The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery

Mehraneh D. Jafari, Kang Hong Lee, Wissam J Halabi, Steven D. Mills, Joseph C. Carmichael, Michael J. Stamos, Alessio Pigazzi

Research output: Contribution to journalArticle

139 Citations (Scopus)

Abstract

Background: Decreased blood perfusion at an intestinal anastomosis may contribute to postoperative anastomotic leak (AL) resulting in substantial morbidity and mortality. Near-infrared (NIR) laparoscopy in conjunction with indocyanine green (ICG) allows for visualization of the microcirculation before formation of the anastomosis, thereby allowing the surgeon to choose the point of transection at an optimally perfused area. Methods: This is a retrospective case-control analysis examining the effectiveness of NIR + ICG in reducing the rate of AL after low anterior resection (LAR) for rectal cancer. Records of patients undergoing robot-assisted LAR for rectal cancer with and without ICG were analyzed for the years 2011 and 2012. Results: Among the 40 patients who underwent robotic LAR, NIR + ICG was used in 16 cases (41 %). Male patients accounted for the majority of cases in both groups (74 %). The median level of the anastomosis was 3.5 cm in the NIR + ICG group and 5.5 cm in the control group. There was no difference in the use of diverting ileostomy. In 3 patients (19 %), the use of NIR + ICG resulted in revision of the proximal bowel (colonic) transection point before formation of the anastomosis. The distal transection point was never revised. The rate of AL in the NIR + ICG group was 6 % versus 18 % in control group. Conclusions: ICG fluorescence may play a role in anastomotic tissue perfusion assessment and affect the AL rate. Larger prospective studies are needed to further validate this novel technology.

Original languageEnglish (US)
Pages (from-to)3003-3008
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume27
Issue number8
DOIs
StatePublished - Aug 1 2013
Externally publishedYes

Fingerprint

Indocyanine Green
Robotics
Laparoscopy
Perfusion
Fluorescence
Anastomotic Leak
Rectal Neoplasms
Ileostomy
Control Groups
Microcirculation
Prospective Studies
Technology
Morbidity
Mortality

Keywords

  • Anastomosis
  • Colorectal cancer
  • Perfusion
  • Technical
  • Tissue

ASJC Scopus subject areas

  • Surgery

Cite this

The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. / Jafari, Mehraneh D.; Lee, Kang Hong; Halabi, Wissam J; Mills, Steven D.; Carmichael, Joseph C.; Stamos, Michael J.; Pigazzi, Alessio.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 27, No. 8, 01.08.2013, p. 3003-3008.

Research output: Contribution to journalArticle

Jafari, Mehraneh D. ; Lee, Kang Hong ; Halabi, Wissam J ; Mills, Steven D. ; Carmichael, Joseph C. ; Stamos, Michael J. ; Pigazzi, Alessio. / The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. In: Surgical Endoscopy and Other Interventional Techniques. 2013 ; Vol. 27, No. 8. pp. 3003-3008.
@article{8489f66ded274e509f7baac98eb82946,
title = "The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery",
abstract = "Background: Decreased blood perfusion at an intestinal anastomosis may contribute to postoperative anastomotic leak (AL) resulting in substantial morbidity and mortality. Near-infrared (NIR) laparoscopy in conjunction with indocyanine green (ICG) allows for visualization of the microcirculation before formation of the anastomosis, thereby allowing the surgeon to choose the point of transection at an optimally perfused area. Methods: This is a retrospective case-control analysis examining the effectiveness of NIR + ICG in reducing the rate of AL after low anterior resection (LAR) for rectal cancer. Records of patients undergoing robot-assisted LAR for rectal cancer with and without ICG were analyzed for the years 2011 and 2012. Results: Among the 40 patients who underwent robotic LAR, NIR + ICG was used in 16 cases (41 {\%}). Male patients accounted for the majority of cases in both groups (74 {\%}). The median level of the anastomosis was 3.5 cm in the NIR + ICG group and 5.5 cm in the control group. There was no difference in the use of diverting ileostomy. In 3 patients (19 {\%}), the use of NIR + ICG resulted in revision of the proximal bowel (colonic) transection point before formation of the anastomosis. The distal transection point was never revised. The rate of AL in the NIR + ICG group was 6 {\%} versus 18 {\%} in control group. Conclusions: ICG fluorescence may play a role in anastomotic tissue perfusion assessment and affect the AL rate. Larger prospective studies are needed to further validate this novel technology.",
keywords = "Anastomosis, Colorectal cancer, Perfusion, Technical, Tissue",
author = "Jafari, {Mehraneh D.} and Lee, {Kang Hong} and Halabi, {Wissam J} and Mills, {Steven D.} and Carmichael, {Joseph C.} and Stamos, {Michael J.} and Alessio Pigazzi",
year = "2013",
month = "8",
day = "1",
doi = "10.1007/s00464-013-2832-8",
language = "English (US)",
volume = "27",
pages = "3003--3008",
journal = "Surgical Endoscopy and Other Interventional Techniques",
issn = "0930-2794",
publisher = "Springer New York",
number = "8",

