Intra‐operative visualization of the ureter by near‐infrared fluorescence during robotic‐assisted laparoscopic sigmoidectomy for diverticulitis – a video vignette

Khan, Fatima; Keyes, Alan; Ra, Chisei

doi:10.1111/codi.14908

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…Notably, it is already impacting decision-making and step-sequencing in reconstructive surgery both of the gastrointestinal tract 18 and other tissues 19 . As well as a means to demarcate watersheds between perfused and non-perfused intestine, other uses include critical boundary identifications such as ureters 20 , 21 and fascial planes 22 by direct instillation. For cancer and draining lymph node identification, ICG has been placed peritumorally submucosally by endoscopic tattoo 23 – 25 .…”

Section: Discussionmentioning

confidence: 99%

Digital dynamic discrimination of primary colorectal cancer using systemic indocyanine green with near-infrared endoscopy

Dalli

Loughman

Hardy

et al. 2021

Sci Rep

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As indocyanine green (ICG) with near-infrared (NIR) endoscopy enhances real-time intraoperative tissue microperfusion appreciation, it may also dynamically reveal neoplasia distinctively from normal tissue especially with video software fluorescence analysis. Colorectal tumours of patients were imaged mucosally following ICG administration (0.25 mg/kg i.v.) using an endo-laparoscopic NIR system (PINPOINT Endoscopic Fluorescence System, Stryker) including immediate, continuous in situ visualization of rectal lesions transanally for up to 20 min. Spot and dynamic temporal fluorescence intensities (FI) were quantified using ImageJ (including videos at one frame/second, fps) and by a bespoke MATLAB® application that provided digitalized video tracking and signal logging at 30fps (Fluorescence Tracker App downloadable via MATLAB® file exchange). Statistical analysis of FI-time plots compared tumours (benign and malignant) against control during FI curve rise, peak and decline from apex. Early kinetic FI signal measurement delineated discriminative temporal signatures from tumours (n = 20, 9 cancers) offering rich data for analysis versus delayed spot measurement (n = 10 cancers). Malignant lesion dynamic curves peaked significantly later with a shallower gradient than normal tissue while benign lesions showed significantly greater and faster intensity drop from apex versus cancer. Automated tracker quantification efficiently expanded manual results and provided algorithmic KNN clustering. Photobleaching appeared clinically irrelevant. Analysis of a continuous stream of intraoperatively acquired early ICG fluorescence data can act as an in situ tumour-identifier with greater detail than later snapshot observation alone. Software quantification of such kinetic signatures may distinguish invasive from non-invasive neoplasia with potential for real-time in silico diagnosis.

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Section: Discussionmentioning

confidence: 99%

Digital dynamic discrimination of primary colorectal cancer using systemic indocyanine green with near-infrared endoscopy

Dalli

Loughman

Hardy

et al. 2021

Sci Rep

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“…Aforementioned groups have injected ICG directly into the ureters or even placed ICG-filled catheters into the ureters for visualization, although such techniques have been found impractical for widespread adoption ( 103 ). In recognition of the unmet clinical need, several imaging agents for visualizing the ureters have been designed specifically with robotic-assisted surgery in mind ( 104 – 106 ) and are in various phases of clinical development.…”

Section: Methodsmentioning

confidence: 99%

A narrative review of fluorescence imaging in robotic-assisted surgery

Lee

Berg

Orosco³

et al. 2021

Laparosc Surg

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Objective: In this review, we provide examples of applications of fluorescence imaging in urologic, gynecologic, general, and endocrine surgeries. Background: While robotic-assisted surgery has helped increase the availability of minimally invasive procedures across surgical specialties, there remains an opportunity to reduce adverse events associated with open, laparoscopic, and robotic-assisted methods. In 2011, fluorescence imaging was introduced as an option to the da Vinci Surgical System, and has been standard equipment since 2014. Without interfering with surgical workflow, this fluorescence technology named Firefly ® allows for acquisition and display of near-infrared fluorescent signals that are co-registered with white light endoscopic images. As a result, robotic surgeons of all specialties have been able to explore the clinical utility of fluorescence guided surgery. Methods: Literature searches were performed using the PubMed and MEDLINE databases using the keywords “robotic-assisted fluorescence surgery”, “ICG robotic surgery”, and “fluorescence guided surgery” covering the years 2011–2020. Conclusions: Real-time intraoperative fluorescence guidance has shown great potential in helping guide surgeons in both simple and complex surgical interventions. Indocyanine green is one of the most widely-used imaging agents in fluorescence guided surgery, and other targeted, near-infrared imaging agents are in various stages of development. Fluorescence is becoming a reliable tool that can help surgeons in their decision-making process in some specialties, while explorations continue in others.

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“…In recent years, the robotic approach has been gaining traction for use in emergency and elective surgery for diverticular disease. Robotic surgery offers 3-dimensional visualization of the operative field, improved range of motion compared with laparoscopic instruments, and immunofluorescence to better visualize the ureters . These tools may be particularly useful in surgery for diverticulitis, where the operative field may be scarred, inflamed, and indurated.…”

Section: Minimally Invasive Techniquesmentioning

confidence: 99%

Management of Diverticulitis

Sacks,

Hall

2024

JAMA Surg

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ImportanceCare of patients with diverticulitis is undergoing a paradigm shift. This narrative review summarizes the current evidence for left-sided uncomplicated and complicated diverticulitis. The latest pathophysiology, advances in diagnosis, and prevention strategies are also reviewed.ObservationsTreatment is moving to the outpatient setting, physicians are forgoing antibiotics for uncomplicated disease, and the decision for elective surgery for diverticulitis has become preference sensitive. Furthermore, the most current data guiding surgical management of diverticulitis include the adoption of new minimally invasive and robot-assisted techniques.Conclusions and RelevanceThis review provides an updated summary of the best practices in the management of diverticulitis to guide colorectal and general surgeons in their treatment of patients with this common disease.

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Intra‐operative visualization of the ureter by near‐infrared fluorescence during robotic‐assisted laparoscopic sigmoidectomy for diverticulitis – a video vignette

Cited by 5 publications

References 7 publications

Digital dynamic discrimination of primary colorectal cancer using systemic indocyanine green with near-infrared endoscopy

Digital dynamic discrimination of primary colorectal cancer using systemic indocyanine green with near-infrared endoscopy

A narrative review of fluorescence imaging in robotic-assisted surgery

Management of Diverticulitis

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