Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery

Abstract

The quality of mesorectal resection is crucial for resection in rectal cancer, which should be performed by laparoscopy for better outcome. The use of indocyanine green (ICG) fluorescence is now routinely used in some centers to evaluate bowel perfusion. Previous studies have demonstrated in animal models that selective intra-arterial ICG staining can be used to define and visualize resection margins in rectal cancer. In this animal study, we investigate if laparoscopic intra-arterial catheterization is feasible and the staining of resection margins when performing total mesorectal excision with a laparoscopic medial to lateral approach is possible. In 4 pigs, laparoscopic catheterization of the inferior mesenteric artery (IMA) is performed using a seldinger technique. After a bolus injection of 10 ml ICG with a concentration of 0.25 mg/ml, a continuous intra-arterial perfusion was established at a rate of 2 ml/min. The quality of the staining was evaluated qualitatively. Laparoscopic catheterization was possible in all cases, and the average time for this was 30.25 ± 3.54 min. We observed a significant fluorescent signal in all areas of the IMA supplied, but not in other parts of the abdominal cavity or organs. In addition, the mesorectum showed a sharp border between stained and unstained tissue. Intraoperative isolated fluorescence augmentation of the rectum, including the mesorectum by laparoscopic catheterization, is feasible. Inferior mesenteric artery catheterization and ICG perfusion can provide a fluorescence-guided roadmap to identify the correct plane in total mesorectal excision, which should be investigated in further studies.

Animal models for large vessel vasculitis – The unmet need

“…In large animals whose aorta contains vasa vasorum, the originating arteries can be identified with assistance of imaging technology such as intravital microscopy or indocyanine green (ICG) fluorescence in live animals. [ 25 ] As early as in 1965, using X-ray microscopy, Clarke has identified that brachiocephalic and intercostal arteries feed ascending and descending aorta respectively, while the lumbar and mesenteric arteries feed the abdominal artery in post-natal humans. [ 26 ] It appears feasible to verify these vasa vasorum originating arteries in live animals such as porcine models using ICG fluorescence and perform selective intraarterial injections with TLR ligands to activate adventitial DC ( Figure 1 ).…”

Multifunctional Imaging of Vessels, Brown Adipose Tissue, and Bones in the Visible and Second Near-infrared Region Using Dual-Emitting Polymer Dots

“…In vivo fluorescence imaging technology provides a good application prospect for precision surgical navigation technology due to its instantaneous, high-resolution, and high-specificity detection advantages. − Over the past few years, researchers have focused on near-infrared-I (NIR-I) and NIR-II fluorescence imaging, − which has significantly improved imaging sensitivity, penetration depth, and spatial resolution. There are currently two clinically approved NIR fluorophores, methylene blue (MB, λ em = 700 nm) and indocyanine green (ICG, λ em = 800 nm), − both of which are small molecules with the shortcomings of rapid clearance and easy leakage to the surrounding tissues. − The development of fluorescent probes with high fluorescence efficiency, good water solubility, and good biocompatibility is of great significance to the development of fluorescence imaging technology.…”