Short term outcomes in laparoscopic colorectal surgery with and without the use of fluorescent angiography.

Carolyn Moore, MD¹, Jacquelyn Turner, MD, FACS², Clayton Naddell³, Adatee Okonkwo, MD¹, Ed Childs, MD, FACS¹, Clarence Clark, MD, FACS, FASCRS². ¹Morehouse School Of Medicine, Department of Surgery, ²Morehouse School of Medicine, Department of Surgery, Section of Colon and Rectal Surgery, ³Morehouse School of Medicine

Background: Laparoscopic colectomy is associated improved short-term outcomes compared to open colectomy. Fluorescent imaging, particularly the use of indocyanine green imaging in a laparoscopic platform is a relatively recent imaging method showing promise in improved outcomes in laparoscopic colorectal surgery. Here, we compare 30 day outcomes of laparoscopic colorectal surgeries with (LapFI) and without (Lap) the use of indocyanine green fluorescent imaging.

Methods: All adult patients who underwent elective laparoscopic (hand assisted, single incision, or multi-port) colorectal surgery with and without fluorescent angiography were retrospectively reviewed in a prospectively maintained database from 6/2013 to 6/2015 at a single institution. Emergent and multi-organ cases were excluded as well as those with incomplete data. Demographics, intra-operative data, and postoperative data were recorded and analyzed using STATA 12.

Results: No difference was seen between ages, sex, BMI, comorbidities, or ASA scores between the two groups. LapFI group (n=30) had significantly longer operative time compared to Lap group (n=53). There were no conversions to open. No significant difference was seen in the overall complication rate.  However, the LapFI group was shown to have fewer complications at a rate of 6.7% compared to 17% for the Lap alone group including for anastomotic leak (0% vs 3.8%, respectively). This trend was seen in mortality and length of stay as well. Readmission rate was higher in the Lap group at 13.2% vs 0% for the LapFI group.

Conclusion: LapFI is safe and adds more operative time to laparoscopic colorectal surgery with a trend to a lower complication rate including anastomotic leak.