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McEntee PD, Singaravelu A, McCarrick CA, Murphy E, Boland PA, Cahill RA. Quantification of indocyanine green fluorescence angiography in colorectal surgery: a systematic review of the literature. Surg Endosc 2025; 39:2677-2691. [PMID: 40019566 PMCID: PMC11933147 DOI: 10.1007/s00464-025-11621-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 02/15/2025] [Indexed: 03/01/2025]
Abstract
BACKGROUND Indocyanine green fluorescence angiography (ICGFA) during colorectal surgery associates with reduced post-operative anastomotic complication rates. Because its interpretation is subjective, quantification has been proposed to address inter-user variability. This study reviews the published literature regarding ICGFA quantification during colorectal surgery with a focus on impactful clinical deployment. METHODS A systematic review was performed of English language publications regarding clinical studies of ICGFA quantification in colorectal surgery in PubMed, Scopus, Web of Science and Cochrane Library on 29th August 2024, updated to 18th November 2024, following PRISMA guidelines. Newcastle Ottawa scale (NOS) was used to assess quality. RESULTS A total of 1428 studies were screened with 22 studies (1469 patients) selected. There was significant heterogeneity of ICGFA methodology, quantification methods and parameter selection and only three studies were NOS "high" quality. Extracorporeal application was most common. Four studies (154 patients) conducted real-time ICGFA analyses (others were post hoc) and four utilised artificial intelligence methods. Eleven studies only included patients undergoing left-sided resection (six focusing specifically on rectal resections). Only one study employed the quantification method to guide intra-operative decision-making regarding colonic transection. Twenty-six different perfusion parameters were assessed, with time from injection to visible fluorescence and maximum intensity the most commonly (but not only) correlated parameters regarding anastomotic complication (n = 18). Other grounding correlates were tissue oxygenation (n = 3, two with hyperspectral imagery), metabolites (n = 2) and surgeon interpretation (n = 5). CONCLUSION Quantification of the ICGFA signal for colorectal surgery is feasible but has so far seen limited academic advancement beyond feasibility.
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Affiliation(s)
- Philip D McEntee
- UCD Centre for Precision Surgery, UCD, 47 Eccles Street, Dublin 7, Dublin, Ireland
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Cathleen A McCarrick
- UCD Centre for Precision Surgery, UCD, 47 Eccles Street, Dublin 7, Dublin, Ireland
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Edward Murphy
- UCD Centre for Precision Surgery, UCD, 47 Eccles Street, Dublin 7, Dublin, Ireland
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Patrick A Boland
- UCD Centre for Precision Surgery, UCD, 47 Eccles Street, Dublin 7, Dublin, Ireland
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, UCD, 47 Eccles Street, Dublin 7, Dublin, Ireland.
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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Zhang XQ, Zhang CF, Zhou XJ, Shuai LY, Peng D, Ji GY. Evaluation of anastomotic blood supply during digestive tract reconstruction with the use of the oxygen saturation index: A pooling up analysis. Int J Colorectal Dis 2025; 40:71. [PMID: 40102303 PMCID: PMC11920329 DOI: 10.1007/s00384-025-04864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2024] [Indexed: 03/20/2025]
Abstract
PURPOSE Anastomotic leakage (AL) is one of the most serious clinical complications in digestive tract reconstruction (DTR) surgery, and it is currently hypothesized that this may be related to insufficient anastomotic blood supply. Thus, Therefore, we aimed to assess the ability of tissue oxygen saturation(StO2) as a measure to evaluate anastomotic blood supply. METHODS A comprehensive literature search was performed using Embase, PubMed and Cochrane Library. StO2 was used as an evaluation index of anastomotic blood supply after DTR to analyze the potential association between this index and the occurrence of AL in the postoperative period. RESULTS A total of eleven articles involving 867 participants were included in this systematic review and meta-analysis. After pooling the standardized mean difference (SMD) and 95% confidence intervals (Cls), low StO2 was found to be an independent risk factor for AL (P < 0.00001; 95%CI: 1.02 [0.53-1.51]). The mean StO2 in the AL group (62.3%) was significantly lower than that in the non-AL group (74.3%); AL incidence increased with the reduction of StO2 to a certain value to 201.8% and 338.1% respectively. CONCLUSION Oxygen saturation index can be utilized in DTR to accurately and quantitatively evaluate the anastomotic blood supply to reduce the probability of postoperative AL.
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Affiliation(s)
- Xiao-Qiang Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Chao-Fu Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Xiang-Jun Zhou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Lei-Yuan Shuai
- Department of Anorectal Surgery, Jiangjin Central Hospital of Chongqing, Chongqing, 404000, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Guang-Yan Ji
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China.
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Khalid MU, Ali D, Wu JY, Lee H, Khan A. Impact and Measurement of Mechanical Tension in Bowel Anastomosis: A Scoping Review of the Current Literature. J Surg Res 2025; 308:161-173. [PMID: 40090052 DOI: 10.1016/j.jss.2025.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Revised: 01/13/2025] [Accepted: 02/10/2025] [Indexed: 03/18/2025]
Abstract
INTRODUCTION Creating a "tension-free anastomosis" is a fundamental principle in safe bowel surgery. This review aims to summarize the current literature regarding the measurement and impact of tension on bowel anastomoses. METHODS This scoping review was conducted using a systematic literature search in the PubMed, SCOPUS, and EMBASE databases. Data were synthesized in tables and summarized paragraphically, with studies assessed using the Newcastle-Ottawa scale. RESULTS Out of the 350 studies identified in the initial literature review, 25 were included in this study. Several studies indicated that anastomotic leak and tension are strongly associated, with the presence of tension making leaks up to 10 times more likely. However, no objective and clinically available methods exist to measure tension on bowel anastomosis in humans. Freedom from tension has traditionally been measured via surrogate measures of adequate bowel mobilization and subjective assessment by operating surgeons. Animal and cadaveric studies have been the frontier for objective measurement of wall tension. These studies use tensiometers to measure tension and automated machines or pulley and ratcheting systems to increase tension at specified intervals. However, these methods are universally destructive due to their design of measuring maximal tensile load and are not readily adaptable to the operating room. CONCLUSIONS The current literature does not address the objective measurement of bowel tension in live human subjects. Given the importance of tension, developing an objective, safe, intraoperative method to measure bowel wall tension would be a valuable surgical tool.
