Usefulness of blood flow evaluation by indocyanine green fluorescent system in laparoscopic colectomy.

Jun Higashijima, PhD, Mitsuo Shimada, Professor, Takashi Iwata, PhD, Kozo Yoshikawa, PhD, Toshihiro Nakao, PhD, Masaaki Nishi, PhD, Hideya Kashihara, PhD, Chie Takasu, PhD. Department of Surgery, Tokushima University, Japan

[Introduction] Insufficient blood flow is the major cause of anastomotic leakage. So intraoperative blood flow evaluation is very important. Indocyanine green (ICG) fluorescent system can perform intraoperative bloodflow evaluation in various organs. In this report, we show the clinical usefulness of indocyanine green (ICG) fluorescent system in laparoscopic colectomy.

[Methods] 1. Usefulness of ICG system in anterior resection : Rectal cancer patients (n=67) who underwent laparoscopic anterior resection were included. Bloodflow of the stumps of the colon were evaluated using ICG fluorescent system. After resection of rectum, 7.5mg of ICG was administered, and the blood flow of oral stump was evaluated by measuring fluorescent time. Relationship between the time until recognition of blood flow at the stump and anastomotic leakage was investigated. And to evaluate the both stump in laparoscopic anterior resection, laparoscopic ICG fluorescent system was used. Fluorsecnt time of both stumps were measured and the blood flow of both stumps were evaluated.

2. Usefulness of ICG fluorescent system in other operation.

[Results] 1. Three of sixty seven patients (4.5%) suffered anastomotic leakage. The fluorescent time of two patients were over sixty seconds and in one patient, fluorescent was not recognized. Under sixty seconds cases, patients suffered no anastomotic leakage. In eighty seconds case, we could avoid anastomotic leakage by additional resection of the colon with low blood flow. And in laparoscopic ICG fluorescent system evaluation, fluorescent time of both stumps were all under sixty seconds and there was no leakage.

2. Laparoscopic ICG fluorescence system is also useful in other operation. Laparoscopic ICG system can evaluate the bloodflow of intestine and other organs in abdominal cavity, so this system can be used widely in various operation. For example, our one interesting case, in patient with advanced cancer in SD junction, the oral colon was ischemic after resection of the tumor and we could avoid anastomotic leakage. Like this case, laparoscopic ICG system is usefull not only in anterior resection but also in other operation.

[Conclusion] ICG fluorescent system is useful for evaluating blood flow, and avoiding anastomotic leakage in laparoscopic colectomy.

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