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.

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.

Evaluation of Indocyanine Green Fluorescence Imaging for Intraoperative Identification of Liver Malignancy

2021 ◽  
Vol 39 ◽  
Author(s):  
Jorge Rodriguez ◽  
◽  
Jan Grendar ◽  
Zeljka Jutric ◽  
Maria Cassera ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Predictive Value ◽  
False Positives ◽  
False Negatives ◽  
Imaging Evaluation ◽  
Liver Malignancy ◽  
Indocyanine Green Fluorescence ◽  
Indocyanine Green Fluorescence Imaging ◽  
Hepatic Lesions

Introduction: There is early evidence that indocyanine green (ICG) fluorescence imaging has the ability to detect metastatic and primary malignancies in the liver that are too small to be identified by other methods. However, the rate of false positives and false negatives remains unknown. Materials and Methods: This is a single institution prospective single-arm study. Patients with suspected hepatic or pancreatic malignancies were intravenously injected with ICG one to three days prior to their scheduled surgical therapy. At the beginning of the procedure, the liver was assessed with fluorescence imaging and all identified lesions were biopsied and evaluated. Results: Twenty-three patients were enrolled from April 2015 through February 2016. Fifteen patients with confirmed malignancy had adequate fluorescence imaging evaluation of the liver; 10 with pancreatic primary malignancies and five with hepatic primaries. Fluorescence imaging was the only modality that identified nine concerning hepatic lesions, all of which were benign on pathology examination. Out of 11 malignant hepatic masses, six were visible on fluorescence imaging. Out of nine benign hepatic lesions, five were visible. No side effects or complications of the fluorescence imaging were encountered. The sensitivity for ICG fluorescence was 45.5%, the specificity 21.2%, the positive predictive value 25%, and the negative predictive value 40%. Conclusion: Intraoperative hepatic assessment with ICG fluorescence imaging to identify malignancy in the liver is feasible and safe. However, in this study the significant number of false positives limit the utility of the technique. Our preliminary data do not support its routine use for detection of malignancies in the liver.

Sentinel Node Mapping Guided by Indocyanine Green Fluorescence Imaging in Gastric Cancer

2009 ◽  
Vol 249 (1) ◽  
pp. 58-62 ◽  
Author(s):  
Yusuke Tajima ◽  
Kimiyasu Yamazaki ◽  
Yuki Masuda ◽  
Masanori Kato ◽  
Daisuke Yasuda ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Indocyanine Green ◽  
Sentinel Node ◽  
Fluorescence Imaging ◽  
Green Fluorescence ◽  
Sentinel Node Mapping ◽  
Indocyanine Green Fluorescence ◽  
Indocyanine Green Fluorescence Imaging
Sign in / Sign up

Export Citation Format

Share Document