scholarly journals Assessment of Anastomotic Perfusion in Left-Sided Robotic Assisted Colorectal Resection by Indocyanine Green Fluorescence Angiography

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Emanuel Shapera ◽  
Roger W. Hsiung
Keyword(s):  
Indocyanine Green ◽  
Colorectal Resection ◽  
Case Series ◽  
Fluorescence Angiography ◽  
Control Group ◽  
Invasive Approach ◽  
Robotic Assisted ◽  
Anastomotic Complications ◽  
Intraoperative Management ◽  
Resection And Anastomosis

Background. Indocyanine green fluorescent angiography (IcGA) has been used with success in guiding intraoperative management to prevent colorectal anastomotic complications. Prior studies in open and laparoscopic colorectal surgery, such as PILLAR II, have demonstrated a low anastomotic leak rate (1.4%). As the minimally invasive approach progresses from laparoscopic to robotic approach, the effect and safety of IcGA in assessing anastomotic perfusion in the latter deserve further investigation. Methods. The objective of the study was to determine the safety of IcGA in guiding intraoperative management of robotic assisted colorectal resection via perfusion assessment. The design was single-surgeon, retrospective case-control study. 74 patients underwent left-sided robotic assisted colorectal resection and anastomosis with IcGA guidance. 30 historical controls underwent left-sided robotic assisted colorectal resection and anastomosis without IcGA. Clinical, demographic, operative, and outcome variables were tabulated. Results. In the control group, 1 patient suffered a postoperative anastomotic stricture requiring no surgery, and 1 patient suffered an anastomotic dehiscence requiring return to the operating room. There were no anastomotic complications in the IcGA group, including 4 patients who underwent a change in the chosen level of anastomosis based on intraoperative IcGA. Conclusion. IcGA is safe to use as demonstrated by the very low rate of complications in this case series. It is also safe to rely on to guide re-resection and recreation of an anastomosis intraoperatively by demonstration of blood flow. This may help offset the loss of tactile feedback and assessment of tension in the robotic platform.

P5 FEASIBILITY AND EFFICACY OF INDOCYANINE GREEN ANGIOGRAPHY DURING ESOPHAGECTOMY: A SYSTEMATIC REVIEW

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Van Daele Elke ◽  
Vanommeslaeghe Hanne ◽  
Van Nieuwenhove Yves ◽  
Ceelen Wim ◽  
Vanhove Christian ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Indocyanine Green Angiography ◽  
Assessment Tool ◽  
Fluorescence Angiography ◽  
Control Group ◽  
High Morbidity ◽  
Easy Method ◽  
Nirf Imaging ◽  
Perfusion Assessment ◽  
The Impact

Abstract Aim The aim of this review was to evaluate feasibility and effectiveness of Indocyanine green fluorescence angiography (ICGA) as an assessment tool for gastric tube (GT) perfusion during the construction of the esophago-gastric anastomosis, and as a predictor of anastomotic leakage (AL). Moreover, attention was given to attempts made to quantify this method in esophageal surgery. Background & Methods After an esophagectomy, a GT is most commonly used to restore continuity of the upper gastrointestinal tract. Esophago-gastric anastomoses are known for their complications such as AL, associated with high morbidity and mortality. Graft perfusion is an important predictor for anastomotic integrity. Tissue perfusion assessment is currently based on subjective parameters as tissue color and vessel pulsations. Near infrared fluorescent (NIRF) imaging is an emerging medical imaging modality, requiring penetrating NIR light that excites a NIRF agent within the tissue, generating fluorescence that can then be captured by adapted cameras. Indocyanine green Angiography (ICGA) is such a NIRF imaging technique which can be used as a method to visualize anastomotic perfusion. For this review, 2 reviewers independently searched Pubmed and Embase for studies evaluating intraoperative ICGA perfusion assessment of the GT. Feasibility, complications, intraoperative surgical changes based on ICGA findings, quantification attempts, anatomical data and the impact of ICGA on postoperative anastomotic complications were documented and further analyzed. Results Nineteen studies were included for qualitative analyses. All described ICGA as a safe and easy method for gastric graft perfusion assessment. AL occurred in 13.8% of the entire cohort, 10% in the ICG guided group and 20.6% in the control group (p<.001). AL in the well-perfused group was 6.3% vs. 20.5% in the control group without ICGA (p< .001). The group with an altered surgical plan based on the ICG image had similar AL rates as the well perfused group (6.5% vs. 6.3%) and significantly less than the poorly perfused group (47.8%) (p<.001), suggesting that the technique is able to identify and alter a potential bad outcome. Conclusion the present review suggest that ICGA is a safe and easy method for GT perfusion assessment. Differences in AL rate between the well perfused and poor perfused anastomotic sites suggest that a good fluorescent signal is a predictor of good outcome.

