Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery

Abstract

BackgroundAnastomotic leakage is a devastating complication of colorectal surgery. However, there is no technology indicative of in situ perfusion of a laparoscopic colorectal anastomosis.MethodsWe detail the use of near-infrared (NIR) laparoscopy (PinPoint System, NOVADAQ, Canada) in association with fluorophore [indocyanine green (ICG), 2.5 mg/ml] injection in 30 consecutive patients who underwent elective minimally invasive colorectal resection using the simultaneous appearance of the cecum or distal ileum as positive control.ResultsThe median (range) age of the patients was 64 (40–81) years with a median (range) BMI of 26.7 (20–35.5) kg/m2. Twenty-four patients had left-sided resections (including six low anterior resections) and six had right-sided resections. Of the total, 25 operations were cancer resections and five were for benign disease [either diverticular strictures (n = 3) or Crohn’s disease (n = 2)]. A high-quality intraoperative ICG angiogram was achieved in 29/30 patients. After ICG injection, median (range) time to perfusion fluorescence was 35 (15–45) s. Median (range) added time for the technique was 5 (3–9) min. Anastomotic perfusion was documented as satisfactory in every successful case and encouraged avoidance of defunctioning stomas in three patients with low anastomoses. There were no postoperative anastomotic leaks.ConclusionPerfusion angiography of colorectal anastomosis at the time of their laparoscopic construction is feasible and readily achievable with minimal added intraoperative time. Further work is required to determine optimum sensitivity and threshold levels for assessment of perfusion sufficiency, in particular with regard to anastomotic viability.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-014-3432-y) contains supplementary material, which is available to authorized users.

New Trends in Robotic Colorectal Surgery

“…As it was demonstrated for biliary surgery [16,17], the introduction of a new robotic near-infrared camera using indocyanine green (ICG) showed promising results. Indeed, ICG can be used to assess the vascularization of the colorectal anastomosis either by laparoscopy [18] or by robotic surgery as recently reported by Jafari et al [19]. Indeed, they found a reduction in terms of anastomotic leak (6% in ICG group versus 18% in control group) for low anterior resection.…”

Intraoperative fluorescence angiography in objectification of relegated colon perfusion in oncocoloproctology: first Russian experience and review of the literature

“…В настоящий момент мы можем обобщить опуб-ликованные результаты 8 серий клинических наблю-дений (от 3 до 119 пациентов) [23, [26][27][28][29][30][31][32], 3 контроли-руемых исследований [33-35] и 1 проспективного мультицентрового исследования [36]. Частота возник-новения несостоятельности первичного анастомоза варьирует в различных исследованиях и может дости-гать 20 % [5][6][7].…”

Seeing cancer in a new light

“…We are already seeing the emergence of real-time optical technology to differentiate perfused from ischemic tissues in the open, video-assisted thoracoscopic surgery, and robotic surgery arenas. [3][4][5] The in situ optical imaging took only 8 minutes to perform-clearly more time efficient than our current localization options, with very little procedural risk. Imagine the possibility of having positive lymph nodes glow from beneath the mediastinal pleura, or glow during a mediastinoscopy.…”