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

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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.

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Disclosures

Dr. Alessio Pigazzi is a consultant for Intuitive Surgical. Dr. Steven Mills has received an Ethicon Educational grant paid to the department. Dr. Michael Stamos has had Ethicon, Olympus, NiTi/NovoGI, Adolor/GSK, and Covidien training support paid to UCI for clinical immersion courses for Lap colectomy. Dr. Joseph Carmichael, Dr. Mehraneh Jafari, Dr. Wissam Halabi, and Dr. Kang Hong Lee have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, University of California, Irvine, 333 City Blvd. West, Suite 850, Orange, CA, 92868, USA

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

  2. Department of Surgery, Hanyang University College of Medicine, Seoul, South Korea

    Kang Hong Lee

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  1. Mehraneh D. Jafari
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  2. Kang Hong Lee
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  3. Wissam J. Halabi
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Correspondence to Alessio Pigazzi.

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Jafari, M.D., Lee, K.H., Halabi, W.J. et al. The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc 27, 3003–3008 (2013). https://doi.org/10.1007/s00464-013-2832-8

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