A Novel Fluorescence-Based Leak Test Method for Rectal Anastomoses Using Aerosolized Indocyanine Green

Area of Science:

• Surgical Innovation
• Medical Imaging
• Gastroenterology

Background:

• Intraoperative air leak tests during rectal surgery can be challenging to visualize.
• Current methods for assessing anastomotic integrity have limitations in pinpointing leak sites.

Purpose of the Study:

• To assess the feasibility of using aerosolized indocyanine green (ICG) for detecting rectal anastomotic leakage.
• To evaluate ICG as a potential fluorescent tracer for intraoperative leak detection.

Main Methods:

• A preclinical animal study was conducted using a canine model.
• A rectal anastomotic leakage model was created, and aerosolized ICG was administered transanally.
• Laparoscopic observation with a near-infrared fluorescence laparoscope was used to detect fluorescence at leak sites.

Main Results:

• Aerosolized indocyanine green was successfully visualized at all surgically created anastomosis leak sites.
• Visualization of fluorescence occurred rapidly, with a median time of 4.5 seconds.
• No histological abnormalities were observed at the anastomosis sites 4 weeks post-surgery.

Conclusions:

• Transanal administration of aerosolized indocyanine green allows for laparoscopic visualization of rectal anastomotic air leaks.
• This novel fluorescent leak test is a potentially valid alternative to existing methods for assessing rectal anastomotic integrity.