scholarly journals Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery – valuation of early adopters from Germany

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Mareike Franz ◽  
Jörg Arend ◽  
Stefanie Wolff ◽  
Aristotelis Perrakis ◽  
Mirhasan Rahimli ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Liver Surgery ◽  
False Positive ◽  
Bile Ducts ◽  
Liver Tumors ◽  
Fluorescence Angiography ◽  
Early Adopters ◽  
Robotic Assisted ◽  
Minimally Invasive Liver Surgery

Abstract Objectives Indocyanine green (ICG) is a fluorescent dye which was initially used for liver functional assessment. Moreover, it is of value for intraoperative visualization of liver segments and bile ducts or primary and secondary liver tumors. Especially in minimally invasive liver surgery, this is essential to enhance the precision of anatomical guided surgery and oncological quality. As early adopters of ICG implementation into laparoscopic and robotic-assisted liver surgery in Germany, we summarize the current recommendations and share our experiences. Methods Actual strategies for ICG application in minimally invasive liver surgery were evaluated and summarized during a review of the literature. Experiences in patients who underwent laparoscopic or robotic-assisted liver surgery with intraoperative ICG staining between 2018 and 2020 from the Magdeburg registry for minimally invasive liver surgery (MD-MILS) were evaluated and the data were analyzed retrospectively. Results ICG can be used to identify anatomical liver segments by fluorescence angiography via direct or indirect tissue staining. Fluorescence cholangiography visualizes the intra- and extrahepatic bile ducts. Primary and secondary liver tumors can be identified with a sensitivity of 69–100%. For this 0.5 mg/kg body weight ICG must be applicated intravenously 2–14 days prior to surgery. Within the MD-MILS we identified 18 patients which received ICG for intraoperative tumor staining of hepatocellular carcinoma (HCC), cholangiocarcinoma, peritoneal HCC metastases, adenoma, or colorectal liver metastases. The sensitivity for tumor staining was 100%. In 27.8% additional liver tumors were identified by ICG fluorescence. In 39% a false positive signal could be detected. This occurred mainly in cirrhotic livers. Conclusions ICG staining is a simple and useful tool to assess individual hepatic anatomy or to detect tumors during minimally invasive liver surgery. It may enhance surgical precision and improve oncological quality. False-positive detection rates of liver tumors can be reduced by respecting the tumor entity and liver functional impairments.

Meta-Analysis on the Efficacy of Indocyanine Green Fluorescence Angiography for Reduction of Anastomotic Leakage After Rectal Cancer Surgery

2020 ◽  
pp. 000313482098284
Author(s):  
Zonglin Li ◽  
Yejiang Zhou ◽  
Gang Tian ◽  
Yi Liu ◽  
Yifan Jiang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Indocyanine Green ◽  
Anastomotic Leakage ◽  
Operation Time ◽  
Pooled Analysis ◽  
Fluorescence Angiography ◽  
Cochrane Library ◽  
Control Group ◽  
Significant Heterogeneity ◽  
Colorectal Anastomoses