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Affiliation(s)
- Muhammad Usman Khalid
- Department of Neurological Surgery, Kentucky Neuroscience Institute, University of Kentucky, Lexington, Kentucky
| | - Danish Ali
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jie Ying Wu
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Hanjoo Lee
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Aimal Khan
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
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Rinne JKA, Huhta H, Pinta T, Turunen A, Mattila A, Tahkola K, Helminen O, Ohtonen P, Rautio T, Kössi J. Indocyanine Green Fluorescence Imaging in Prevention of Colorectal Anastomotic Leakage: A Randomized Clinical Trial. JAMA Surg 2025:2830866. [PMID: 40042831 PMCID: PMC11883591 DOI: 10.1001/jamasurg.2025.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Accepted: 12/26/2024] [Indexed: 03/09/2025]
Abstract
Importance Performing a bowel anastomosis is a critical step in colorectal resection. Assessing the risk of anastomotic leakage remains challenging, even for experienced surgeons. Objective To evaluate the use of indocyanine green (ICG) fluorescence imaging in assessing perfusion at the anastomotic site before and after anastomosis and determine whether it helps reduce anastomotic leakages. Design, Setting, and Participants ICG-COLORAL is a prospective, randomized, multicenter study conducted from September 1, 2018, to December 31, 2023. Participants were recruited during preoperative outpatient clinic visits by clinicians not involved in the study, as well as by researchers. Participants were elective patients scheduled for laparoscopic resections, excluding low anterior resections, with planned primary anastomosis in 5 Finnish public hospitals experienced in laparoscopic colorectal surgery. Intervention The intervention group received 5 mg of ICG intravenously before and after anastomosis formation. The fluorescence signal was assessed with a near-infrared-capable camera. The control group did not receive ICG fluorescence imaging. Main Outcome and Measure The primary outcome measure was the anastomotic leak rate as detected by computed tomography. Results Among 1136 patients in the intention-to-treat population, 526 (46.3%) were female and 610 (53.7%) male; they had a mean (SD) age of 70 (11) years, body mass index of 28 (5), and age-adjusted Charlson Comorbidity Index of 5 (3). Overall, the anastomotic leak rate was 5.8% (33/567) in the ICG fluorescence imaging group vs 7.9% (45/569) in the control group (odds ratio [OR], 0.73; 95% CI, 0.48-1.13; P = .16). For right-sided operations, the anastomotic leak rate with ICG fluorescence imaging was 5.9% (16/273) vs 6.7% (20/298) in the control group (OR, 0.87; 95% CI, 0.46-1.65). For left-sided operations, the anastomotic leak rate was 5.2% (14/267) with ICG fluorescence imaging vs 9.5% (23/243) without (OR, 0.55; 95% CI, 0.29-1.05). No patients reported adverse events related to ICG. Conclusions and Relevance This study found that routine use of ICG fluorescence imaging does not significantly reduce the overall anastomotic leak rate in laparoscopic colorectal surgery if low anterior resections are excluded but may be beneficial in left-sided operations. Trial Registration ClinicalTrials.gov Identifier: NCT03602677.
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Affiliation(s)
- Juha K. A. Rinne
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
- University of Tampere, Tampere, Finland
| | - Heikki Huhta
- Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tarja Pinta
- Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Arto Turunen
- Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Hämeenlinna, Finland
| | - Anne Mattila
- Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Kyösti Tahkola
- Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Olli Helminen
- Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pasi Ohtonen
- Research Service Unit, Oulu University Hospital, Oulu, Finland
- Translational Medicine Research Unit, University of Oulu, Oulu, Finland
| | - Tero Rautio
- Department of Surgery, Oulu University Hospital, Oulu, Finland
- Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Jyrki Kössi
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
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De Simone B, Abu-Zidan FM, Boni L, Castillo AMG, Cassinotti E, Corradi F, Di Maggio F, Ashraf H, Baiocchi GL, Tarasconi A, Bonafede M, Truong H, De'Angelis N, Diana M, Coimbra R, Balogh ZJ, Chouillard E, Coccolini F, Kelly MD, Di Saverio S, Di Meo G, Isik A, Leppäniemi A, Litvin A, Moore EE, Pasculli A, Sartelli M, Podda M, Testini M, Wani I, Sakakushev B, Shelat VG, Weber D, Galante JM, Ansaloni L, Agnoletti V, Regimbeau JM, Garulli G, Kirkpatrick AL, Biffl WL, Catena F. Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper. World J Emerg Surg 2025; 20:13. [PMID: 39948641 PMCID: PMC11823064 DOI: 10.1186/s13017-025-00575-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 01/04/2025] [Indexed: 02/16/2025] Open
Abstract
BACKGROUND Decision-making in emergency settings is inherently complex, requiring surgeons to rapidly evaluate various clinical, diagnostic, and environmental factors. The primary objective is to assess a patient's risk for adverse outcomes while balancing diagnoses, management strategies, and available resources. Recently, indocyanine green (ICG) fluorescence imaging has emerged as a valuable tool to enhance surgical vision, demonstrating proven benefits in elective surgeries. AIM This consensus paper provides evidence-based and expert opinion-based recommendations for the standardized use of ICG fluorescence imaging in emergency settings. METHODS Using the PICO framework, the consensus coordinator identified key research areas, topics, and questions regarding the implementation of ICG fluorescence-guided surgery in emergencies. A systematic literature review was conducted, and evidence was evaluated using the GRADE criteria. A panel of expert surgeons reviewed and refined statements and recommendations through a Delphi consensus process, culminating in final approval. RESULTS ICG fluorescence imaging, including angiography and cholangiography, improves intraoperative decision-making in emergency surgeries, potentially reducing procedure duration, complications, and hospital stays. Optimal use requires careful consideration of dosage and timing due to limited tissue penetration (5-10 mm) and variable performance in patients with significant inflammation, scarring, or obesity. ICG is contraindicated in patients with known allergies to iodine or iodine-based contrast agents. Successful implementation depends on appropriate training, availability of equipment, and careful patient selection. CONCLUSIONS Advanced technologies and intraoperative navigation techniques, such as ICG fluorescence-guided surgery, should be prioritized in emergency surgery to improve outcomes. This technology exemplifies precision surgery by enhancing minimally invasive approaches and providing superior real-time evaluation of bowel viability and biliary structures-areas traditionally reliant on the surgeon's visual assessment. Its adoption in emergency settings requires proper training, equipment availability, and standardized protocols. Further research is needed to evaluate cost-effectiveness and expand its applications in urgent surgical procedures.
