469 ASSESSMENT OF PERFUSION OF GASTRIC CONDUIT AND PROXIMAL ESOPHAGEAL STUMP BY INDOCYANINE GREEN FLUORESCENCE IMAGING IN PATIENTS UNDERGOING ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Subramanyeshwar Rao Thammineedi
Keyword(s):  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Visual Inspection ◽  
Near Infrared ◽  
Infrared Camera ◽  
Visual Assessment ◽  
Transhiatal Esophagectomy ◽  
Gastric Conduit ◽  
Indocyanine Green Fluorescence ◽  
Laparoscopic Assisted

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.

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

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.

A systematic study on fluorescence contrast in near infrared diffuse transmittance imaging with indocyanine green

2019 ◽  
Vol 27 (5) ◽  
pp. 333-344
Author(s):  
María V Waks Serra ◽  
Dirk Grosenick ◽  
Rainer Macdonald ◽  
Juan A Pomarico ◽  
Daniela I Iriarte
Keyword(s):  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Near Infrared ◽  
Experimental Studies ◽  
Biological Tissues ◽  
High Ratio ◽  
Infrared Light ◽  
Noninvasive Technique ◽  
Indocyanine Green Fluorescence ◽  
Fluorescence Contrast

Near infrared fluorescence imaging is a sensitive, noninvasive technique for diagnostic applications in biomedical optics. The main purpose of this work is thus to explore how to improve the contrast of images obtained by near infrared light using a fluorescent extrinsic agent. Among different fluorophores, indocyanine green has been mostly studied because it is approved for use in humans. In this work, simulations and experimental studies on phantoms (systems that optically emulate biological tissues) are used to systematically investigate the influence of the increased intrinsic tissue absorption by adding indocyanine green. The experiments reproduce the situation of fluorescence imaging of carcinomas in the human breast, where the natural absorption due to neovascularization is increased by the injection of this fluorophore. Assuming measurements in transmission geometry, the breast is modeled by a homogeneous background medium containing a tumor-like inclusion (or lesion) with two- or threefold increased absorption. Fluorescence contrast is simulated over a broad range of dye concentrations using diffusion theory. Selected concentrations ratios are applied in experimental studies with laser excitation of indocyanine green fluorescence and with a charge-coupled device camera for fluorescence detection. Both simulations and experiments show that the intrinsic absorption of the inclusion strongly reduces the number of detected fluorescence photons and that the fluorescence contrast can be canceled or become even negative. It was found that for typical optical properties and geometrical conditions, in fluorescence imaging of breast cancer, a dye ratio of about 10:1 (lesion:background) is required to turn from negative to positive fluorescence contrast. Since such a high ratio is difficult to attain, raw fluorescence images need to be normalized by the intrinsic lesion absorption (without indocyanine green (ICG)) to enhance the presence of the dye in the lesion.

scholarly journals Near-Infrared Intraoperative Imaging of Pelvic Autonomic Nerves:Clinical Trial

2020 ◽  
Author(s):  
Hao Jin ◽  
Ligong Lu ◽  
Min Cui
Keyword(s):  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Near Infrared ◽  
Autonomic Nerves ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Background Ratio ◽  
Laparoscopic Equipment ◽  
Indocyanine Green Fluorescence Imaging ◽  
Pelvic Autonomic Nerves

Abstract Background: The pelvic autonomic nerves control and regulate anorectal and urogenital function. The dysfunction of pelvic autonomic nerves lead to disorders of anorectum, bladder and male sex organs. Thus the intraoperative identification of pelvic autonomic nerves could be crucial in complications prevention and diseases treatment. Our clinical trial aims at estimating the effectiveness and validity of intraoperative indocyanine green fluorescence imaging in pelvic autonomic nerves identification.Methods: Intraoperative fluorescence imaging using indocyanine green was performed in 10 patients and the feasibility was determined. From February 2019 to June 2019, the 10 patients undergoing laparoscopic colorectectomy was administrated 4.5 mg/Kg indocyanine green 24 hours before surgery. The near-infrared fluorescence imaging was conducted during surgery. A novel white light and near-infrared dual-channel laparoscopic equipment was applied. For each patient, signal background ratio values for pelvic autonomic nerves were recorded and analyzed.Results: We confirmed the best dose and timing of indocyanine green administration was 4.5 mg/Kg and 24 hours before surgery. Using the dual laparoscopic equipment, we could observe the splanchnic plexus, inferior mesenteric artery plexus, and sacral plexus successfully with a high signal background ratio value of 3.18 (standard deviation: 0.48). Conclusion: Pelvic autonomic nerves could be observed using indocyanine green fluorescence imaging during surgery. The novel method may replace the current visual identification method and become the standard clinical practice.