}

TY - JOUR

T1 - The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery

AU - Jafari, Mehraneh D.

AU - Lee, Kang Hong

AU - Halabi, Wissam J

AU - Mills, Steven D.

AU - Carmichael, Joseph C.

AU - Stamos, Michael J.

AU - Pigazzi, Alessio

PY - 2013/8/1

Y1 - 2013/8/1

N2 - Background: Decreased blood perfusion at an intestinal anastomosis may contribute to postoperative anastomotic leak (AL) resulting in substantial morbidity and mortality. Near-infrared (NIR) laparoscopy in conjunction with indocyanine green (ICG) allows for visualization of the microcirculation before formation of the anastomosis, thereby allowing the surgeon to choose the point of transection at an optimally perfused area. Methods: This is a retrospective case-control analysis examining the effectiveness of NIR + ICG in reducing the rate of AL after low anterior resection (LAR) for rectal cancer. Records of patients undergoing robot-assisted LAR for rectal cancer with and without ICG were analyzed for the years 2011 and 2012. Results: Among the 40 patients who underwent robotic LAR, NIR + ICG was used in 16 cases (41 %). Male patients accounted for the majority of cases in both groups (74 %). The median level of the anastomosis was 3.5 cm in the NIR + ICG group and 5.5 cm in the control group. There was no difference in the use of diverting ileostomy. In 3 patients (19 %), the use of NIR + ICG resulted in revision of the proximal bowel (colonic) transection point before formation of the anastomosis. The distal transection point was never revised. The rate of AL in the NIR + ICG group was 6 % versus 18 % in control group. Conclusions: ICG fluorescence may play a role in anastomotic tissue perfusion assessment and affect the AL rate. Larger prospective studies are needed to further validate this novel technology.

AB - Background: Decreased blood perfusion at an intestinal anastomosis may contribute to postoperative anastomotic leak (AL) resulting in substantial morbidity and mortality. Near-infrared (NIR) laparoscopy in conjunction with indocyanine green (ICG) allows for visualization of the microcirculation before formation of the anastomosis, thereby allowing the surgeon to choose the point of transection at an optimally perfused area. Methods: This is a retrospective case-control analysis examining the effectiveness of NIR + ICG in reducing the rate of AL after low anterior resection (LAR) for rectal cancer. Records of patients undergoing robot-assisted LAR for rectal cancer with and without ICG were analyzed for the years 2011 and 2012. Results: Among the 40 patients who underwent robotic LAR, NIR + ICG was used in 16 cases (41 %). Male patients accounted for the majority of cases in both groups (74 %). The median level of the anastomosis was 3.5 cm in the NIR + ICG group and 5.5 cm in the control group. There was no difference in the use of diverting ileostomy. In 3 patients (19 %), the use of NIR + ICG resulted in revision of the proximal bowel (colonic) transection point before formation of the anastomosis. The distal transection point was never revised. The rate of AL in the NIR + ICG group was 6 % versus 18 % in control group. Conclusions: ICG fluorescence may play a role in anastomotic tissue perfusion assessment and affect the AL rate. Larger prospective studies are needed to further validate this novel technology.

KW - Anastomosis

KW - Colorectal cancer

KW - Perfusion

KW - Technical

KW - Tissue

UR - http://www.scopus.com/inward/record.url?scp=84881370623&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84881370623&partnerID=8YFLogxK

U2 - 10.1007/s00464-013-2832-8

DO - 10.1007/s00464-013-2832-8

M3 - Article

C2 - 23404152

AN - SCOPUS:84881370623

VL - 27

SP - 3003

EP - 3008

JO - Surgical Endoscopy and Other Interventional Techniques

JF - Surgical Endoscopy and Other Interventional Techniques

SN - 0930-2794

IS - 8

ER -