Background Indocyanine green (ICG) fluorescence angiography is a new technique that help surgeons to assess the blood perfusion of the anastomotic intestine. The aim of this study is to evaluate whether ICG fluorescence angiography can reduce the anastomotic leakage (AL) rate after colorectal anastomoses for rectal cancer (RC) patients. Methods Studies comparing AL rates between use and nonuse of ICG fluorescence angiography up to April 2020 were systematically searched from PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure. A pooled analysis was performed for the available data regarding the baseline features, AL rate, and other surgical outcomes. ReMan 5.3 software was used to perform the statistical analysis. Quality evaluation and publication bias were also conducted. Results Thirteen studies with a total of 2593 patients (1121 in the ICG group and 1472 in the control group) undergoing colorectal anastomoses after RC surgery were included. In the pooled analysis, the baseline data, operation time, and intraoperative blood loss in 2 groups were all comparable and without significant heterogeneity. However, the AL rate in the ICG group was significantly lower (OR .31; 95% CI .22-.44; P < .00001) than that in the control group. Additionally, ICG fluorescence angiography was associated with a decreased overall complication rate (OR .60; 95% CI .47-.76; P < .0001) in patients who undergo RC surgery. Conclusions The present study revealed that ICG fluorescence angiography reduced AL rate after colorectal anastomoses for RC patients. However, more high-quality randomized controlled trials are needed to confirm this benefit.

Choroidal Manifestation of Systemic Non-Tuberculous Mycobacterial Infection: A Case Series

2020 ◽  
Vol 237 (04) ◽  
pp. 493-496
Author(s):  
Veronika Sinner ◽  
Reinhard Rüesch ◽  
Christophe Valmaggia ◽  
Margarita Todorova
Keyword(s):  
Indocyanine Green ◽  
Indocyanine Green Angiography ◽  
Fundus Autofluorescence ◽  
Systemic Disease ◽  
Graft Infection ◽  
Case Series ◽  
Mycobacterial Infection ◽  
Fundus Photography ◽  
Fluorescence Angiography ◽  
Autofluorescence Imaging

Abstract Purpose To describe choroidal findings associated with disseminated systemic non-mycobacterial infection. Methods A retrospective observational case series included two patients (four eyes) with non-tuberculous mycobacterial disease. The activity of choroidal lesions was assessed by clinical examination, supported by colour fundus photography, fundus autofluorescence imaging, indocyanine green angiography, fluorescence angiography, and optical coherence tomography (OCT) angiography. The relationships between clinical symptomatology, choroidal findings, and systemic disease activity were evaluated. Results One subject diagnosed with aortic graft infection showed positive cultures for Mycobacterium chimaera. One HIV-positive subject showed a positive saliva culture for Mycobacterium avium. At presentation, all subjects showed chorioretinal manifestation. In one patient, the lesions were active and in the other patient, the lesions appeared inactive. With activity of disseminated chorioretinitis, the lesions had indistinct, blurred borders on fluorescence angiography and indocyanine green angiography and were hyporeflective with well-defined borders on OCT imaging. Conclusion Multimodal imaging enables distinction between active and inactive lesions, thus supporting therapeutic management. Choroidal presentation of active disseminated mycobacterium infection indicates activity of systemic disease. Thus, even if the patient is not immunocompromised, an underlying systemic involvement should be ruled out.

scholarly journals Intraoperative fluorescence angiography with indocyanine green: retrospective evaluation and detailed analysis of our single-center 5-year experience focused on colorectal surgery

2020 ◽  
Vol 5 (1-2) ◽  
pp. 35-42
Author(s):  
Christoph Marquardt ◽  
Georgi Kalev ◽  
Thomas Schiedeck
Keyword(s):  
Colorectal Surgery ◽  
Indocyanine Green ◽  
Positive Impact ◽  
Operating Time ◽  
Fluorescence Angiography ◽  
Control Group ◽  
Retrospective Evaluation ◽  
Operative Strategy ◽  
Indocyanine Green Fluorescence ◽  
Positive Effects

