Improving LSG technique using fluorescent imaging system

Nova Szoka, MD, Shaina Eckhouse, MD, Daniel Guerron, MD, Keri Seymour, MD, Chan Park, MD, Ranjan Sudan, Dana Portenier, MD, Jin Yoo, MD. Duke University


Fluorescent Imaging Technology (FIT) is an emerging modality that allows for intraoperative fluorescent imaging. FIT uses intravenous indocyanine green (ICG) dye and a near-infrared light source to detect intraoperative changes in tissue.  In the past few years, fluorescent image-guided surgery has seen increased use in oncologic and general surgery, however few instances of its use in bariatric surgery has been described.


This video demonstrates how laparoscopic sleeve gastrectomy (LSG) technique can be improved using optical imaging/FIT to provide intraoperative guidance and to augment intraoperative decision-making. The video consists of several laparoscopic sleeve gastrectomy operations that used FIT and a lighted Bougie with an adjustable sail. We demonstrate how FIT can assist with passage of the Bougie, as well as defining the gastric lesser curvature to prevent narrowing at the incisura and angle of His. We also demonstrate how FIT can be used to evaluate sleeve vascularity along segmental vessel branches and at the gastroesophageal junction.


Our preliminary results show that FIT can help refine LSG technique by enhancing visualization of relevant anatomic structures. The use of FIT does not significantly prolong operative time. There have been no complications related to use of this technology intraoperatively.


Fluorescent image-guided surgery is an emerging technology in the bariatric surgical domain. Further studies are needed to see if checking tissue perfusion at time of operation will lead to better finished sleeve products and decreased perfusion-related complications (leaks & strictures).




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