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Affiliation(s)
- Belinda De Simone
- Department of Emergency and General Minimally Invasive Surgery, Infermi Hospital, AUSL Romagna, Rimini, Italy.
- Department of Theoretical and Applied Sciences, eCampus University, Novedrate, CO, Italy.
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, UAE
| | - Luigi Boni
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Ana Maria Gonzalez Castillo
- Emergency Surgery Unit, Department of General Surgery, Pompeu Fabra University, Hospital del Mar, Barcelona, Spain
| | - Elisa Cassinotti
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Francesco Corradi
- Department of Surgical, Medical andMolecularPathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Di Maggio
- Upper Gastro-Intestinal Surgery Unit, Department of General Surgery, Croydon University Hospital, London, UK
| | - Hajra Ashraf
- Upper Gastro-Intestinal Surgery Unit, Department of General Surgery, Croydon University Hospital, London, UK
| | - Gian Luca Baiocchi
- Unit of General Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | - Hung Truong
- Acute Care and Minimally Invasive Surgery, Scripps Memorial Hospital - La Jolla, Green, and Encinitas, La Jolla, USA
| | - Nicola De'Angelis
- Unit of Robotic and Minimally Invasive Digestive Surgery, Ferrara University Hospital, Ferrara, Italy
| | - Michele Diana
- Department of Surgery, University Hospital of Geneva, 1205, Geneva, Switzerland
- ICube Laboratory, Photonics Instrumentation for Health, 67034, Strasbourg, France
| | - Raul Coimbra
- Riverside University Health System Medical Center, Riverside, CA, USA
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Elie Chouillard
- General Surgery Department, American Hospital of Paris, Paris, France
| | | | | | - Salomone Di Saverio
- General Surgery Unit, Madonna del Soccorso Hospital, AST Ascoli Piceno, San Benedetto del Tronto, Italy
| | - Giovanna Di Meo
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Arda Isik
- Istanbul Medeniyet University, Istanbul, Turkey
| | - Ari Leppäniemi
- Division of Emergency Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, University Clinic, Gomel, Belarus
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Alessandro Pasculli
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Mauro Podda
- Department of Surgical Science, Unit of Emergency Surgery, University of Cagliari, Cagliari, Italy
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Imtiaz Wani
- Department of Surgery, Government Gousia Hospital, DHS, Srinagar, India
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital & The University of Western Australia, Perth, Australia
| | - Joseph M Galante
- UC Davis Health, Hospital Clinical Care Services, University of California, Davis, USA
| | - Luca Ansaloni
- Department of General Surgery, University of Pavia, Pavia, Italy
| | - Vanni Agnoletti
- Level 1 Trauma Center, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Jean-Marc Regimbeau
- Service de Chirurgie Digestive du CHU d'Amiens, CHU Sud, Centre Hospitalier Universitaire Amiens-Picardie Site Sud, 80054, Amiens, France
| | - Gianluca Garulli
- Department of Emergency and General Minimally Invasive Surgery, Infermi Hospital, AUSL Romagna, Rimini, Italy
| | - Andrew L Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Walter L Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, AUSL Romagna, Cesena, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Tange FP, Peul RC, van den Hoven P, Koning S, Kruiswijk MW, Faber RA, Verduijn PS, van Rijswijk CSP, Galema HA, Hilling DE, van Dijk SPJ, van Ginhoven TM, Keereweer S, Mureau MAM, Feitsma EA, Noltes ME, Kruijff S, Driessen C, Achiam MP, Schepers A, van Schaik J, Mieog JSD, Vahrmeijer AL, Hamming JF, van der Vorst JR. Establishing reference curves for vital tissue perfusion using quantitative near-infrared fluorescence imaging with indocyanine green. Langenbecks Arch Surg 2025; 410:28. [PMID: 39777554 PMCID: PMC11706885 DOI: 10.1007/s00423-024-03589-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Accepted: 12/19/2024] [Indexed: 01/11/2025]
Abstract
PURPOSE Assessment of tissue perfusion using near-infrared fluorescence (NIR) with indocyanine green (ICG) is gaining popularity, however reliable and objective interpretation remains a challenge. Therefore, this study aimed to establish reference curves for vital tissue perfusion across target tissues using this imaging modality. METHODS Data from five prospective study cohorts conducted in three Dutch academic medical centres between December 2018 and June 2023 was included. Quantitative analysis using time-intensity curves was performed in ten target tissues, including the colon, ileum, gastric conduit, deep inferior epigastric artery perforator (DIEP) flap, skin of the foot, trachea, sternocleidomastoid muscle (SCM), carotid artery, parathyroid gland, and skin of the neck. RESULTS A total of 178 patients were included in this study, representing 303 target tissues. Three different patterns of reference curves were identified based on a subjective assessment. Seven out of ten tissues showed a reference curve with rapid inflow (median time-to-max (tmax): 13.0-17.8 s, median maximum-normalized-slope (slope norm): 10.6-12.6%/sec), short outflow (median area-under-the-curve of tmax + 60 s (AUC60): 65.0-85.1%) followed by a gradual/absent outflow. Secondly, the DIEP flap and SCM tissue showed a reference curve with longer inflow (median tmax: 24.0, 22.0 s, median slope norm: 9.3, 9.7%/sec respectively) and reduced outflow (median AUC60: 89.1, 89.0% respectively). Thirdly, the skin of the foot showed slow inflow (median tmax 141.1 s, median norm slope 2.1%/sec) without outflow. CONCLUSION This study demonstrates reference curves for vital tissue perfusion of multiple target tissues identified with ICG NIR fluorescence imaging, providing a critical step towards the clinical implementation of this technique.
