The Utility of Indocyanine Green Angiography in the Assessment of Perfusion of Gastric Conduit and Proximal Esophageal Stump Against Visual Assessment in Patients Undergoing Esophagectomy: a Prospective Study

Abstract Post esophagectomy anastomotic leakage and stricture are crucial factors in determining morbidity and mortality. Good vascularity of the gastric conduit is essential to avoid this complications. This prospective study assesses the utility of intraoperative indocyanine green (ICG) fluorescence imaging to determine gastric conduit vascularity in patients undergoing esophagectomy. Methods Thirteen consecutive patients who were undergoing esophagectomy for carcinoma middle, lower third esophagus or gastro-esophageal junction from August 2019 to September 2019, were included. Three patients underwent laparoscopic-assisted transhiatal esophagectomy, ten thoraco-laparoscopic assisted esophagectomy. Reconstruction was done by gastric pull up via posterior mediastinal route. Vascularity of gastric conduit was assessed by the near-infrared camera using ICG. Results On visual assessment of perfusion at the tip of gastric conduit, it was dusky in 11 patients, pink in two. Fuorescence imaging showed inadequate perfusion at the tip of conduit in 12 patients, needing revision. In one patient visual inspection showed adequate perfusion, but ICG disclosed poor vascularity requiring revision of the conduit’s tip. Resection of the devitalized portion of the proximal esophageal stump was needed in 5 patients both by visual and ICG assessment. The median time to appearance of blush from the time of injection of dye was 15 seconds (10 to 23 seconds). Conclusion Visual inspection of the gastric conduit vascularity can underestimate perfusion and hence can compromise resection of the devitalized part. ICG fluorescence imaging is more objective and promising means to ascertain the vascularity of gastric conduit during an esophagectomy. It could complement the visual inspection to decide the site of anastomosis.

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PS02.069: CERVICAL GASTROPLASTY ANASTOMOSIS AFTER ESOPHAGECTOMY: INDOCYANINE GREEN FLUORESCENCE IMAGING EVALUATION AND TECHNICAL SURGICAL ASPECTS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.069 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 140-140

Author(s):

Flavio Takeda ◽

Ulysses Ribeiro Jr ◽

Rubens Sallum ◽

Julio Mariano Rocha ◽

Andre Duarte ◽

...

Keyword(s):

Indocyanine Green ◽

Fluorescence Imaging ◽

Conflicts Of Interest ◽

Visual Assessment ◽

Gastric Conduit ◽

Linear Stapler ◽

Recurrent Nerve ◽

Imaging Evaluation ◽

Indocyanine Green Fluorescence ◽

Surgical Aspects

Abstract Description One of the most frequent complication after esophagectomy is the anastomotic leakage, which is a determiming factor of morbidity and mortality after surgical treatment. The best location for the esophagogastric anastomosis (cervical or intra-thoracic) has been topic of discussion for many years, and surgical aspects as resected margins, recurrent nerve trauma and mainly the vascularization of the anastomosis. In this video we performed a cervical gastroplasty anastomosis (McKeown), side-to-side, stapled (linear stapler) with a thin gastric tube conduit, and after that we aimed to determine the feasibility and usefulness of indocyanine green (ICG) fluorescence imaging to evaluate the gastric conduit perfusion during an esophagectomy. After pulling up the gastric conduit trhought the mediastinum and after performing the cervical anastomosis, 5 mg of ICG was in jected as a bolus and visual assessment of the blood supply of the gastric conduit was seen. This patient was a 63 years old, male, with adenocarcinoma of esophago-gastric junction (Siewert II) underwent to neoadjuvant quimiotherapy (FOLFOX regimen) and submitted after 3 cycles to esophagectomy (thoracoscopy and laparoscopy). No fistula was found in post operative follow-up, and either complications. Disclosure All authors have declared no conflicts of interest.

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Laparoscopic radical prostatectomy using a real-time lymphangiography with transperineal injection of indocyanine green: Results from a prospective study

European Urology Open Science ◽

10.1016/s2666-1683(20)35364-7 ◽

2020 ◽

Vol 20 ◽

pp. S50

Author(s):

F. Claps ◽

M. Ramirez-Backhaus ◽

M.C.Mir Maresma ◽

A. Gomez-Ferrer ◽

J.M. Mascaros ◽

...

Keyword(s):

Radical Prostatectomy ◽

Indocyanine Green ◽

Prospective Study ◽

Real Time ◽

Laparoscopic Radical Prostatectomy ◽

A Prospective Study

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Triple tracer (blue dye, indocyanine green, and Tc99) compared to double tracer (indocyanine green and Tc99) for sentinel lymph node detection in endometrial cancer: a prospective study with random assignment

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000387 ◽

2019 ◽

Vol 29 (7) ◽

pp. 1121-1125 ◽

Cited By ~ 2

Author(s):

Roy Kessous ◽

Jeffrey How ◽

Jeremie Abitbol ◽

Sanam Puzhakkal ◽

Liron Kogan ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Indocyanine Green ◽

Prospective Study ◽

Early Stage ◽

Blue Dye ◽

Detection Rates ◽

A Prospective Study ◽

Early Stage Endometrial Cancer

ObjectiveSentinel lymph node (SLN) mapping is increasingly being used in the treatment of apparent early-stage endometrial cancer. The aim of this study was to evaluate whether three tracers (blue dye, indocyanine green (ICG), and technetium-99 (Tc99)) performed better than two (ICG and Tc99).Study DesignProspective study of all consecutive patients (n=163) diagnosed with clinical early-stage endometrial cancer from 2015 to 2017. All patients were randomly assigned to receive a mixture of ICG and Tc99 with or without blue dye. Subgroup analysis for detection rates was performed for each group (double versus triple tracer).ResultsOne hundred and fifty-seven patients met the inclusion criteria. Eighty patients received ICG and Tc99 with unilateral and bilateral SLN detection rates of 97.5% and 81.3%, respectively. Seventy-seven patients received all three tracers with unilateral and bilateral detection rates of 93.5% and 80.5%, respectively. Only one patient in the triple tracer group was detected by blue dye alone. No significant differences were noticed in unilateral or bilateral detection rates between the two groups, nor in the detection of lymph node metastasis.ConclusionThe addition of blue dye to ICG and Tc99 did not demonstrate any improvement in SLN detection.

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