AbstractObjectivesAssessing bowel perfusion with indocyanine green fluorescence angiography (ICG-FA) shows positive effects on anastomotic healing in colorectal surgery.MethodsA retrospective evaluation of 296 colorectal resections where we performed ICG-FA was undertaken from January 2014 until December 2018. Perfusion of the bowel ends measured with ICG-FA was compared to the visual assessment before and after performing the anastomosis. According to the observations, the operative strategy was confirmed or changed. Sixty-seven low anterior rectal resections (LARs) and 76 right hemicolectomies were evaluated statistically, as ICG-FA was logistically not available for every patient in our service and thus a control group for comparison resulted.ResultsThe operative strategy based on the ICG-FA results was changed in 48 patients (16.2%), from which only one developed an anastomotic leakage (AL) (2.1%). The overall AL rate was calculated as 5.4%. Within the 67 patients with LAR, the strategy was changed in 11 patients (16.4%). No leakage was seen in those. In total three AL happened (4.5%), which was three times lower than the AL rate of 13.6% in the control group but statistically not significant. From the 76 right hemicolectomies a strategy change was undertaken in 10 patients (13.2%), from which only one developed an AL. This was the only AL reported in the whole group (1.3%), which was six times lower than the leakage rate of the control group (8.1%). This difference was statistically significant (p=0.032).ConclusionsBased on the positive impact by ICG-FA on the AL rate, we established the ICG-FA into our clinical routine. Although randomized studies are still missing, ICG-FA can raise patient safety, with only about 10 min longer operating time and almost no additional risk for the patients.

scholarly journals Defining indocyanine green fluorescence to assess anastomotic perfusion during gastrointestinal surgery: systematic review

BJS Open ◽  
2021 ◽  
Vol 5 (2) ◽  
Author(s):  
M D Slooter ◽  
M S E Mansvelders ◽  
P R Bloemen ◽  
S S Gisbertz ◽  
W A Bemelman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Indocyanine Green ◽  
Patient Outcomes ◽  
Gastrointestinal Surgery ◽  
Fluorescence Angiography ◽  
Future Research ◽  
Fluorescence Signal ◽  
Pixel Intensity ◽  
Indocyanine Green Fluorescence ◽  
Quantitative Parameters

Abstract Background The aim of this systematic review was to identify all methods to quantify intraoperative fluorescence angiography (FA) of the gastrointestinal anastomosis, and to find potential thresholds to predict patient outcomes, including anastomotic leakage and necrosis. Methods This systematic review adhered to the PRISMA guidelines. A PubMed and Embase literature search was performed. Articles were included when FA with indocyanine green was performed to assess gastrointestinal perfusion in human or animals, and the fluorescence signal was analysed using quantitative parameters. A parameter was defined as quantitative when a diagnostic numeral threshold for patient outcomes could potentially be produced. Results Some 1317 articles were identified, of which 23 were included. Fourteen studies were done in patients and nine in animals. Eight studies applied FA during upper and 15 during lower gastrointestinal surgery. The quantitative parameters were divided into four categories: time to fluorescence (20 studies); contrast-to-background ratio (3); pixel intensity (2); and numeric classification score (2). The first category was subdivided into manually assessed time (7 studies) and software-derived fluorescence–time curves (13). Cut-off values were derived for manually assessed time (speed in gastric conduit wall) and derivatives of the fluorescence–time curves (Fmax, T1/2, TR and slope) to predict patient outcomes. Conclusion Time to fluorescence seems the most promising category for quantitation of FA. Future research might focus on fluorescence–time curves, as many different parameters can be derived and the fluorescence intensity can be bypassed. However, consensus on study set-up, calibration of fluorescence imaging systems, and validation of software programs is mandatory to allow future data comparison.

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