Management of post-traumatic ischaemic ileal stricture using intraoperative indocyanine green fluorescence-guided resection

2021 ◽  
Vol 14 (8) ◽  
pp. e242497
Author(s):  
Vaibhav Aggarwal ◽  
Venugopal Ravi ◽  
Gopal Puri ◽  
Piyush Ranjan
Keyword(s):  
Indocyanine Green ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Near Infrared ◽  
Indocyanine Green Fluorescence ◽  
Ileal Stricture ◽  
Primary Treatment Modality ◽  
Icg Angiography ◽  
Bowel Perfusion ◽  
Resection And Anastomosis

Blunt abdominal trauma can affect mesenteric circulation which may lead to bowel strictures. Indocyanine green (ICG) angiography can be used to assess mesenteric blood flow and bowel perfusion as a guide to resect length intraoperatively. But this concept has not been applied to ischaemic bowel strictures. We present a case of ischaemic ileal stricture induced by blunt abdominal trauma which was managed by resection and anastomosis. Intraoperative near-infrared (NIR) ICG angiography was used as a guide to resect the bowel length. This case emphasises that ischaemic bowel strictures should be suspected in patients presenting with intestinal obstruction following trauma. Resection and anastomosis of the affected segment remains the primary treatment modality with excellent outcomes. NIR ICG angiography is a real-time objective and useful resource for assessing bowel perfusion and could be used to determine the length of the segment to be resected in patients with ischaemic bowel stricture.

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.

scholarly journals The Use of IndoCyanine Green Fluorescence in the Assessment of Bowel Perfusion in Emergency and Elective Colorectal Surgery

2021 ◽  
Author(s):  
Biagio Picardi ◽  
Stefano Rossi ◽  
Simone Rossi Del Monte ◽  
Francesco Cortese ◽  
Edoardo Maria Muttillo ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Indocyanine Green ◽  
Postoperative Hemorrhage ◽  
Control Group ◽  
Acute Ischemia ◽  
Data Set ◽  
Elective Colorectal Surgery ◽  
Indocyanine Green Fluorescence ◽  
Before And After ◽  
Bowel Perfusion

Abstract Background The use of Indocyanine Green (ICG) fluorescence is a well-established technique in colorectal surgery for the evaluation of bowel stump perfusion. However there is still no definitive acceptance, except intraoperative macroscopic evidence, with reference to the incidence of anastomotic leakage (AL). The objective of this study is to confirm the same efficacy and reliability of ICG in elective colorectal surgery, and emergency cases, which would be more exposed to complications related to inadequate vascularization.Methods From January 2019 to June 2020, we used ICG to evaluate the perfusion of colonicstumps before and after packaging the anastomosis in right and left hemicolectomy, rectal resection and Hartmann’s reversals.Results A total of 40 patients underwent surgery, 21 (52.50%) had benign pathology and 19 (47.50%) exhibited malignant neoplasia. 13 (32.50%) were emergency surgeries and 27 (67.50%) were planned elective surgeries. In almost all cases, the postoperative course was regular, in only 1 (2.5%) case of TaTME there was an AL. Other complications were not related to the anastomosis, but some validated the excellent perfusion despite episodes of prolonged acute ischemia due to postoperative hemorrhage. Data were finally compared to a control group of 39 patients where the ICG fluorescence was not used.Conclusions The study confirms the validity of the use of ICG fluorescence as a method for intraoperative assessment of bowel perfusion even in emergency conditions and in acute postoperative hemorrhage, detecting an incidence of 2.5% (1 case out of 40) of AL. It’s evident that to validate our results, further randomized studies on a larger data set are required. It would also be beneficial to evaluate quantitatively the fluorescence between the mucous and serous layer, to confirm the reduction of AL rate, the better evaluation of bowel perfusion and, especially in emergency surgeries, the potential reduction of further operations.

scholarly journals V11-05 LAPAROENDOSCOPIC SINGLE-SITE (LESS) VARICOCELECTOMY USING INDOCYANINE GREEN FLUORESCENCE (ICG) ANGIOGRAPHY

2016 ◽  
Vol 195 (4S) ◽  
Author(s):  
Keiji Tomita ◽  
Eiki Hanada ◽  
Susumu Kageyama ◽  
Kazuyoshi Johnin ◽  
Mitsuhiro Narita ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Single Site ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Laparoendoscopic Single Site ◽  
Icg Angiography

Indocyanine Green Fluorescence Angiography of the Transverse Cervical Arterial Supply to Clavicle Flaps: An Anatomical Study

2021 ◽  
pp. 019459982110004
Author(s):  
Pichtat Muangsiri ◽  
Rungkit Tanjapatkul ◽  
Papat Sriswadpong ◽  
Pojanan Jomkoh ◽  
Supasid Jirawatnotai
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Fluorescence Angiography ◽  
Head And Neck Reconstruction ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Cervical Artery ◽  
Indocyanine Green Fluorescence Angiography ◽  
Vascularized Bone ◽  
Transverse Cervical Artery