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Affiliation(s)
- Floris P Tange
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Roderick C Peul
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Pim van den Hoven
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Stefan Koning
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Mo W Kruiswijk
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Robin A Faber
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Pieter S Verduijn
- Department of Plastic and Reconstructive Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Carla S P van Rijswijk
- Department of Interventional Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hidde A Galema
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Denise E Hilling
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Sam P J van Dijk
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Tessa M van Ginhoven
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Stijn Keereweer
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eline A Feitsma
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Milou E Noltes
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Caroline Driessen
- Department of Plastic and Reconstructive Surgery, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Michael P Achiam
- Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, The Capital Region of Denmark, Copenhagen, Denmark
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Jan van Schaik
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Alexander L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Jaap F Hamming
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Joost R van der Vorst
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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7
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Ben-David M, Makwana R, Yered T, Sanger GJ, Knowles CH, Wasserberg N, Shor E. Local Myoelectric Sensing During Human Colonic Tissue Perfusion. Diagnostics (Basel) 2024; 14:2870. [PMID: 39767231 PMCID: PMC11675604 DOI: 10.3390/diagnostics14242870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 12/07/2024] [Accepted: 12/17/2024] [Indexed: 01/11/2025] Open
Abstract
Objectives: Anastomotic leakage (AL) is one of the most devastating complications after colorectal surgery. The verification of the adequate perfusion of the anastomosis is essential to ensuring anastomosis integrity following colonic resections. This study aimed to evaluate the efficacy of measuring the electrical activity of the colonic muscularis externa at an anastomosis site for perfusion analysis following colorectal surgery. Methods: Strips of human isolated colon were maintained in a horizontal tissue bath to record spontaneous contractions and myoelectric activity and spike potentials (using a bipolar electrode array for the wireless transmission of myoelectric data-the xBar system) from the circular muscle. Intraoperative myoelectric signal assessment was performed by placing the electrode array on the colon prior to and following mesenteric artery ligation, just prior to colonic resection. Results: In human isolated colon, the amplitude, duration, and frequency of contractions were inhibited during hypoxia by >80% for each measurement, compared to control values and time-matched oxygenated muscle. Intraoperative (N = 5; mean age, 64.8 years; range, 54-74 years; 60% females) myoelectric signal assessment revealed a decline in spike rate following arterial ligation, with a mean reduction of 112.64 to 51.13 spikes/min (p < 0.0008). No adverse events were observed during the study, and the device did not substantially alter the surgical procedure. Conclusions: The electrical and contraction force of the human colon was reduced by ischemia, both in vitro and in vivo. These preliminary findings also suggest the potential of the xBar system to measure such changes during intraoperative and possibly postoperative periods to predict the risk of anastomotic viability as a surrogate of evolving dehiscence.
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Affiliation(s)
- Matan Ben-David
- Townsville Hospital and Health Service, Douglas, QLD 4814, Australia
- Exero Medical Ltd., Or Yehuda 6037606, Israel (E.S.)
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4814, Australia
| | - Raj Makwana
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (R.M.); (C.H.K.)
| | - Tal Yered
- Exero Medical Ltd., Or Yehuda 6037606, Israel (E.S.)
| | - Gareth J. Sanger
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (R.M.); (C.H.K.)
| | - Charles H. Knowles
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (R.M.); (C.H.K.)
| | - Nir Wasserberg
- Rabin Medical Center, Faculty of Health and Medical Sciences, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Erez Shor
- Exero Medical Ltd., Or Yehuda 6037606, Israel (E.S.)
