• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • SAGES 2021 Annual Meeting
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2021
      • SAGES 2020
      • SAGES 2019
      • SAGES 2018
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • SAGES Logo Products
    • “Unofficial” Logo Products
  • Log In

PINPOINT endoscopic fluorescence perfusion assessment of colorectal anastomoses – Will this impact outcomes? The PILLAR II Study.

Michael J Stamos, MD, on behalf of the PILLAR II Study Investigators

University of California, Irvine

Objective of the Study/Technique
Anastomotic leakage following colorectal resection and primary anastomosis is an important clinical problem that causes increased morbidity and mortality to the patient, especially in low anterior resections (LAR). The incidence of anastomotic leaks reported in the literature varies between 0.5% and 30%. Inadequate perfusion at the anastomotic site is believed to be a major determinant of leak. The PINPOINT® Endoscopic Fluorescence Imaging system (Novadaq Technologies Inc., Ontario, Canada) allows the surgeon to intra-operatively assess tissue perfusion during laparoscopic left-sided colectomy. The utility of intraoperative assessment of tissue perfusion using the PINPOINT® system is being evaluated in a multicenter clinical trial (PILLAR II-www.clinicaltrial.org)

Description of the methods
PINPOINT consists of a rigid endoscope, a camera and a light source optimized for both high definition (HD) white light and Near Infra Red Fluorescence (NIRF) images. The NIRF images are acquired following administration of an intravenous bolus of indocyanine green (ICG), an agent which is confined to the vascular space and fluoresces in the NIR when excited with light at the appropriate wavelength. A separate injection of ICG is given for each image sequence acquisition and multiple sequences can be acquired over the course of a surgery. Perfusion is assessed by qualitative inspection of the NIRF images. Images can be displayed separately or in a combined “PINPOINT” mode with the NIRF image superimposed on the HD white light image, thus providing anatomical context for the NIRF image.

Perfusion at the planned distal resection margin of the colon is assessed following division of the relevant blood vessels and mesentery. A bolus of ICG is injected and the area of interest viewed in PINPOINT mode during the passage of the bolus through the field of view. The colon may then be transected within an area of good perfusion as assessed by the PINPOINT image. Following completion of the anastomosis, perfusion of the mucosal aspect is assessed. The PINPOINT endoscope is inserted trans-anally using a customized introducer, advanced to the anastomotic line, a bolus of ICG injected and the tissue is viewed in PINPOINT mode.

Results
Preliminary experience in 9 patients indicates that assessment of perfusion at both the colonic transection margin and the mucosal aspect of the completed anastomosis during laparoscopic LAR are feasible. Further evaluation will indicate the frequency of alteration in operative plans as indicated by the perfusion assessment.

Conclusions
It is anticipated that assessment of perfusion at the colonic resection margin using the PINPOINT system may decrease the incidence of postoperative anastomotic leak. Subsequent perfusion assessment of the completed anastomosis, with the colon in its final anatomical position and tension, may assist in decision making regarding the need for a diverting ileostomy.


Session: Poster Presentation

Program Number: P617

1,150

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2013 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Surgery is Safer with Vaccination 1

Addressing Religious Concerns About COVID-19 Vaccine

This may be a difficult subject matter for you and your patient to talk about.  Be assured, all major organized religious groups encourage and recommend the COVID-19 vaccine. Listed below are references and websites you can direct your patient towards to help them make an informed decision with regards to their religious concerns against the […]

SAGES Statement on AAPI Violence

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) stands in solidarity with the Asian American and Pacific Islander (AAPI) community. In the summer of 2020, SAGES released a statement condemning the violence, racism, and hatred toward the Black community in the wake of George Floyd and Breonna Taylor’s murders. It is with great sorrow […]

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
[email protected]
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2022 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2022 Society of American Gastrointestinal and Endoscopic Surgeons