Ana Otero, Beatriz Martin, Borja de Lacy, Bravo Raquel, Antonio de Lacy. Hospital Clinic
INTRODUCTION: Hypoperfusion is an important risk factor for anastomotic leakage in colorectal surgery. The etiology of anastomotic leaks is a multifactorial problem (male sex, level of anastomosis, tobacco use, preoperative radiation, etc.). Besides technical aspects, adequate bowel perfusion is the main factor in ensuring the integrity of an anastomosis. Adequate perfusion of the resection margins and the anastomosis is usually determined using clinical judgment alone. The surgeon observes the color of the tissue, checks for bleeding from the cut edges, and palpates for arterial pulses and evaluates peristalsis. This method of assessment is subjective, difficult to quantify, and can be inaccurate, making it a poor predictor of the risk of anastomotic leakage. Currently available literature on open and minimally invasive surgery, suggests that additional visualization of tissue perfusion with fluorescence imaging can add relevant information for determining a well-perfused location for colorectal transections, thus leading to fewer anastomotic leaks.
METHODS: The system used is Endoscopic Fluorescence Imagin System. It enables the surgeon to assess perfusion with realtime endoscopic high definition visible and near infrared fluorescence imaging. Indocyanine green absorbs infrared light, and emits fluorescence. Indocyanine green rapidly and extensively binds to plasma proteins and is confined to the intravascular compartment, with minimal leakage into the interstitium. It is cleared by the liver in 3 to 5 minutes into bile with no known metabolites.
Once completed the division of the proximal mesocolon the anesthesia team inject 5-10 mg Indocyanine green. The perfusion became visible in the proximal bowel and is followed with the camera to mark transection point. The distal stump is evaluated either during visualization of the proximal stump or prior to creation of the anastomosis. The anastomosis is then performed and and if required we can re-evaluate perfusion at this time. In our video we present two cases in which this methodology was used, operated by laparoscopic and robotic approach.
CONCLUSIONS: Both patients were discharged without complications. To date there are few studies about it, but for now we can say that fluorescence imaging during colorectal procedures provides important additional information about bowel perfusion at the transection site during colorectal procedures, and can lead to a change of transection location. This may eventually help to better evaluate perfusion at the anastomosis and thus decrease the rates of anastomotic leak and thereby improve patient outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80172
Program Number: V039
Presentation Session: Thursday Exhibit Hall Video Presentations Session 2 (Non CME)
Presentation Type: EHVideo