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Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study
Mehraneh D Jafari1, Steven D Wexner2, Joseph E Martz3
1Department of Surgery, University of California, Irvine Medical Center, Orange, CA.
Journal of the American College of Surgeons
|December 3, 2014
Summary
Intraoperative fluorescence angiography (FA) using the PINPOINT system is a feasible tool for assessing colon and rectal perfusion during surgery. This technique helped avoid anastomotic leaks in patients whose surgical plans were altered based on perfusion assessment.
Area of Science:
- Colorectal Surgery
- Surgical Imaging
- Medical Devices
Background:
- Anastomotic leak (AL) is a significant complication after colorectal resection, increasing morbidity, mortality, and cancer recurrence.
- Inadequate tissue perfusion is a potential contributor to AL.
- Intraoperative assessment of perfusion is crucial for preventing AL.
Purpose of the Study:
- To evaluate the utility and feasibility of intraoperative fluorescence angiography (FA) for assessing colon and rectal perfusion.
- To determine if FA can guide surgical decisions and reduce AL rates during left-sided colectomy and anterior resection.
Main Methods:
- Prospective, multicenter, open-label clinical trial involving 147 patients undergoing left-sided colectomy or anterior resection.
- Utilized the PINPOINT Endoscopic Fluorescence Imaging System for intraoperative FA.
- Assessed feasibility, utility, surgical plan changes, and AL rates.
Main Results:
- FA demonstrated a 99% success rate in assessing perfusion.
- Surgical plans were altered in 8% of patients based on FA findings, primarily at the proximal margin transection.
- The overall AL rate was 1.4%, with no leaks occurring in patients whose surgery was revised due to inadequate perfusion identified by FA.
Conclusions:
- The PINPOINT system is a safe and feasible tool for intraoperative perfusion assessment in colorectal surgery.
- Revising anastomoses based on FA findings of inadequate perfusion was associated with zero anastomotic leaks.
