Redefining Perfusion: Fluorescence Angiography in Sleeve Gastrectomies

Shanglei Liu, MD, Ran B Luo, MD, Jonathan C DeLong, MD, Alisa M Coker, MD, Caitlin Houghton, MD, Bryan J Sandler, MD, FACS, Garth R Jacobsen, MD, FACS, Santiago Houghton, MD, FACS. University of California, San Diego

This video shows a laparoscopic sleeve gastrectomy utilizing fluorescence angiography to delineate perfusion to the tubularized stomach.  Indocyanine green (ICG) is a near infrared (NIR) fluorescence dye that has been used for decades, but only recently has laparoscopic camera technology allowed us to use it to its full potential. Staple-line leaks remain one of the most feared complications of sleeve gastrectomies. One possible etiology has been attributed to poor perfusion of the staple-line at the Angle of His. The fluorescence-guided angiography allows us to visualize the perfusion of the remnant stomach. Key steps of the sleeve gastrectomy and subsequent fluorescence angiography of the remnant stomach are shown and described.

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