INITIAL EXPERIENCE WITH INDOCYANINE GREEN FLUORESCENCE IMAGING DURING MINIMALLY INVASIVE COLORECTAL CANCER SURGERY
EAES Academy. Kyosev V. 07/05/22; 363016; P060
Dr. Vasil Kyosev
Contributions
Contributions
Abstract
Aims:
One of the main causes of anastomotic leak in colorectal surgery is insufficient vascular supply. Fluorescence imaging by means of Indocyanine green (ICG) have been applied to intraoperatively determine the perfusion of the anastomosis. This study evaluate the feasibility and safety of intraoperative assessment of anastomotic perfusion using ICG angiography in patients undergoing left-sided colon or rectal minimally invasive resection with colorectal anastomosis.
Methods:
From October 2018 to March 2020 in our Unit one hundred and two consecutive patients with colorectal cancer who underwent totally laparoscopic surgery were enrolled retrospectively and grouped into the ICFI (Indocyanine green fluorescence imaging group, n = 46) and control group (CG, n = 56). Based on the type of surgery, patients of two groups were divided in two categories: Cat A – left Hemicolectomy (ICFI-A, n=22 / CG-A, n=34); and Cat B - anterior resection of the rectum (ICFI-B, n=24 / CG-B, n=22). In the ICFI group, indocyanine green (ICG) was injected intravenously, and the bowel perfusion was observed using a fluorescence camera system prior to and after completion of the anastomosis.
Results:
The two groups were demographically comparable. The CG-A&B group exhibited a significantly shorter operative time (p = 0.0417) while intraoperative blood loss did not significantly differ among the ICFI&CG groups (p = 0.078). In the IGFI group, average time to perfusion fluorescence was 42 .6 ± 17.0 s after ICG injection, and twelve patients (26.1%) were required to choose a more proximal point of resection due to the lack of adequate fluorescence at the point previously selected, 7 ICFI-A patients (15.2%) and 5 ICFI-B patients (10.9%). Anastomotic leakage (AL) was occurred in 4 CG-B patients (7.1%) and 2 CG-A patients (3.6%). There were no differences in terms of pathological outcomes and postoperative recovery between the groups (p>0.05).
Conclusions:
ICG leads to signifcantly more changes in the resection line in left hemicolectomy minimally invasive operations than anterior resection and reduce the AL incidence. To confrm this data, further studies with wider sample size and with an objective evaluation of the anastomotic perfusion are required.
Keywords: Minimally invasive surgery – Colorectal cancer – Fluorescence imaging – Indocyanine green (ICG) – Fluorescence angiography (FA)
One of the main causes of anastomotic leak in colorectal surgery is insufficient vascular supply. Fluorescence imaging by means of Indocyanine green (ICG) have been applied to intraoperatively determine the perfusion of the anastomosis. This study evaluate the feasibility and safety of intraoperative assessment of anastomotic perfusion using ICG angiography in patients undergoing left-sided colon or rectal minimally invasive resection with colorectal anastomosis.
Methods:
From October 2018 to March 2020 in our Unit one hundred and two consecutive patients with colorectal cancer who underwent totally laparoscopic surgery were enrolled retrospectively and grouped into the ICFI (Indocyanine green fluorescence imaging group, n = 46) and control group (CG, n = 56). Based on the type of surgery, patients of two groups were divided in two categories: Cat A – left Hemicolectomy (ICFI-A, n=22 / CG-A, n=34); and Cat B - anterior resection of the rectum (ICFI-B, n=24 / CG-B, n=22). In the ICFI group, indocyanine green (ICG) was injected intravenously, and the bowel perfusion was observed using a fluorescence camera system prior to and after completion of the anastomosis.
Results:
The two groups were demographically comparable. The CG-A&B group exhibited a significantly shorter operative time (p = 0.0417) while intraoperative blood loss did not significantly differ among the ICFI&CG groups (p = 0.078). In the IGFI group, average time to perfusion fluorescence was 42 .6 ± 17.0 s after ICG injection, and twelve patients (26.1%) were required to choose a more proximal point of resection due to the lack of adequate fluorescence at the point previously selected, 7 ICFI-A patients (15.2%) and 5 ICFI-B patients (10.9%). Anastomotic leakage (AL) was occurred in 4 CG-B patients (7.1%) and 2 CG-A patients (3.6%). There were no differences in terms of pathological outcomes and postoperative recovery between the groups (p>0.05).
Conclusions:
ICG leads to signifcantly more changes in the resection line in left hemicolectomy minimally invasive operations than anterior resection and reduce the AL incidence. To confrm this data, further studies with wider sample size and with an objective evaluation of the anastomotic perfusion are required.
