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 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.

Triple function of indocyanine green fluorescence in colorectal surgery

2020 ◽  
Vol 98 (8) ◽  
pp. 483
Author(s):  
Elvis Vargas Castillo ◽  
Luis Tresierrea ◽  
Rafael Díaz ◽  
César Ginesta
Keyword(s):  
Colorectal Surgery ◽  
Indocyanine Green ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence

Disability Onset among Aging Canadians: Evidence from Panel Data

2002 ◽  
Vol 21 (1) ◽  
pp. 117-136 ◽  
Author(s):  
Derek Hum ◽  
Wayne Simpson
Keyword(s):  
Panel Data ◽  
Control Group ◽  
Unique Contribution ◽  
Age Group ◽  
Income Dynamics ◽  
Cross Sectional ◽  
Data Set ◽  
Disability Status ◽  
Before And After ◽  
And Gender

ABSTRACTPast studies of aging and disability have been restricted to and by cross-sectional data. When cross-sectional surveys measure income, disability status and age at a common point in time, it is impossible to discern the process, and consequences, of a disability onset. In other words, it is not possible to examine the circumstances of the same individuals before, and after, the disability onset; nor whether effects differ according to the age at which the disability occurs. The present study uses a new panel data set, the Survey of Labour and Income Dynamics (SLID), to examine the prevalence of disability with respect to age, gender, and other socio-economic characteristics; however, its unique contribution is its investigation of disability onset, and the rates of entry into, and exit from, disability status by age group and gender. Further, we assess the financial circumstances of those who become disabled vis-à-vis a “control group”.

PS01.187: ASSESSMENT OF THE BLOOD SUPPLY USING THE INDOCYANINE GREEN FLUORESCENCE METHOD AND POSTOPERATIVE ENDOSCOPIC EVALUATION OF ANASTOMOSIS DURING ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 103-103
Author(s):  
Hiroyuki Kitagawa ◽  
Jun Iwabu ◽  
Tsutomu Namikawa ◽  
Kazuhiro Hanazaki
Keyword(s):  
Indocyanine Green ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Fluorescence Method ◽  
Control Group ◽  
Indocyanine Green Fluorescence ◽  
Conventional Procedure ◽  
Endoscopic Assessment ◽  
Gastric Tube Reconstruction

Abstract Background Postoperative anastomotic leakage is a severe complication after gastric tube reconstruction during esophagectomy. The aim of this study was to evaluate the usefulness of postoperative endoscopic assessment of anastomosis and its correlation with intraoperative indocyanine green (ICG) fluorescence assessment of the gastric tube. Methods We retrospectively reviewed 72 consecutive patients who underwent gastric tube reconstruction using the ICG fluorescence method during esophagectomy. Forty-six patients underwent the ICG line-marking method (LMM group; ICG before gastric tube creation). The other 26 underwent the conventional procedure and comprised the control group (ICG after gastric tube creation). Postoperative endoscopic assessment (PEA) of anastomosis was performed 7 days after surgery and results were classified as follows: grade 1 (normal or partial white coat), grade 2 (ulcer comprising less than half the circumference), and grade 3 (ulcer comprising more than half the circumference). Results Anastomotic leakage occurred in 7 of 72 patients (9.7%). The incidence of anastomotic leakage in the LMM group was tended to be lower than those in the control group (6.5% vs. 15.4%; P = 0.244). Of the 40 patients who underwent PEA, 3 (7.5%) had leakage. PEA grading was significantly associated with anastomotic leakage (P < 0.001). Better intraoperative ICG assessment was significantly associated with better endoscopic assessment grade (P = 0.041). Conclusion Intraoperative ICG assessment of the gastric tube was associated with PEA grading on anastomosis during esophagectomy. Disclosure All authors have declared no conflicts of interest.

Will neoadjuvant chemotherapy affect the lymphatic routes to the sentinel lymph node? Investigation using indocyanine green fluorescence method.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 164-164
Author(s):  
Shigeru Tsuyuki ◽  
Yukiko Kawata ◽  
Ayane Yamaguchi ◽  
Kosuke Kawaguchi ◽  
Miru Okamura ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
Indocyanine Green ◽  
Fluorescence Method ◽  
Node Negative ◽  
Indocyanine Green Fluorescence ◽  
Identification Rate ◽  
Node Positive ◽  
Before And After

164 Background: Neoadjuvant chemotherapy (NAC) is a standard therapy for breast cancer. However, the changes in the lymphatic route to the sentinel lymph node (SLN) before and after NAC are unclear. Indocyanine green (ICG) fluorescence method of SLN biopsy (ICG-SLNB) is useful because of its high identification rate of the SLN and ability to visualize lymphatic routes. Using ICG-SLNB, we compared the lymphatic routes to the SLN (sentinel lymphatic routes) before and after NAC and investigated whether chemotherapy affects the sentinel lymphatic routes. Methods: From October 2010 to April 2012 20 patients received NAC. In 13 cases of clinical node-negative cancer, we performed SLNB before NAC. We recorded the sentinel lymphatic routes before NAC and confirmed the routes at surgery after NAC by using the same method. In 7 cases of clinical node-positive cancer, we recorded the localization of SLN and lymphatic routes by using the ICG fluorescence method before NAC. After NAC, we performed SLNB with axillary dissection and recorded the sentinel lymphatic routes by photography and drawing. Results: Regardless of the presence or absence of lymph node metastasis, the SLN and sentinel lymphatic routes could be detected before and after NAC in all cases. All sentinel lymphatic routes reached the same location of the SLN before and after NAC. In 3 cases, the number of sentinel lymphatic routes had increased after NAC, but the location of the SLN was the same before and after NAC. Other cases showed no changes in the sentinel lymphatic routes. In clinical node-positive cases of pathological complete response, there was no metastasis to the SLN, but there were 2 metastases in the lymph nodes after back-up dissection. Conclusions: ICG fluorescence method provided visual confirmation that the sentinel lymphatic routes were not affected by NAC. This result suggests that SLNB after NAC can be used to safely and positively identify the SLN in clinical node-negative patients. Further investigation would be required to safely perform SLNB after NAC in clinical node-positive patients.

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.

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