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Clinical utility of transanal indocyanine green near-infrared fluorescence imaging for evaluation of colorectal anastomotic perfusion

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Abstract

Background

Although indocyanine green (ICG) fluorescence imaging has been reported to be useful for assessing colorectal perfusion, unstable quantification remains an issue. We performed ICG fluorescence observation from the luminal side and examined the usefulness of the transanal approach.

Methods

A total of 69 patients who underwent left-side colon surgery were enrolled in this cohort study. After the anastomosis had been constructed, ICG 0.2 mg/kg was injected intravenously. The anastomotic site was then observed by a scope inserted transanally. The following items were examined in the areas of the anastomotic site with the highest- and lowest-fluorescence intensity: maximum fluorescence (Fmax), time from ICG injection to Fmax (Tmax), time from start of dyeing to Fmax (ΔT), and the contrast pattern of the mucosa.

Results

Anastomotic leakage (AL) occurred in nine cases. Tmax and ΔT values of the lowest-fluorescence area in the distal intestine showed significant differences in the cases with AL (P = 0.015 and P = 0.040, respectively). Regarding the contrast pattern of the mucosa of the lowest-fluorescence area in the proximal and distal intestine, the patients in whom the vessels were not depicted in the area had a significantly higher incidence of AL than those in whom vessels were depicted in the area (P = 0.031 and P = 0.030, respectively). Some of the areas in which vessels were not depicted by ICG fluorescence observation from the luminal side corresponded to the points of leakage. There were heterogeneous changes that might not be grasped by observation from the serosal side.

Conclusion

Transanal ICG fluorescence imaging can evaluate perfusion over the entire circumference of the anastomosis in detail and aid in assessing the risk of AL. Therefore, the examination of the detailed low-perfusion area enables us to take measures for AL and to search for safer operative managements.

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Acknowledgements

The authors thank Chiba Medical Journal for providing the figure data (Fig. 1). We thank Editage (www.editage.jp) for English language editing. This work was supported by JSPS KAKENHI Grant Number JP 18K16343.

Funding

This work was supported by JSPS KAKENHI Grant Number JP 18K16343.

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Authors and Affiliations

  1. Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan

    Hiroyuki Amagai, Hideaki Miyauchi, Masaya Uesato, Gaku Ohira, Shunsuke Imanishi, Tetsuro Maruyama, Toru Tochigi, Koichiro Okada, Michihiro Maruyama & Hisahiro Matsubara

  2. Tsujinaka Hospital, Kashiwa City, Japan

    Yorihiko Muto

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  1. Hiroyuki Amagai
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Correspondence to Hiroyuki Amagai.

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Hiroyuki Amagai, Hideaki Miyauchi, Yorihiko Muto, Masaya Uesato, Gaku Ohira, Shunsuke Imanishi, Tetsuro Maruyama, Toru Tochigi, Koichiro Okada, Michihiro Maruyama, and Hisahiro Matsubara have no conflicts of interest or financial ties to disclose.

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Amagai, H., Miyauchi, H., Muto, Y. et al. Clinical utility of transanal indocyanine green near-infrared fluorescence imaging for evaluation of colorectal anastomotic perfusion. Surg Endosc 34, 5283–5293 (2020). https://doi.org/10.1007/s00464-019-07315-7

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