Skip to main content

Advertisement

SpringerLink
Log in

Fluorescence angiography with indocyanine green (ICG) to evaluate anastomosis in colorectal surgery: where does it have more value?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Indocyanine green (ICG) fluorescence angiography (FA) was introduced to provide the real-time intraoperative evaluation of the vascular supply of anastomosis. However, further studies are required to evaluate its advantages in colorectal surgery and to know in which procedure this technology has more value. The aim of the present study is to assess the usefulness of the ICG-FA in the colorectal anastomosis evaluation and to evaluate where it is most useful depending on type of resection performed in terms of change of section line based on the ICG-FA and anastomotic leakage (AL) rates.

Methods

This is a prospective study. From September 2014 to November 2018, all patients who underwent any colorectal surgical procedure with ICG-FA in our center were enrolled in the study. Based on the type of surgery, patients were grouped in 4 categories: Group A, right hemicolectomy; Group B, segmental resection of the splenic flexure; Group C, left hemicolectomy; and Group D, anterior resection of the rectum.

Results

One-hundred-ninety-two unselected consecutive patients were enrolled: 67 in group A, 9 in B, 81 in C, and 35 in D. Change of section line based on ICG-FA occurred in 35 cases (18.2%): 4 in group A (6%), 1 in group B (11.1%), 21 in group C (25.9%), and 9 in group D (25.7%). ALs occurred in 5 patients (2.6%): 2 in group A (3%), 1 in C (1.2%), and 2 in D (5.7%).

Conclusions

ICG-FA leads to significantly more changes in the resection line in case of left hemicolectomy followed by anterior resection. FA is a promising optical imaging technique to reduce the AL incidence after colorectal procedures. To confirm this data, further studies with wider sample size and with an objective evaluation of the anastomotic perfusion are required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Blanco-Colino R, Espin-Basany E (2018) Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol 22(1):15–23. https://doi.org/10.1007/s10151-017-1731-8

    Article  CAS  PubMed  Google Scholar 

  2. Jutesten H, Draus J, Frey J, Neovius G, Lindmark G, Buchwald P, Lydrup ML (2019) High risk of permanent stoma after anastomotic leakage in anterior resection for rectal cancer. Colorectal Dis 21(2):174–182. https://doi.org/10.1111/codi.14469

    Article  CAS  PubMed  Google Scholar 

  3. Matsuda K, Hotta T, Takifuji K, Yokoyama S, Watanabe T, Mitani Y, Ieda J, Iwamoto H, Mizumoto Y, Yamaue H (2015) Clinical characteristics of anastomotic leakage after an anterior resection for rectal cancer by assessing of the international classification on anastomotic leakage. Langenbecks Arch Surg 400(2):207–212. https://doi.org/10.1007/s00423-015-1272-4

    Article  PubMed  Google Scholar 

  4. Park JS, Choi GS, Kim SH, Kim HR, Kim NK, Lee KY, Kang SB, Kim JY, Lee KY, Kim BC, Bae BN, Son GM, Lee SI, Kang H (2013) Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg 257(4):665–671. https://doi.org/10.1097/SLA.0b013e31827b8ed9

    Article  PubMed  Google Scholar 

  5. Voron T, Bruzzi M, Ragot E, Zinzindohoue F, Chevallier JM, Douard R, Berger A (2019) Anastomotic location predicts anastomotic leakage after elective colonic resection for cancer. J Gastrointest Surg 23(2):339–347. https://doi.org/10.1007/s11605-018-3891-x

    Article  PubMed  Google Scholar 

  6. van den Bos J, Jongen ACHM, Melenhorst J, Breukink SO, Lenaerts K, Schols RM, Bouvy ND, Stassen LPS (2019) Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study. Surg Endosc. https://doi.org/10.1007/s00464-019-06673-6

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wada T, Kawada K, Takahashi R, Yoshitomi M, Hida K, Hasegawa S, Sakai Y (2017) ICG fluorescence imaging for quantitative evaluation of colonic perfusion in laparoscopic colorectal surgery. Surg Endosc 31(10):4184–4193. https://doi.org/10.1007/s00464-017-5475-3

    Article  PubMed  Google Scholar 

  8. Frasson M, Flor-Lorente B, Rodríguez JL, Granero-Castro P, Hervás D, Alvarez Rico MA, Brao MJ, Sánchez González JM, Garcia-Granero E, ANACO Study Group (2015) Risk factors for anastomotic leak after colon resection for cancer: multivariate analysis and nomogram from a multicentric, prospective, national study with 3193 patients. Ann Surg 262(2):321–330. https://doi.org/10.1097/sla.0000000000000973