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8
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Salman L, Hogen L, Maganti M, May T. Anastomotic diversion rates following integration of indocyanine green fluorescence angiography in cytoreductive surgery for ovarian cancer. Int J Gynecol Cancer 2024; 34:1775-1779. [PMID: 39237157 DOI: 10.1136/ijgc-2024-005753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVE To compare rates of diverting ileostomy in patients with ovarian cancer, undergoing cytoreduction with bowel resection before and after the acquisition of indocyanine green fluorescence angiographic scans for anastomotic perfusion assessment. METHODS A retrospective cohort study of patients with ovarian cancer undergoing bowel resection during cytoreductive surgery between 2010 and 2021. We evaluated whether using indocyanine green fluorescence angiography impacted rates of diverting ileostomy. Baseline characteristics and rates of diversion were compared between those who had indocyanine green fluorescence assessment and those with bowel resection without anastomotic fluorescence assessment. RESULTS Overall, 181 patients were included. Of whom, 84 (46%) underwent anastomotic fluorescence assessment following bowel resection, and 97 (54%) had bowel resection without assessment. Mean age of the cohort was 58.2 years and 132 (73%) had stage III disease. There was no difference between groups in rates of diverting ileostomy (41% vs 41%, p=1.0). In a univariable logistic regression, the odds of having an ileostomy were 2.92 times higher in patients undergoing primary surgery than in patients undergoing interval cytoreductive surgery (95% CI 1.25 to 6.85, p=0.013). The use of fluorescence angiography did not predict performing diverting ileostomy (OR=0.97, 95% CI (0.53 to 1.76), p=0.92). CONCLUSION In this cohort, the simple introduction of indocyanine green fluorescence angiography had no impact on the rates of anastomotic diversion. Developing a systematic, reproducible diversion protocol with selection criteria that include fluorescence angiography is needed to assess the impact of this surgically innovative tool on the rates of anastomotic diversion in patients with advanced ovarian cancer.
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Affiliation(s)
- Lina Salman
- Department of Obstetrics and Gynecology, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Liat Hogen
- Department of Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Manjula Maganti
- Department of Biostatistics, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Taymaa May
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Gynecologic Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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9
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Faber RA, Meijer RPJ, Droogh DHM, Jongbloed JJ, Bijlstra OD, Boersma F, Braak JPBM, Meershoek-Klein Kranenbarg E, Putter H, Holman FA, Mieog JSD, Neijenhuis PA, van Staveren E, Bloemen JG, Burger JWA, Aukema TS, Brouwers MAM, Marinelli AWKS, Westerterp M, Doornebosch PG, van der Weijde A, Bosscha K, Handgraaf HJM, Consten ECJ, Sikkenk DJ, Burggraaf J, Keereweer S, van der Vorst JR, Hutteman M, Peeters KCMJ, Vahrmeijer AL, Hilling DE. Indocyanine green near-infrared fluorescence bowel perfusion assessment to prevent anastomotic leakage in minimally invasive colorectal surgery (AVOID): a multicentre, randomised, controlled, phase 3 trial. Lancet Gastroenterol Hepatol 2024; 9:924-934. [PMID: 39151436 DOI: 10.1016/s2468-1253(24)00198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Anastomotic leakage is a severe postoperative complication in colorectal surgery and compromised bowel perfusion is considered a major contributing factor. Conventional methods to assess bowel perfusion have a low predictive value for anastomotic leakage. We therefore aimed to evaluate the efficacy of real-time assessment with near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) in the prevention of anastomotic leakage. METHODS This multicentre, randomised, controlled, phase 3 trial was done in eight hospitals in the Netherlands. We included adults (aged >18 years) who were scheduled for laparoscopic or robotic colorectal surgery (with planned primary anastomosis) for benign and malignant diseases. Preoperatively, patients were randomly assigned (1:1) to fluorescence-guided bowel anastomosis (FGBA) or conventional bowel anastomosis (CBA) by variable block randomisation (block sizes 4, 6, and 8) and stratified by site. The operating surgeon and investigators analysing the data were not masked to group assignment. Patients were unmasked after the surgical procedure or after study end. In the FGBA group, surgeons marked anastomosis levels per conventional perfusion assessment and then administered 5 mg of ICG by 2 mL intravenous bolus. They assessed bowel perfusion using NIR fluorescence imaging and adjusted (or kept) transection lines accordingly. Only conventional methods for bowel perfusion assessment were used in the CBA group. The primary outcome was the difference in the rate of clinically relevant anastomotic leakage (ie, requiring active therapeutic intervention but manageable without reoperation [grade B] or requiring reoperation [grade C], per the International Study Group of Rectal Cancer) between the FGBA group and the CBA group within 90 days post-surgery. The primary outcome and safety were assessed in the intention-to-treat population. This study was registered with ToetsingOnline.nl (NL7502) and ClinicalTrials.gov (NCT04712032) and is complete. FINDINGS Between July 2, 2020, and Feb 21, 2023, 982 patients were enrolled, of whom 490 were assigned to FGBA and 492 were assigned to CBA. After excluding 51 patients, the intention-to-treat population comprised 931 (463 assigned FGBA and 468 assigned CBA). Patients had a median age of 68·0 years (IQR 59·0-75·0) and 485 (52%) were male and 446 (48%) were female. Ethnicity data were not available. The overall 90-day rate of clinically relevant anastomotic leakage was not significantly different between the FGBA group (32 [7%] of 463 patients) and the CBA group (42 [9%] of 468 patients; relative risk 0·77 [95% CI 0·50-1·20]; p=0·24). No adverse events related to ICG use were observed. 313 serious adverse events in 229 (25%) patients were at 90-day follow-up (159 serious adverse events in 113 [24%] patients in the FGBA group and 154 serious adverse events in 116 [25%] patients in the CBA group). 18 (2%) people died by 90 days (ten in the FGBA group and eight in the CBA group). INTERPRETATION ICG NIR fluorescence imaging did not reduce 90-day anastomotic leakage rates in this trial across all types of colorectal surgeries. Further research should be done in subgroups, such as rectosigmoid resections, for which evidence suggests ICG NIR might be beneficial. FUNDING Olympus Medical, Diagnostic Green, and Intuitive Foundation.
