Usefulness of blood supply visualization by indocyanine green fluorescence for reconstruction during esophagectomy

Abstract

BackgroundAdequate blood supply for the reconstructed organ is important for safe esophagogastric anastomosis during esophagectomy. Recently, indocyanine green (ICG) has been used for visualization of the blood supply when anastomosis is performed in vascular surgery. To visualize the blood supply for reconstruction, we employed ICG fluorescence during esophagectomy.MethodsFrom August 2008, 40 patients received cervical or thoracic esophagectomy. They consisted of 33 patients having esophagectomy for thoracic esophageal cancer, 3 being treated for cervical esophageal cancer, and 4 with double cancer of the thoracic and cervical regions. Before and after pulling up the reconstructed organ, 2.5 mg of ICG was injected as a bolus. Then ICG fluorescence was detected by a camera and recorded.ResultsICG fluorescence was easily detected in all patients at 1 min after injection. The vascular network was well visualized in the gastric wall, colonic grafts, and free jejunal grafts. In five patients, we also performed anastomosis between the short gastric vein and the external cervical vein or superficial cervical vein. The intraoperative and postoperative course of all patients was uneventful apart from three anastomotic leakages.ConclusionsICG fluorescence can be employed to evaluate the blood supply to reconstructed organs and can be useful in selecting the patients who do not need additional vessel anastomosis. However, anastomotic leakage was not reduced, so the microcirculation detected by ICG fluorescence did not necessarily provide appropriate blood supply for a viable anastomosis.

Perfusion Assessment in Laparoscopic Left-Sided/Anterior Resection (PILLAR II): A Multi-Institutional Study

“…Fluorescence angiography has been found to be beneficial in assessing perfusion in earlier reports, aiding in surgical decision making and improving outcomes in cardiothoracic, hepatobiliary, colorectal, foregut, transplant, and plastic surgery. 1,5,[20][21][22][23][24][25][26] The feasibility and applicability of this new technology with the implications of potentially reducing anastomotic leak rates could make it an invaluable tool for use in high-risk colorectal resections. 28 Our results indicate that assessment of microperfusion of the transected bowel and planned site of anastomosis was associated with revision of surgical plan in nearly 8% of patients.…”

“…Fluorescence angiography has been shown to be an accurate tool for assessing microperfusion and has been associated with improved outcomes in hepatobiliary, foregut, transplant, and plastic surgery. [20][21][22][23][24][25][26] Therefore, we proposed a multicenter, open label clinical trial to demonstrate the utility and feasibility of intraoperative perfusion assessment using near infrared (NIR) indocyanine green (ICG)-induced fluorescence angiography at the time of anastomosis creation. …”

Esophageal Anastomotic Leak

“…A few small case series have identified a larger degree of conduit ischemia in patients who developed anastomotic complications [38][39][40][41]. The sensitivity of this method in predicting leakage, however, remains to be seen.…”

Applications of indocyanine green based near-infrared fluorescence imaging in thoracic surgery

“…The traditional method of blood supply evaluation is based on palpation and inspection of the gastric serosa. In 2011, Shimada and his colleagues (11) applied ICG for visualization of the gastric conduit perfusion. Their results showed the ICG fluorescence could help to observe the small vessels and the microcirculation of the gastric tube.…”