scholarly journals Assessment of intraoperative use of indocyanine green fluorescence imaging on the number of lymph node dissection during minimally invasive gastrectomy: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Chun Deng ◽  
◽  
Zhenyu Zhang ◽  
Zhi Guo ◽  
Hengduo Qi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Near Infrared ◽  
Fluorescent Imaging ◽  
Radical Gastrectomy ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Indocyanine Green Fluorescence Imaging

Review question / Objective: Whether is indocyanine green fluorescence imaging-guided lymphadenectomy feasible to improve the number of lymph node dissections during radical gastrectomy in patients with gastric cancer undergoing curative resection? Condition being studied: Gastric cancer was the sixth most common malignant tumor and the fourth leading cause of cancer-related death in the world. Radical lymphadenectomy was a standard procedure in radical gastrectomy for gastric cancer. The retrieval of more lymph nodes was beneficial for improving the accuracy of tumor staging and the long-term survival of patients with gastric cancer. Indocyanine green(ICG) near-infrared fluorescent imaging has been found to provide surgeons with effective visualization of the lymphatic anatomy. As a new surgical navigation technique, ICG near-infrared fluorescent imaging was a hot spot and had already demonstrated promising results in the localization of lymph nodes during surgery in patients with breast cancer, non–small cell lung cancer, and gastric cancer. In addition, ICG had increasingly been reported in the localization of tumor, lymph node dissection, and the evaluation of anastomotic blood supply during radical gastrectomy for gastric cancer. However, it remained unclear whether ICG fluorescence imaging would assist surgeons in performing safe and sufficient lymphadenectomy.

scholarly journals Near-infrared Intraoperative Imaging of Pelvic Autonomic Nerves: Clinical Trial

2020 ◽  
Author(s):  
Hao Jin ◽  
Ligong Lu ◽  
Min Cui
Keyword(s):  
Clinical Trial ◽  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Near Infrared ◽  
Autonomic Nerves ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Laparoscopic Equipment ◽  
Indocyanine Green Fluorescence Imaging ◽  
Pelvic Autonomic Nerves

Abstract Background: The pelvic autonomic nerves control and regulate anorectal and urogenital function. The dysfunction of pelvic autonomic nerves lead to disorders of anorectum, bladder and male sex organs. Thus the intraoperative identification of pelvic autonomic nerves could be crucial in complications prevention and diseases treatment. Our clinical trial aims at estimating the effectiveness and validity of intraoperative indocyanine green fluorescence imaging in pelvic autonomic nerves identification.Methods: Intraoperative fluorescence imaging using indocyanine green was performed in 10 patients and the feasibility was determined. From February 2019 to June 2019, the 10 patients undergoing laparoscopic colorectectomy was administrated 4.5 mg/Kg indocyanine green 24 hours before surgery. The near-infrared fluorescence imaging was conducted during surgery. A novel white light and near-infrared dual-channel laparoscopic equipment was applied. For each patient, signal background ratio values for pelvic autonomic nerves were recorded and analyzed.Results: We confirmed the best dose and timing of indocyanine green administration was 4.5 mg/Kg and 24 hours before surgery. Using the dual laparoscopic equipment, we could observe the splanchnic plexus, inferior mesenteric artery plexus, and sacral plexus successfully with a high signal background ratio value of 3.18 (standard deviation: 0.48). Conclusion: Pelvic autonomic nerves could be observed using indocyanine green fluorescence imaging during surgery. The novel method may replace the current visual identification method and become the standard clinical practice.

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