Indocyanine Green-Guided Intraoperative Imaging to Facilitate Video-Assisted Retroperitoneal Debridement for Treating...

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Surgical Imaging

Background:

• Severe acute necrotizing pancreatitis often requires surgical intervention like video-assisted retroperitoneal debridement (VARD).
• Standard VARD using white light imaging faces challenges in differentiating necrotic tissue from healthy tissue due to adhesions, increasing risks of vascular or enteric injury.
• Minimally invasive necrosectomy is crucial for managing infected necrosis in the retroperitoneum.

Purpose of the Study:

• To evaluate the utility of real-time intraoperative near-infrared fluorescence imaging with indocyanine green (ICG) during VARD.
• To assess if ICG-guided VARD can improve visualization of well-perfused tissues and delineate the separation plane between necrotic and healthy tissue.
• To determine if this modified technique reduces the risk of complications such as vascular or enteric injury during necrosectomy.

Main Methods:

• Implementation of real-time intraoperative near-infrared fluorescence imaging using indocyanine green (ICG) during video-assisted retroperitoneal debridement (VARD).
• Utilizing ICG to visualize well-perfused adjacent normal tissues, creating a clear separating surface during debridement.
• Comparing the outcomes and safety profile of ICG-guided VARD with conventional VARD.

Main Results:

• ICG-guided VARD enables clear visualization of the separating surface between necrotic debris and adjacent normal tissues.
• The technique facilitates differentiation of healthy, well-perfused tissue from necrotic areas, reducing the risk of inadvertent injury.
• ICG-guided VARD demonstrated potential in enhancing surgical precision during debridement for severe acute necrotizing pancreatitis.

Conclusions:

• ICG-guided VARD is a modified technique that enhances visualization during minimally invasive necrosectomy for severe acute necrotizing pancreatitis.
• This approach offers a clearer demarcation of tissue planes, potentially reducing the risk of vascular and enteric injuries.
• ICG-guided VARD represents a safer debridement strategy for complex cases of retroperitoneal infected necrosis.