Laparoscopic fluorescence angiography with indocyanine green to control the perfusion of colorectal anastomoses intraoperatively

Carus, Th.; Lienhard, H.

doi:10.1007/978-3-642-00625-8_120

Cited by 19 publications

(16 citation statements)

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“…Recently, Carus et al [9] proposed the use of laparoscopic ICG fluorescence angiography to intraoperatively assess anastomosis perfusion in a series of 45 patients undergoing colorectal resections and four patients undergoing sleeve gastrectomy. To confirm perfusion adequacy, Carus et al used the degree of ''relative blueness,'' as provided by computer analysis.…”

Section: Discussionmentioning

confidence: 99%

“…A variety of fluorescence-based optical systems have been developed and the range of clinical applications of this technology has constantly increased over recent years (e.g., sentinel lymph node navigation [5], biliary tree anatomy detection [6], tissue perfusion in complex abdominal wall repair [7], real-time assessment of anastomotic perfusion in colorectal resections [8,9], or before gastric pull-up after esophageal resections [10]).…”

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confidence: 99%

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Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery

et al. 2014

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery

et al. 2014

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“…Estimation of fluorescence intensity is a rapid, user‐friendly approach, which is completely integrated into the surgical workflow, and could potentially become part of routine practice. To date, only a few investigators have undertaken fluorescence‐based evaluation of bowel perfusion in the clinical setting, using different commercially available devices designed for minimally invasive surgery.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative fluorescence-based enhanced reality laparoscopic real-time imaging to assess bowel perfusion at the anastomotic site in an experimental model

Diana

Agnus

Halvax

et al. 2015

British Journal of Surgery

113

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Background: Fluorescence videography is a promising technique for assessing bowel perfusion. Fluorescence-based enhanced reality (FLER) is a novel concept, in which a dynamic perfusion cartogram, generated by computer analysis, is superimposed on to real-time laparoscopic images. The aim of this experimental study was to assess the accuracy of FLER in detecting differences in perfusion in a small bowel resection-anastomosis model. Methods:A small bowel ischaemic segment was created laparoscopically in 13 pigs. Animals were allocated to having anastomoses performed at either low perfusion (25 per cent; n = 7) or high perfusion (75 per cent; n = 6), as determined by FLER analysis. Capillary lactate levels were measured in blood samples obtained by serosal puncturing in the ischaemic area, resection lines and vascularized areas. Pathological inflammation scoring of the anastomosis was carried out.Results: Lactate levels in the ischaemic area (mean(s.d.) 5⋅6(2⋅8) mmol/l) were higher than those in resection lines at 25 per cent perfusion (3⋅7(1⋅7) mmol/l; P = 0⋅010) and 75 per cent perfusion (2⋅9(1⋅3) mmol/l; P < 0⋅001), and higher than levels in vascular zones (2⋅5(1⋅0) mmol/l; P < 0⋅001). Lactate levels in resection lines with 75 per cent perfusion were lower than those in lines with 25 per cent perfusion (P < 0⋅001), and similar to those in vascular zones (P = 0⋅188). Levels at resection lines with 25 per cent perfusion were higher than those in vascular zones (P = 0⋅001). Mean(s.d.) global inflammation scores were higher in the 25 per cent perfusion group compared with the 75 per cent perfusion group for mucosa/submucosa (2⋅1(0⋅4) versus 1⋅2(0⋅4); P = 0⋅003) and serosa (1⋅8(0⋅4) versus 0⋅8(0⋅8); P = 0⋅014). A ratio of preanastomotic lactate levels in the ischaemic area relative to the resection lines of 2 or less was predictive of a more severe inflammation score. Conclusion:In an experimental model, FLER appeared accurate in discriminating bowel perfusion levels. Surgical relevanceClinical assessment has limited accuracy in evaluating bowel perfusion before anastomosis. Fluorescence videography estimates intestinal perfusion based on the fluorescence intensity of injected fluorophores, which is proportional to bowel vascularization. However, evaluation of fluorescence intensity remains a static and subjective measure.Fluorescence-based enhanced reality (FLER) is a dynamic fluorescence videography technique integrating near-infrared endoscopy and specific software. The software generates a virtual perfusion cartogram based on time to peak fluorescence, which can be superimposed on to real-time laparoscopic images. This experimental study demonstrates the accuracy of FLER in detecting differences in bowel perfusion in a survival model of laparoscopic small bowel resection-anastomosis, based on biochemical and histopathological data.It is concluded that real-time imaging of bowel perfusion is easy to use and accurate, and should be translated into clinical use.

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“…Near-infrared fluorescence videography, is a promising approach for the intraoperative assessment of intestinal blood supply since it is easy to use, rapid, safe, and it does not imbalance the surgical workflow. Carus and Dammer [6] proposed the use of laparoscopic fluorescence angiography in a series of 45 patients undergoing colorectal resections. To determine perfusion adequacy, Carus and Dammer used the degree of ''relative blueness'', as provided by computer analysis.…”

Section: Discussionmentioning

confidence: 99%

Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia

et al. 2014

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Laparoscopic fluorescence angiography with indocyanine green to control the perfusion of colorectal anastomoses intraoperatively

Cited by 19 publications

References 2 publications

Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery

Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery

Intraoperative fluorescence-based enhanced reality laparoscopic real-time imaging to assess bowel perfusion at the anastomotic site in an experimental model

Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia

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