Frederick H Koh1, Ker-Kan Tan2,3. 1. Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health Systems, Singapore, Singapore. 2. Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health Systems, Singapore, Singapore. surtkk@nus.edu.sg. 3. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. surtkk@nus.edu.sg.
Abstract
BACKGROUND: Anastomotic leakage after gastrointestinal surgery is associated with significant morbidity and mortality.1 Insufficient vascular supply is one cause.2 Recent reports of using intraoperative indocyanine green (ICG) fluorescent angiography to evaluate whether perfusion of the anastomosis is adequate has yielded positive outcomes.3 - 6 The authors describe their use of ICG-enhanced fluorescence angiography in a laparoscopic anterior resection. METHODS: The patient was an 80-year-old with an upper rectal adenocarcinoma and significant cardiovascular risk factors. Fluorescence angiography with 0.4 mg/kg of ICG was administered intravenously just before the colorectal anastomosis was fashioned. A near-infrared (NIR) laparoscopic camera (KARLSTORZ, GmbH & Co. KG, Tuttlingen, Germany) was used to inspect the anastomosis. For this video, 0.4 mg/kg of ICG also was injected after ligation of the inferior mesenteric artery to demonstrate the appearance of a poorly perfused sigmoid bowel. RESULTS: Just before the staple was fired to fashion the colorectal anastomosis, an intravenous bolus of ICG was administered. Within seconds, vessels on both ends of the anastomosis turned fluorescent blue, indicating adequacy of perfusion. The use of ICG did not significantly lengthen the operative time (285 min) because its effect appeared within seconds after its administration. The patient recovered well and was discharged on postoperative day 5. Another four patients who also underwent intraoperative fluorescent angiography for left-sided colorectal lesions did not experience anastomotic leakage. CONCLUSION: The study showed that ICG fluorescent angiography is a simple and quick intraoperative tool for evaluating the perfusion of the anastomosis. The authors' experience with ICG fluorescent angiography has shown promising results, with a 0 % anastomotic leak rate.
BACKGROUND:Anastomotic leakage after gastrointestinal surgery is associated with significant morbidity and mortality.1 Insufficient vascular supply is one cause.2 Recent reports of using intraoperative indocyanine green (ICG) fluorescent angiography to evaluate whether perfusion of the anastomosis is adequate has yielded positive outcomes.3 - 6 The authors describe their use of ICG-enhanced fluorescence angiography in a laparoscopic anterior resection. METHODS: The patient was an 80-year-old with an upper rectal adenocarcinoma and significant cardiovascular risk factors. Fluorescence angiography with 0.4 mg/kg of ICG was administered intravenously just before the colorectal anastomosis was fashioned. A near-infrared (NIR) laparoscopic camera (KARLSTORZ, GmbH & Co. KG, Tuttlingen, Germany) was used to inspect the anastomosis. For this video, 0.4 mg/kg of ICG also was injected after ligation of the inferior mesenteric artery to demonstrate the appearance of a poorly perfused sigmoid bowel. RESULTS: Just before the staple was fired to fashion the colorectal anastomosis, an intravenous bolus of ICG was administered. Within seconds, vessels on both ends of the anastomosis turned fluorescent blue, indicating adequacy of perfusion. The use of ICG did not significantly lengthen the operative time (285 min) because its effect appeared within seconds after its administration. The patient recovered well and was discharged on postoperative day 5. Another four patients who also underwent intraoperative fluorescent angiography for left-sided colorectal lesions did not experience anastomotic leakage. CONCLUSION: The study showed that ICG fluorescent angiography is a simple and quick intraoperative tool for evaluating the perfusion of the anastomosis. The authors' experience with ICG fluorescent angiography has shown promising results, with a 0 % anastomotic leak rate.