Experimental study of the quantification of indocyanine green fluorescence in ischemic and non-ischemic anastomoses, using the SERGREEN software program

Abstract

Tissue ischemia is a key risk factor in anastomotic leak (AL). Indocyanine green (ICG) is widely used in colorectal surgery to define the segments with the best vascularization. In an experimental model, we present a new system for quantifying ICG fluorescence intensity, the SERGREEN software. Controlled experimental study with eight pigs. In the initial control stage, ICG fluorescence intensity was analyzed at the level of two anastomoses, in the right and in the left colon. Control images of the two segments were taken after ICG administration. The images were processed with the SERGREEN program. Then, in the experimental ischemia stage, the inferior mesenteric artery was sectioned at the level of the anastomosis of the left colon. Fifteen minutes after the section, sequential images of the two anastomoses were taken every 30 min for the following 2 h. At the control stage, the mean scores were 134.2 (95% CI 116.3–152.2) for the right colon and 147 (95% CI 134.7–159.3) for the left colon (p = 0.174) (Scale RGB—Red, Green, Blue). The right colon remained stable throughout the experiment. In the left colon, intensity fell by 47.9 points with respect to the pre-ischemia value (p < 0.01). After the first post-ischemia determination, the values of the ischemic left colon remained stable throughout the experiment. The relative decrease in ICG fluorescence intensity of the ischemic left colon was 32.6%. The SERGREEN program quantifies ICG fluorescence intensity in normal and ischemic situations and detects differences between them. A reduction in ICG fluorescence intensity of 32.6% or more was correlated with complete tissue ischemia.

Indocyanine Green Angiography for Detecting Quantitative Perfusion Changes in Deep Inferior Epigastric Perforator Flap Breast Reconstruction With Second Venous Drainage

“…Anker et al 28 also investigated how the number, diameter, and location of perforator rows impact DIEP flap microperfusion. Quantification of ICG using computer software programs has been utilized in previous studies, including investigations of ischemic and nonischemic anastomoses or the detection of venous anastomotic failure in free jejunal grafts 29,30 . In our study, we employed quantitative analysis using ImageJ to compare ICG angiograms of DIEP flaps before and after implementing the SIEV-IMV retrograde anastomosis.…”

“…Quantification of ICG using computer software programs has been utilized in previous studies, including investigations of ischemic and nonischemic anastomoses or the detection of venous anastomotic failure in free jejunal grafts. 29,30 In our study, we employed quantitative analysis using ImageJ to compare ICG angiograms of DIEP flaps before and after implementing the SIEV-IMV retrograde anastomosis. By examining different zones within the flaps, we demonstrated a significant improvement in perfusion after adding the second vein, particularly in less perfused (P < 0.001) and lateral (P = 0.012) zones.…”

Indocyanine green: The guide to safer and more effective surgery

“…A primary limitation of this approach is its subjective nature. To mitigate this concern, recent studies have sought to address it by incorporating software that assesses saturation of the indocyanine green[ 34 , 49 , 50 ]. However, in order to identify the optimal software for perfusion assessment and to obtain parameters that are validated, quantifiable and reproducible, further researches on larger and more homogeneous patient populations are necessary.…”