Keywords: Minimally invasive surgery – Colorectal cancer – Fluorescence imaging – Indocyanine green (ICG) – Fluorescence angiography (FA)
Aims:
One of the main causes of anastomotic leak in colorectal surgery is insufficient vascular supply. Fluorescence imaging by means of Indocyanine green (ICG) have been applied to intraoperatively determine the perfusion of the anastomosis. This study evaluate the feasibility and safety of intraoperative assessment of anastomotic perfusion using ICG angiography in patients undergoing left-sided colon or rectal minimally invasive resection with colorectal anastomosis.
Methods:
From October 2018 to March 2020 in our Unit one hundred and two consecutive patients with colorectal cancer who underwent totally laparoscopic surgery were enrolled retrospectively and grouped into the ICFI (Indocyanine green fluorescence imaging group, n = 46) and control group (CG, n = 56). Based on the type of surgery, patients of two groups were divided in two categories: Cat A – left Hemicolectomy (ICFI-A, n=22 / CG-A, n=34); and Cat B - anterior resection of the rectum (ICFI-B, n=24 / CG-B, n=22). In the ICFI group, indocyanine green (ICG) was injected intravenously, and the bowel perfusion was observed using a fluorescence camera system prior to and after completion of the anastomosis.
Results:
The two groups were demographically comparable. The CG-A&B group exhibited a significantly shorter operative time (p = 0.0417) while intraoperative blood loss did not significantly differ among the ICFI&CG groups (p = 0.078). In the IGFI group, average time to perfusion fluorescence was 42 .6 ± 17.0 s after ICG injection, and twelve patients (26.1%) were required to choose a more proximal point of resection due to the lack of adequate fluorescence at the point previously selected, 7 ICFI-A patients (15.2%) and 5 ICFI-B patients (10.9%). Anastomotic leakage (AL) was occurred in 4 CG-B patients (7.1%) and 2 CG-A patients (3.6%). There were no differences in terms of pathological outcomes and postoperative recovery between the groups (p>0.05).
Conclusions:
ICG leads to signifcantly more changes in the resection line in left hemicolectomy minimally invasive operations than anterior resection and reduce the AL incidence. To confrm this data, further studies with wider sample size and with an objective evaluation of the anastomotic perfusion are required.
Keywords: Minimally invasive surgery – Colorectal cancer – Fluorescence imaging – Indocyanine green (ICG) – Fluorescence angiography (FA)
One of the main causes of anastomotic leak in colorectal surgery is insufficient vascular supply. Fluorescence imaging by means of Indocyanine green (ICG) have been applied to intraoperatively determine the perfusion of the anastomosis. This study evaluate the feasibility and safety of intraoperative assessment of anastomotic perfusion using ICG angiography in patients undergoing left-sided colon or rectal minimally invasive resection with colorectal anastomosis.
Methods:
From October 2018 to March 2020 in our Unit one hundred and two consecutive patients with colorectal cancer who underwent totally laparoscopic surgery were enrolled retrospectively and grouped into the ICFI (Indocyanine green fluorescence imaging group, n = 46) and control group (CG, n = 56). Based on the type of surgery, patients of two groups were divided in two categories: Cat A – left Hemicolectomy (ICFI-A, n=22 / CG-A, n=34); and Cat B - anterior resection of the rectum (ICFI-B, n=24 / CG-B, n=22). In the ICFI group, indocyanine green (ICG) was injected intravenously, and the bowel perfusion was observed using a fluorescence camera system prior to and after completion of the anastomosis.
Results:
The two groups were demographically comparable. The CG-A&B group exhibited a significantly shorter operative time (p = 0.0417) while intraoperative blood loss did not significantly differ among the ICFI&CG groups (p = 0.078). In the IGFI group, average time to perfusion fluorescence was 42 .6 ± 17.0 s after ICG injection, and twelve patients (26.1%) were required to choose a more proximal point of resection due to the lack of adequate fluorescence at the point previously selected, 7 ICFI-A patients (15.2%) and 5 ICFI-B patients (10.9%). Anastomotic leakage (AL) was occurred in 4 CG-B patients (7.1%) and 2 CG-A patients (3.6%). There were no differences in terms of pathological outcomes and postoperative recovery between the groups (p>0.05).
Conclusions:
ICG leads to signifcantly more changes in the resection line in left hemicolectomy minimally invasive operations than anterior resection and reduce the AL incidence. To confrm this data, further studies with wider sample size and with an objective evaluation of the anastomotic perfusion are required.
Keywords: Minimally invasive surgery – Colorectal cancer – Fluorescence imaging – Indocyanine green (ICG) – Fluorescence angiography (FA)
{{ help_message }}
{{filter}}