Optimizing quantitative fluorescence angiography for visceral perfusion assessment.

Area of Science:

• Surgical Innovation
• Gastrointestinal Surgery
• Medical Imaging

Background:

• Anastomotic leakage is a major complication after intestinal resection, increasing morbidity and mortality.
• Objective assessment of tissue perfusion is crucial for preventing anastomotic leakage.
• Quantitative indocyanine green angiography (Q-ICG) offers a novel approach to evaluate tissue perfusion during surgery.

Purpose of the Study:

• To systematically review and determine the optimal methodology for performing Q-ICG.
• To identify Q-ICG parameters that accurately predict anastomotic leakage risk.

Main Methods:

• A comprehensive literature search was conducted across PubMed, Embase, Scopus, and Cochrane databases following PRISMA guidelines.
• Included clinical studies assessed visceral perfusion using Q-ICG during gastrointestinal surgery.
• Bias assessment was performed using the Newcastle Ottawa Scale.

Main Results:

• Thirteen studies were included, revealing that intensity parameters (e.g., maximum intensity) did not predict anastomotic leakage.
• Inflow parameters (time-to-peak, slope, t1/2max) were significantly associated with anastomotic leakage.
• Most studies performed Q-ICG retrospectively; only two used intraoperative assessments, indicating heterogeneity and low-to-moderate evidence levels.

Conclusions:

• Fluorescence intensity parameters in Q-ICG are unstable and do not correlate with clinical outcomes.
• Inflow parameters demonstrate resilience in clinical settings and are superior predictors of anastomotic leakage.
• Further research with standardized intraoperative Q-ICG methodologies is warranted to optimize its clinical application.