    Article  PubMed  Google Scholar 

  9. Parthasarathy M, Greensmith M, Bowers D, Groot-Wassink T (2017) Risk factors for anastomotic leakage after colorectal resection: a retrospective analysis of 17 518 patients. Colorectal Dis 19(3):288–298. https://doi.org/10.1111/codi.13476

    Article  CAS  PubMed  Google Scholar 

  10. Zhang W, Lou Z, Liu Q, Meng R, Gong H, Hao L, Liu P, Sun G, Ma J, Zhang W (2017) Multicenter analysis of risk factors for anastomotic leakage after middle and low rectal cancer resection without diverting stoma: a retrospective study of 319 consecutive patients. Int J Colorectal Dis 32(10):1431–1437. https://doi.org/10.1007/s00384-017-2875-8

    Article  PubMed  Google Scholar 

  11. Tanaka K, Okuda J, Yamamoto S, Ito M, Sakamoto K, Kokuba Y, Yoshimura K, Watanabe M (2017) Risk factors for anastomotic leakage after laparoscopic surgery with the double stapling technique for stage 0/I rectal carcinoma: a subgroup analysis of a multicenter, single-arm phase II trial. Surg Today 47(10):1215–1222. https://doi.org/10.1007/s00595-017-1496-8

    Article  PubMed  Google Scholar 

  12. Dekker JW, de Mol van Otterloo JC, Putter H, Tollenaar RA (2011) Predicting the risk of anastomotic leakage in left-sided colorectal surgery using a colon leakage score. J Surg Res 166(1):e27–e34. https://doi.org/10.1016/j.jss.2010.11.004

    Article  PubMed  Google Scholar 

  13. Sparreboom CL, van Groningen JT, Lingsma HF, Wouters MWJM, Menon AG, Kleinrensink GJ, Jeekel J, Lange JF, Dutch ColoRectal Audit Group (2018) Different risk factors for early and late colorectal anastomotic leakage in a nationwide audit. Dis Colon Rectum 61(11):1258–1266. https://doi.org/10.1097/DCR.0000000000001202

    Article  PubMed  Google Scholar 

  14. Jung SH, Yu CS, Choi PW, Kim DD, Park IJ, Kim HC, Kim JC (2008) Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum 51(6):902–908. https://doi.org/10.1007/s10350-008-9272-x

    Article  PubMed  Google Scholar 

  15. Jafari MD, Lee KH, Halabi WJ, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A (2013) The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc 27(8):3003–3008. https://doi.org/10.1007/s00464-013-2832-8

    Article  PubMed  Google Scholar 

  16. Boni L, Fingerhut A, Marzorati A, Rausei S, Dionigi G, Cassinotti E (2017) Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc 31(4):1836–1840. https://doi.org/10.1007/s00464-016-5181-6

    Article  PubMed  Google Scholar 

  17. Kudszus S, Roesel C, Schachtrupp A, Höer JJ (2010) Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbecks Arch Surg 395(8):1025–1030. https://doi.org/10.1007/s00423-010-0699-x

    Article  PubMed  Google Scholar 

  18. Mizrahi I, Abu-Gazala M, Rickles AS, Fernandez LM, Petrucci A, Wolf J, Sands DR, Wexner SD (2018) Indocyanine green fluorescence angiography during low anterior resection for low rectal cancer: results of a comparative cohort study. Tech Coloproctol 22(7):535–540. https://doi.org/10.1007/s10151-018-1832-z

    Article  CAS  PubMed  Google Scholar 

  19. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  Google Scholar 

  20. Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, Holm T, Wong WD, Tiret E, Moriya Y, Laurberg S, den Dulk M, van de Velde C, Büchler MW (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3):339–351. https://doi.org/10.1016/j.surg.2009.10.012

    Article  PubMed  Google Scholar 

  21. Karliczek A, Harlaar NJ, Zeebregts CJ, Wiggers T, Baas PC, van Dam GM (2009) Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis 24(5):569–576. https://doi.org/10.1007/s00384-009-0658-6

    Article  CAS  PubMed  Google Scholar 

  22. Urbanavičius L, Pattyn P, de Putte DV, Venskutonis D (2011) How to assess intestinal viability during surgery: a review of techniques. World J Gastrointest Surg 3(5):59–69. https://doi.org/10.4240/wjgs.v3.i5.59

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ambrosetti P, Robert J, Mathey P, Rohner A (1994) Left-sided colon and colorectal anastomoses: Doppler ultrasound as an aid to assess bowel vascularization. A prospective evaluation of 200 consecutive elective cases. Int J Colorectal Dis 9(4):211–214

    Article  CAS  Google Scholar 

  24. Boyle NH, Manifold D, Jordan MH, Mason RC (2000) Intraoperative assessment of colonic perfusion using scanning laser Doppler flowmetry during colonic resection. J Am Coll Surg 191(5):504–510