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Affiliation(s)
- Robin A Faber
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Ruben P J Meijer
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Daphne H M Droogh
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Jasmijn J Jongbloed
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Okker D Bijlstra
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Fran Boersma
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Jeffrey P B M Braak
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Hein Putter
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Fabian A Holman
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Johanne G Bloemen
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Jacobus W A Burger
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | | | | | | | - Marinke Westerterp
- Department of Surgery, Haaglanden Medical Center, Leidschendam, Netherlands
| | | | | | - Koop Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | | | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort, Netherlands; Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Daan J Sikkenk
- Department of Surgery, Meander Medical Center, Amersfoort, Netherlands
| | | | - Stijn Keereweer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Merlijn Hutteman
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Denise E Hilling
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands; Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
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Skinner GC, Marois M, Oberlin J, McCulloh CJ, Schwaitzberg SD, Kim PC. Dye-less quantification of tissue perfusion by laser speckle contrast imaging is equivalent to quantified indocyanine green in a porcine model. Surg Endosc 2024; 38:5957-5966. [PMID: 39075313 DOI: 10.1007/s00464-024-11061-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/06/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION Subjective surgeon interpretation of near-infrared perfusion video is limited by low inter-observer agreement and poor correlation to clinical outcomes. In contrast, quantification of indocyanine green fluorescence video (Q-ICG) correlates with histologic level of perfusion as well as clinical outcomes. Measuring dye volume over time, however, has limitations, such as it is not on-demand, has poor spatial resolution, and is not easily repeatable. Laser speckle contrast imaging quantification (Q-LSCI) is a real-time, dye-free alternative, but further validation is needed. We hypothesize that Q-LSCI will distinguish ischemic tissue and correlate over a range of perfusion levels equivalent to Q-ICG. METHODS Nine sections of intestine in three swine were devascularized. Pairs of indocyanine green fluorescence imaging and laser speckle contrast imaging video were quantified within perfused, watershed, and ischemic regions. Q-ICG used normalized peak inflow slope. Q-LSCI methods were laser speckle perfusion units (LSPU), the base unit of laser speckle imaging, relative perfusion units (RPU), a previously described methodology which utilizes an internal control, and zero-lag normalized cross-correlation (X-Corr), to investigate if the signal deviations convey accurate perfusion information. We determine the ability to distinguish ischemic regions and correlation to Q-ICG over a perfusion gradient. RESULTS All modalities distinguished ischemic from perfused regions of interest; Q-ICG values of 0.028 and 0.155 (p < 0.001); RPU values of 0.15 and 0.68 (p < 0.001); and X-corr values of 0.73 and 0.24 (p < 0.001). Over a range of perfusion levels, RPU had the best correlation with Q-ICG (r = 0.79, p < 0.001) compared with LSPU (r = 0.74, p < 0.001) and X-Corr (r = 0.46, p < 0.001). CONCLUSION These results demonstrate that Q-LSCI discriminates ischemic from perfused tissue and represents similar perfusion information over a broad range of perfusion levels comparable to clinically validated Q-ICG. This suggests that Q-LSCI might offer clinically predictive real-time dye-free quantification of tissue perfusion. Further work should include validation in histologic studies and human clinical trials.
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Affiliation(s)
- Garrett C Skinner
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Conventus, Buffalo, NY, USA
- Activ Surgical Inc., Boston, MA, USA
| | | | | | | | - Steven D Schwaitzberg
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Conventus, Buffalo, NY, USA
| | - Peter C Kim
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Conventus, Buffalo, NY, USA.
- Activ Surgical Inc., Boston, MA, USA.
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11
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Van TN, Trong HN, Thanh SL, Gia KN, Van HP, Van DN, To HN, Anh TN. Evaluation of the gastric conduit perfusion using indocyanine green in thoracoscopic esophagectomy for esophageal cancer. SAGE Open Med 2024; 12:20503121241269631. [PMID: 39263633 PMCID: PMC11388304 DOI: 10.1177/20503121241269631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/24/2024] [Indexed: 09/13/2024] Open
Abstract
Objective Indocyanine green has been used in the assessment of the gastric conduit perfusion in thoracoscopic esophagectomy to prevent malperfusion-associated anastomotic leak. This study aims to evaluate the initial results of investigating the gastric conduit perfusion with indocyanine green in the surgical treatment of esophageal cancer. Patients and methods This cross-sectional descriptive study was carried out on 54 esophageal cancer patients undergoing thoracoscopic esophagectomy and gastric conduit reconstruction. The blood flow in the gastric conduit was observed using an infrared camera and indocyanine green after completion of the conduit and after tunneling the conduit through the mediastinum to the neck. Results The gastric conduit width and length were 5.2 ± 0.3 cm, and 31.5 ± 1.6 cm, respectively. The length of the gastric conduit from the junction between the right and left gastroepiploic to the point where the distal end of the gastric conduit still has a vascular pulse was 11.9 ± 4.3 cm. Seventeen patients (31.5%) had poor blood supply at the distal end of the gastric conduit, with indocyanine green appearance time ⩾ 60 s, in whom anastomotic leaks occurred in five patients (9.3%). The lack of connection between the right and left gastroepiploic vessels was associated with poor blood supply of the distal gastric conduit (p = 0.04). Multivariable logistic regression analysis showed association between the time of indocyanine green appearance at the distal gastric conduit and the risk of anastomotic leak (OR = 1.99, 95% CI = 1.10-3.60, p = 0.02). Conclusion Investigation of gastric conduit perfusion using indocyanine green in gastric conduit reconstruction detected 31.5% of patients with poor blood supply at the distal end of the conduit, in whom 9.3% had anastomotic leak. The longer indocyanine green appearance time in the distal gastric conduit (segment BC), was associated with the higher rate of the anastomotic leak.
