Near-Infrared Fluorescence Imaging for Real-Time Intraoperative Guidance in Anastomotic Colorectal Surgery: A Systematic Review of Literature

Abstract

Although the feasibility of the technique seems to be agreed on by all current research, large clinical trials are mandatory to further evaluate the added value of the technique.

Preliminary Use of Indocyanine Green Fluorescence Angiography and Value in Predicting the Vascular Supply of Tissues Needed to Perform Cloacal, Anorectal Malformation, and Hirschsprung Reconstructions

“…Benefits of ICG enhanced fluorescence were reviewed in 10 colorectal surgery studies dealing with bowel anastomosis. 13 Colon resection margin changed by 5 to 10 cm in 10.8% of cases. Anastomotic leak rates decreased from 7.4 to 3.5% with the addition of ICG enhanced fluorescence.…”

“…Cost per single use to the patient was $99 to 1099. 13 One issue with all studies including ours was the lack of standardization, interpretation quantification, or validation of the fluorescence signal and perfusion. Cost analysis utilizing institutionally owned equipment (at a cost of $80/ use) resulted in avoidance of one anastomotic leak for every 125 to 625 patients operated with ICG-FA for this technique to be cost-effective.…”

“…Cost analysis utilizing institutionally owned equipment (at a cost of $80/ use) resulted in avoidance of one anastomotic leak for every 125 to 625 patients operated with ICG-FA for this technique to be cost-effective. 13 However, these studied did not take into account the stricture rate of anastomosis or pull-through bowel or other organs such as vagina that are a concern in complex pediatric colorectal surgeries.…”

“…To illustrate this point, an anastomotic leak rate of 8.9% was found after revision of the surgical plan, compared with 2.8% in the patients with initial good fluorescence signal. 13 This could mean that a good signal predicts good outcome, while a lesser signal identifies a higher risk of anastomotic leak, whether or not the transection line is moved. 2,17 There are additional capabilities of this technique that remain in need of ongoing investigation.…”

Prevention of colorectal anastomotic leakage by using of intraoperative fluorescent angiography: prospective trial data

“…Послеоперационная летальность при возникновении несостоятельности анастомоза варьирует от 6 до 22%, также НА увеличивает частоту сопутствующих осложнений, что выражается в необходимости длительного пребывания пациента в стационаре и проведении дорогостоящего лечения. Факторами риска НА являются мужской пол, высота анастомоза от края ануса, курение, предоперационная химиолучевая терапия, а также интраоперационные технические особенности (натяжение кишки, отсутствие целостности «колец» после прошивания циркулярным аппаратом, положительная проба на герметичность анастомоза) [7,8,11,14]. В основе патогенеза НА наиболее часто лежит нарушение микроциркуляции в зоне формируемого соустья, и этот фактор, наряду с хирургической техникой, имеет «хирургозависимый» характер и должен быть устранен во время операции.…”