    Article  CAS  Google Scholar 

  25. Karliczek A, Benaron DA, Baas PC, Zeebregts CJ, Wiggers T, van Dam GM (2010) Intraoperative assessment of microperfusion with visible light spectroscopy for prediction of anastomotic leakage in colorectal anastomoses. Colorectal Dis 12(10):1018–1025. https://doi.org/10.1111/j.1463-1318.2009.01944.x

    Article  CAS  PubMed  Google Scholar 

  26. Kawada K, Hasegawa S, Wada T, Takahashi R, Hisamori S, Hida K, Sakai Y (2017) Evaluation of intestinal perfusion by ICG fluorescence imaging in laparoscopic colorectal surgery with DST anastomosis. Surg Endosc 31(3):1061–1069. https://doi.org/10.1007/s00464-016-5064-x

    Article  PubMed  Google Scholar 

  27. Gröne J, Koch D, Kreis ME (2015) Impact of intraoperative microperfusion assessment with Pinpoint Perfusion Imaging on surgical management of laparoscopic low rectal and anorectal anastomoses. Colorectal Dis 17(Suppl 3):22–28. https://doi.org/10.1111/codi.13031

    Article  PubMed  Google Scholar 

  28. Ris F, Hompes R, Cunningham C, Lindsey I, Guy R, Jones O, George B, Cahill RA, Mortensen NJ (2014) Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery. Surg Endosc 28(7):2221–2226. https://doi.org/10.1007/s00464-014-3432-y

    Article  PubMed  PubMed Central  Google Scholar 

  29. Boni L, David G, Dionigi G, Rausei S, Cassinotti E, Fingerhut A (2016) Indocyanine green-enhanced fluorescence to assess bowel perfusion during laparoscopic colorectal resection. Surg Endosc 30(7):2736–2742. https://doi.org/10.1007/s00464-015-4540-z

    Article  PubMed  Google Scholar 

  30. De Nardi P, Elmore U, Maggi G, Maggiore R, Boni L, Cassinotti E, Fumagalli U, Gardani M, De Pascale S, Parise P, Vignali A, Rosati R (2019) Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: results of a multicenter randomized controlled trial. Surg Endosc. https://doi.org/10.1007/s00464-019-06730-0

    Article  PubMed  Google Scholar 

  31. Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, Lee SW, Senagore AJ, Phelan MJ, Stamos MJ (2015) Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 220(1):82–92. https://doi.org/10.1016/j.jamcollsurg.2014.09.015

    Article  PubMed  Google Scholar 

  32. Chang YK, Foo CC, Yip J, Wei R, Ng KK, Lo O, Choi HK, Law WL (2018) The impact of indocyanine-green fluorescence angiogram on colorectal resection. Surgeon. https://doi.org/10.1016/j.surge.2018.08.006

    Article  PubMed  Google Scholar 

  33. Protyniak B, Dinallo AM, Boyan WP Jr, Dressner RM, Arvanitis ML (2015) Intraoperative indocyanine green fluorescence angiography—an objective evaluation of anastomotic perfusion in colorectal surgery. Am Surg 81(6):580–584

    PubMed  Google Scholar 

  34. Son GM, Kwon MS, Kim Y, Kim J, Kim SH, Lee JW (2018) Quantitative analysis of colon perfusion pattern using indocyanine green (ICG) angiography in laparoscopic colorectal surgery. Surg Endosc. https://doi.org/10.1007/s00464-018-6439-y

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital “Virgen del Rocio”, University of Sevilla, Seville, Spain

    Salvador Morales-Conde, Isaias Alarcón, Tao Yang, Violeta Camacho, Fátima Aguilar del Castillo & Andrea Balla

  2. Unit of General and Digestive Surgery, Hospital QuironSalud Sagrado Corazón, Seville, Spain

    Salvador Morales-Conde & Eugenio Licardie

  3. Department of General Surgery and Surgical Specialties “Paride Stefanini”, Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Andrea Balla

Authors
  1. Salvador Morales-Conde
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Isaias Alarcón
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tao Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eugenio Licardie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Violeta Camacho
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fátima Aguilar del Castillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrea Balla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea Balla.

Ethics declarations

Disclosures

Prof. Salvador Morales-Conde, Dr. Isaias Alarcón, Dr. Tao Yang, Dr. Eugenio Licardie, Dr. Violeta Camacho, Dr. Fátima Aguilar del Castillo, and Dr. Andrea Balla declare that they have no conflict of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morales-Conde, S., Alarcón, I., Yang, T. et al. Fluorescence angiography with indocyanine green (ICG) to evaluate anastomosis in colorectal surgery: where does it have more value?. Surg Endosc 34, 3897–3907 (2020). https://doi.org/10.1007/s00464-019-07159-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-07159-1

Keywords

Search

Navigation