can lead to noise and interference with the quantitative analysis [ 75 , 76 ]. In addition, previous studies used different protocols for ICG dosage ( Table 1 and Table 2 ).…”

Section: Quantitative Assessment Of Colon Perfusion Using Icg-fluores...mentioning

confidence: 99%

A Narrative Review of the Usefulness of Indocyanine Green Fluorescence Angiography for Perfusion Assessment in Colorectal Surgery

Iwamoto

Kawamura

2022

Cancers

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Anastomotic leakage is one of the most dreaded complications of colorectal surgery and is strongly associated with tissue perfusion. Indocyanine green fluorescence angiography (ICG-FA) using indocyanine green and near-infrared systems is an innovative technique that allows the visualization of anastomotic perfusion. Based on this information on tissue perfusion status, surgeons will be able to clearly identify colorectal segments with good blood flow for safer colorectal anastomosis. The results of several clinical trials indicate that ICG-FA may reduce the risk of AL in colorectal resection; however, the level of evidence is not high, as several other studies have failed to demonstrate a reduction in the risk of AL. Several large-scale RCTs are currently underway, and their results will determine whether ICG-FA is, indeed, useful. The major limitation of the current ICG-FA evaluation method, however, is that it is subjective and based on visual assessment by the surgeon. To complement this, the utility of objective evaluation methods for fluorescence using quantitative parameters is being investigated. Promising results have been reported from several clinical trials, but all trials are preliminary owing to their small sample size and lack of standardized protocols for quantitative evaluation. Therefore, appropriately standardized, high-quality, large-scale studies are warranted.

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When should indocyanine green be assessed in colorectal surgery, and at what distance from the tissue? Quantitative measurement using the SERGREEN program

Cited by 8 publications

References 15 publications

Quantification of Indocyanine Green Fluorescence Imaging in General, Visceral and Transplant Surgery

Quantification of Indocyanine Green Fluorescence Imaging in General, Visceral and Transplant Surgery

Indocyanine Green Fluorescence Guided Surgery in Colorectal Surgery

A Narrative Review of the Usefulness of Indocyanine Green Fluorescence Angiography for Perfusion Assessment in Colorectal Surgery

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