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Affiliation(s)
- Tiep Nguyen Van
- Gastrointestinal Surgery Department, Digestive Surgery Center, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Hoe Nguyen Trong
- Gastrointestinal Surgery Department, Digestive Surgery Center, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Son Le Thanh
- Gastrointestinal Surgery Department, Digestive Surgery Center, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Khanh Ngo Gia
- Gastrointestinal Surgery Department, Digestive Surgery Center, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Hiep Pham Van
- Department of Gastrointestinal Tract Surgery, Central Military 108 Hospital, Hanoi, Vietnam
| | - Du Nguyen Van
- Department of Gastrointestinal Tract Surgery, Central Military 108 Hospital, Hanoi, Vietnam
| | - Hoai Nguyen To
- Department of Gastrointestinal Tract Surgery, Central Military 108 Hospital, Hanoi, Vietnam
| | - Tuan Nguyen Anh
- Department of Gastrointestinal Tract Surgery, Central Military 108 Hospital, Hanoi, Vietnam
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Tong C, Jamous N, Schmitz ND, Szwarcensztein K, Morton DG, Pinkney TD, El-Hussuna A, Battersby N, Bhangu A, Blackwell S, Buchs N, Chaudhri S, Dardanov D, Dulskas A, El-Hussuna A, Frasson M, Gallo G, Glasbey J, Keatley J, Kelly M, Knowles C, Li YE, McCourt V, Minaya-Bravo A, Neary P, Negoi I, Nepogodiev D, Pata F, Pellino G, Poskus T, Sanchez-Guillen L, Singh B, Sivrikoz E, van Ramshorst G, Zmora O, Pinkney TD, Perry R, Magill EL, Keatley J, Tong C, Ahmed SE, Abdalkoddus M, Abelevich A, Abraham S, Abraham-Nordling M, Achkasov SI, Adamina M, Agalar C, Agalar F, Agarwal T, Agcaoglu O, Agresta F, Ahmad G, Ainkov A, Aiupov R, Aledo VS, Aleksic A, Aleotti F, Alias D, Allison AS, Alonso A, Alonso S, Alós R, Altinel Y, Alvarez-Gallego M, Amorim E, Anania G, Andreev PS, Andrejevic P, Andriola V, Antonacci N, Antos F, Anwer M, Aonzo P, Arenal JJ, Arencibia B, Argeny S, Arnold SJ, Arolfo S, Artioukh DY, Ashraf MA, Aslam MI, Asteria CR, Atif M, Avital S, Bacchion M, Bach SM, Balestri R, Balfour A, Balik E, Baloyiannis I, Banipal GS, Baral JEM, Barišić B, Bartella I, Barugola G, Bass GA, Bedford MR, Bedzhanyan A, Belli A, Beltrán de Heredia J, Bemelman WA, Benčurik V, Benevento A, Bergkvist DJ, Bernal-Sprekelsen JC, Besznyák I, Bettencourt V, Beveridge AJ, Bhan C, Bilali S, Bilali V, Binboga E, Bintintan V, Birindelli A, Birsan T, Blanco-Antona F, Blom RLGM, Boerma EG, Bogdan M, Boland MZ, Bondeven P, Bondurri A, Broadhurst J, Brown SA, Buccianti P, Buchs NC, Buchwald P, Bugra D, Bursics A, Burton HLE, Buskens CJ, Bustamante Recuenco C, Cagigas-Fernandez C, Calero-Lillo A, Calu V, Camps I, Canda AE, Canning L, Cantafio S, Carpelan A, Carrillo Lopez MJ, Carvas JM, Carvello M, Castellvi J, Castillo J, Castillo-Diego J, Cavenaile V, Cayetano Paniagua L, Ceccotti AA, Cervera-Aldama J, Chabok A, Chandrasinghe PC, Chandratreya N, Chaudhri SS, Chaudhry ZU, Chirletti P, Chi-Yong Ngu J, Chouliaras C, Chowdhary M, Chowdri NA, Christiano AB, Christiansen P, Citores MA, Ciubotaru C, Ciuce C, Clemente N, Clerc D, Codina-Cazador A, Colak E, Colao García L, Coletta D, Colombo F, Connelly TM, Cornaglia S, Corte Real J, Costa Pereira J, Costa S, Cotte E, Courtney ED, Coveney AP, Crapa P, Cristian DA, Cuadrado M, Cuinas K, Cuk MV, Cuk VV, Cunha MF, Curinga R, Curtis N, Dainius E, d'Alessandro A, Dalton RSJ, Daniels IR, Dardanov D, Dauser B, Davydova O, De Andrés-Asenjo B, de Graaf EJR, De la Portilla F, de Lacy FB, De Laspra ECD, Defoort B, Dehli T, Del Prete L, Delrio P, Demirbas S, Demirkiran A, Den Boer FC, Di Saverio S, Diego A, Dieguez B, Diez-Alonso M, Dimitrijevic I, Dimitrios B, Dimitriou N, Dindelegan G, Dindyal S, Domingos H, Doornebosch PG, Dorot S, Draga M, Drami I, Dulskas A, Dzulkarnaen Zakaria A, Echazarreta-Gallego