The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery

Jafari, Mehraneh D.; Lee, Kang Hong; Halabi, Wissam J.; Mills, Steven; Carmichael, Joseph C.; Stamos, Michael J.; Pigazzi, Alessio

doi:10.1007/s00464-013-2832-8

Cited by 303 publications

(228 citation statements)

References 36 publications

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“…These publications corroborate our findings that the fluorescence technique is able to accurately identify colonic anastomosis with critical ischemia, which requires modifications of surgical procedures (e.g. confection of a temporary deviation ostoma or, more often, an extension of the bowel resection and confection of a new anastomosis) to reduce the rate of anastomotic dehiscence 9 . Unlike the intraoperative near infrared fluorescence adopted in minimally-invasive surgery, especially the imaging platform -named Firefly system -integrated into the da Vinci robot 28 , the fluorescein fluorescence technique under ultraviolet light is extremely cheap, making it an affordable diagnostic test to be used in developing countries.…”

Section: ■ Discussionsupporting

confidence: 88%

“…In the last decades, several authors have investigated the use of fluorescence techniques to evaluate the feasibility of anastomosis in the left colon and rectum in both conventional and minimally-invasive surgeries (laparoscopic and robotic) 9,28 . These publications corroborate our findings that the fluorescence technique is able to accurately identify colonic anastomosis with critical ischemia, which requires modifications of surgical procedures (e.g.…”

Section: ■ Discussionmentioning

confidence: 99%

“…Therefore, a rigorous intraoperative evaluation of the intestinal perfusion is essential for the prevention of anastomotic dehiscence 1,6 . Clinical tests to predict the occurrence of anastomotic dehiscence have very low accuracy, with a failure rate up to 60% 4,[7][8][9] . Several studies have been conducted to find an objective and reliable method of intraoperative evaluation of intestinal blood supply in the last four decades 2,3,7,[10][11][12][13][14] .…”

Section: ■ Introductionmentioning

confidence: 99%

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Fluorescent test accurately predicts leak of ischemic colon anastomosis in rats

et al. 2017

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Methods: This experimental controlled trial randomly assigned 55 rats to four groups. Anastomoses were performed in non-ischemic colon segments (control group) and in ischemic colon segments measuring 1, 2 or 3 cm long (groups 1, 2 and 3, respectively). Fluorescein was injected and the tissues were examined under ultraviolet light. Seven days later, a second-look surgery was performed to check for the presence or absence of anastomosis dehiscence. Results: Twenty-four rats presented anastomotic dehiscence during the second-look surgery. Reticular and nonfluorescent patterns were significantly associated with the occurrence of anastomotic dehiscence. Fluorescein fluorescence had a sensitivity of 95.8%, specificity of 89.2%, positive predictive value of 88.4%, negative predictive value of 96.2%, and accuracy of 92.3% to predict anastomotic dehiscence. Conclusion: Fluorescein fluorescent test can accurately predict leak in a model of ischemic colonic anastomosis in rats.

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Section: ■ Discussionsupporting

confidence: 88%

Section: ■ Discussionmentioning

confidence: 99%

Section: ■ Introductionmentioning

confidence: 99%

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Fluorescent test accurately predicts leak of ischemic colon anastomosis in rats

et al. 2017

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“…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.…”

mentioning

confidence: 91%

New Trends in Robotic Colorectal Surgery

Buchs¹

2014

Adv Robot Autom

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“…This is analogous to (using the aviation paradigm) a ground-proximity warning system designed to alert pilots of approaching terrain. Other applications include (b) the use of intra-operative ultrasound imaging to localize anatomic targets (such as with liver metastasectomy); (c) fluorescent angiography to quantify tissue perfusion [4]; and (d) PACS images overlayed with navigational markers to determine the 3D position in space of a surgeon's instrument so that correct anatomic planes are realized and maintained during complex surgery-such has been demonstrated with transanal total mesorectal excision [5,6] (Fig. 1a, b).…”

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confidence: 99%

The dawn of the digital operating theatre and the rise of the digital surgeon

Atallah¹

2015

Tech Coloproctol

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Let us begin by asking this seemingly simple question: What is minimally invasive surgery? While minimally invasive surgery (MIS) is typically defined as using smaller incisions to accomplish the same operative task as conventional surgery, it must also be appreciated that this methodology has been an important step towards the creation of the digital operating theatre. Why?Fundamentally, both laparoscopic and robotic MIS rely on a digitized video image sequences from a charge-coupled device (CCD) camera, which are then converted into digital signals and relayed at near-instant speed-approximately 0.7 times the speed of light. These signals are then typically processed and then projected onto a liquid crystal display (LCD) high-definition monitor. In the simplest sense, an MIS surgeon performs digital surgery, because the operation is carried out based on the surgeon's interpretation of the real-time digitized cine displayed on LCD rather than direct visualization of the patient's anatomy.This concept, essential to all forms of MIS, represents an important departure from conventional surgery, and a crucial segue towards the realm of true digital surgery. Thus, an MIS surgeon operates not by looking at a patient but rather by looking at digitized information that represents the patient-a sequential stream of 1 and 0 s converted into 'picture elements' (aka, pixels) via LCD and the image rendered visible by red-green-blue colour modelling. With robotic master-slave platforms, the surgeon is removed from the patient altogether. Nevertheless, despite the absence of haptic feedback, very precise surgical dissection is possible with robotic MIS and the prospect of telemedicine becomes real-because of the ability to convert human anatomy into digital data points that can be streamed to a remote site in real time.In the field of surgery, parallels are often drawn to the aviation industry due to the rigorous, safety-oriented protocols it mandates [1]. But another important aviation paradigm relates to navigation and includes the digitization of information and the processes used for data interpretation via advanced avionics. For instance, a pilot utilizes sophisticated navigational aides and fly-by-wire technology that allow an aircraft to travel safely in precise flight paths and at high velocity without reliance on visual references. In essence, a pilot can determine craft position and trajectory by using digital navigation inputs from various computer-centric instruments including the geostationary satellite global positioning system. For more complex vehicle navigation, system informatics and computing centres are necessary-such as those utilized for the manned space flight programme. The reason such systems are employed is because they are accurate and reliable and because a digital-based, augmented reality provides more meaningful information than visual cues alone. So then, if a pilot is able to navigate an aircraft by relying on digital information only, can a surgeon navigate though surgical planes in the same f...

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The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery

Abstract: ICG fluorescence may play a role in anastomotic tissue perfusion assessment and affect the AL rate. Larger prospective studies are needed to further validate this novel technology.

Cited by 303 publications

References 36 publications

Fluorescent test accurately predicts leak of ischemic colon anastomosis in rats

Fluorescent test accurately predicts leak of ischemic colon anastomosis in rats

New Trends in Robotic Colorectal Surgery

The dawn of the digital operating theatre and the rise of the digital surgeon

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