[Intraoperative fluorescence angiography in colorectal surgery].

Area of Science:

• Surgical Innovation
• Medical Imaging
• Gastrointestinal Surgery

Background:

• Indocyanine green fluorescence angiography (ICG-FA) is a valuable tool for assessing anastomotic perfusion in colorectal surgery.
• Previous studies indicate a low anastomotic leakage rate with ICG-FA, such as the PILLAR II study (1.4%).
• This article presents original findings on ICG-FA efficacy and application in colorectal procedures.

Purpose of the Study:

• To evaluate if current ICG-FA results support its expanded use in colorectal surgery.
• To determine the impact of ICG-FA on anastomotic leakage rates.

Main Methods:

• A total of 378 colorectal resections (280 colon, 98 rectal) were performed between July 2009 and June 2019.
• Intraoperative assessment of anastomosis perfusion using ICG-FA was conducted.
• In 13 patients (3.4%), reduced perfusion detected by ICG-FA led to procedural changes.

Main Results:

• The overall anastomotic leakage rate was 3.7% (8 leaks in colon, 6 in rectum).
• Without intraoperative adjustments guided by ICG-FA, the leakage rate could have reached 7.1%.
• ICG-FA use potentially reduced the leakage rate by 48% in the studied cohort.

Conclusions:

• ICG-FA demonstrates a very low anastomotic leakage rate in colorectal surgery.
• While promising, further controlled randomized studies are needed before widespread recommendation.
• ICG-FA shows potential for improving outcomes in colorectal surgery.