Objective To describe the anatomy of the transverse cervical artery and to prove its perfusion to the clavicle using indocyanine green fluorescence angiography as an alternative vascularized bone for head and neck reconstruction. Study Design Cadaveric dissection. Setting Anatomy lab. Methods Twenty-two necks and shoulders from 11 fresh-frozen cadavers were dissected. The transverse cervical artery diameter, length, emerging point, and the length of clavicle segment harvested were described. Photographic and near-infrared video recordings of the bone’s medial and longitudinal cut surfaces were taken prior to, during, and after indocyanine green injection. Results The transverse cervical artery originated from the thyrocervical trunk and emerged at the level of the medial one-third of the clavicle in 22 of 22 (100%) specimens. The average length of the pedicle was 3.6 cm (range, 2.2-4.4 cm), and the mean diameter was 2.5 mm (range, 1.8-3.4 mm). The harvested bone had a mean length of 5.1 cm (range, 4.3-5.8 cm). After injecting the indocyanine green, 22 of 22 (100%) specimens showed enhancement in the periosteum, bony cortex, and medulla. Conclusion The middle third of the clavicle can be reliably harvested as a vascularized bone with its perfusion solely from the transverse cervical artery pedicle, as shown by the near-infrared fluorescence imaging. The pedicle was sizable and constant in origin.

scholarly journals Indocyanine Green Fluorescence in Surgical Practice – A Narrative Review of Clinical Applications

2017 ◽  
Vol 12 (2) ◽  
pp. 119-123
Author(s):  
Catalin ALIUS ◽  
◽  
Eugen-Sebastian GRADINARU ◽  
Adriana Elena NICA ◽  
◽  
...  
Keyword(s):  
Augmented Reality ◽  
Indocyanine Green ◽  
Clinical Applications ◽  
Intraoperative Cholangiography ◽  
Endocrine Surgery ◽  
Green Fluorescence ◽  
Surgical Practice ◽  
Indocyanine Green Fluorescence ◽  
Bowel Perfusion ◽  
Perfusion Assessment

The introduction in surgical practice of NIR fluorescent systems with their augmented reality enhanced the visual abilities of the surgeons who imagined over just a decade a myriad of uses for this emergent technology. We reviewed the clinical applications of Indocyanine Green from intraoperative cholangiography and SLN identification to bowel perfusion assessment, endocrine surgery and evaluation of Crohn’s disease and Barrett’s esophagus. The immense value of this new method of functional and anatomical assessment is unequivocal, but there are pitfalls and drawbacks of the commercially available systems. By presenting all these we hope to disseminate the importance and the potential of the technology and to promote the interest in usage and research in the field.

scholarly journals Indocyanine green fluorescence imaging to assess bowel perfusion during totally laparoscopic surgery for colon cancer

2020 ◽  
Author(s):  
Hao Su ◽  
Hongliang Wu ◽  
Bao Mandula ◽  
Shou Luo ◽  
Xuewei Wang ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Operative Time ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Indocyanine Green Fluorescence Imaging ◽  
Bowel Perfusion ◽  
Totally Laparoscopic

Abstract Aim: To retrospectively evaluate the feasibility and safety of intraoperative assessment of bowel perfusion in totally laparoscopic surgery for colon cancer using indocyanine green fluorescence imaging (IGFI).Methods: From October 2017 to June 2019, consecutive patients with colon cancer who underwent totally laparoscopic surgery were enrolled retrospectively and grouped into the IGFI group (n=84) and control group (n=105). In the IGFI 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 IGFI group exhibited a significantly shorter operative time (p=0.0374) while intraoperative blood loss did not significantly differ among the groups (p=0.062). In the IGFI group, average time to perfusion fluorescence was 48.4±14.0 s after ICG injection, and four patients (4.8%) were required to choose a more proximal point of resection due to the lack of adequate fluorescence at the point previously selected. There were no differences in terms of pathological outcomes, postoperative recovery and the postoperative complication rates between the groups (p＞0.05). Conclusion: IGFI shows promise as a safe and feasible tool to assess bowel perfusion during a totally laparoscopic surgery for colon cancer and may reduce the operative time.

Influence of vessel stenosis on indocyanine green fluorescence intensity assessed by near-infrared fluorescence angiography

Surgery Today ◽  
2016 ◽  
Vol 47 (7) ◽  
pp. 877-882 ◽  
Author(s):  
Masaki Yamamoto ◽  
Hideaki Nishimori ◽  
Takashi Fukutomi ◽  
Takemi Handa ◽  
Kazuki Kihara ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Fluorescence Intensity ◽  
Near Infrared ◽  
Fluorescence Angiography ◽  
Green Fluorescence ◽  
Near Infrared Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Vessel Stenosis
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