E, Edden Y, Egenvall M, Eismontas V, El Nakeeb A, El Sorogy M, Elfike H, Elgeidie A, El-Hussuna A, Elía Guedea M, Ellul S, El-Masry S, Elmore U, Emile SH, Enciu O, Enriquez-Navascues JM, Epstein JC, Escolà Ripoll D, Espina B, Espin-Basany E, Estévez Diz AM, Evans MD, Farina PA, Fatayer, Feliu F, Feo C, Feo CV, Fernando J, Feroci F, Ferreira L, Feryn T, Flor-Lorente B, Forero-Torres A, Francis N, Frasson M, Freund MR, Fróis Borges M, Frontali A, Gallardo AB, Galleano R, Gallo G, Garcia D, García Flórez LJ, García Marín JA, García Septiem J, Garcia-Cabrera AM, García-González JM, Garcia-Granero E, Garipov M, Gefen R, Gennadiy P, Gerkis S, Germain A, Germanos S, Gianotti L, Gil Santos M, Gingert C, Glehen O, Golda T, Gómez Ruiz M, Gonçalves D, González JS, Grainger J, Grama F, Grant C, Griniatsos J, Grolich T, Grosek J, Guevara-Martínez J, Gulcu B, Gupta SK, Gurjar SV, Haapaniemi S, Hamad Y, Hamid M, Hardt J, Harries RL, Harris GJC, Harsanyi L, Hayes J, Hendriks ER, Herbst F, Hermann N, Heuberger A, Hompes R, Hrora A, Hübner M, Huhtinen H, Hunt L, Hyöty M, Ibañez N, Ignjatovic D, Ilkanich A, Inama M, Infantino MS, Iqbal MR, Isik A, Isik O, Ismaiel M, Ivanovich SO, Jadhav V, Jajtner D, Jiménez Carneros V, Jimenez-Rodriguez RM, Jotautas V, Jukka K, Juloski J, Jung B, Kara Y, Karabacak U, Karachun A, Karagul S, Kassai M, Katorkin Sergei E, Katsaounis D, Katsoulis IE, Kelly ME, Kenjić B, Keogh-Bootland S, Khasan D, Khazov A, Kho SH, Khrykov GN, Kivelä AJ, Kjaer MD, Knight JS, Kocián P, Koëter T, Konsten JLM, Korček J, Korkolis D, Korsgen S, Kostić IS, Krarup PM, Krastev P, Krdzic I, Kreisler Moreno E, Krivokapic Z, Krones CJ, Kršul D, Kumar Kaul N, La Torre F, Lahodzich N, Lai CW, Laina JLB, Lakkis Z, Lamas S, Lange CP, Lauretta A, Lee KA, Lefèvre J, Lehtonen T, Leo CA, Leong KJ, Lepistö A, Licari L, Lizdenis P, Loftås P, Longhi M, Lopez-Dominguez J, López-Fernández J, Lovén H, Lozoya Trujillo R, Lunin R, Luzzi AP, Lydrup ML, Lykke J, Maderuelo-Garcia VM, Madsboell T, Madsen AH, Maffioli A, Majbar MA, Makhmudov A, Makhmudov D, Malik KI, Malik SS, Mamedli ZZ, Manatakis DK, Mankotia R, Maria J, Mariani NM, Marimuthu K, Marinello F, Marino F, Marom G, Maroni N, Maroulis I, Marsanic P, Marsman HA, Martí-Gallostra M, Martin ST, Martinez Alegre J, Martinez Manzano A, Martins R, Maslyankov S, McArdle K, McArthur DR, McFaul C, McWhirter D, Mege D, Mehraj A, Metwally MZ, Metwally IH, Millan M, Miller AS, Minaya-Bravo A, Mingoli A, Minguez Ruiz G, Minusa C, Mirshekar-Syahkal B, Mistrangelo M, Mogoanta SS, Mohamed I, Möller PH, Möller T, Molteni M, Mompart S, Monami B, Mondragon-Pritchard M, Moniz-Pereira P, Montesdeoca Cabrera D, Morais M, Moran BJ, Moretto G, Morino M, Moscovici A, Muench S, Mukhtar H, Muller P, Muñoz-Duyos A, Muratore A, Muriel P, Myrelid P, Nachtergaele M, Nadav H, Nastos K, Navarro-Sánchez A, Negoi I, Nesbakken A, Nestler G, Nicholls J, Nicol D, Nikberg M, Nobre JMS, Nonner J, Norčič G, Norderval S, Norwood MGA, Nygren J, O’Brien JW, O’Connell PR, O'Kelly J, Okkabaz N, Oliveira-Cunha M, Omar GEEI, Onody P, Opocher E, Orhalmi J, Orts-Micó FJ, Ozbalci GS, Ozgen U, Ozkan BB, Ozturk E, Pace K, Padín MH, Pandey SB, Pando JA, Papaconstantinou I, Papadopoulos A, Papadopoulos G, Papp G, Paraskakis S, Parc Y, Parra Baños P, Parray FQ, Parvuletu R, Pascariello A, Pascual Migueláñez I, Pata F, Patel H, Patel PK, Paterson HM, Patrón Uriburu JC, Pattacini GC, Pavlov V, Pcolkins A, Pellicer-Franco EM, Peña Ros E, Pérez HD, Petkov P, Picarella P, Pikarsky AJ, Pisani Ceretti A, Platt E, Pletinckx P, Podda M, Popov D, Poskus E, Poskus T, Prats MC, Pravosudov I, Primo-Romaguera V, Prochazka V, Pros Ribas I, Proud D, Psaila J, Pullig F, Qureshi Jinnah MS, Rachadell Montero J, Radovanovic D, Radovanovic Z, Rahman MM, Rainho R, Rama N, Ramos D, Ramsanahie A, Rantala A, Rasulov A, Rautio T, Raymond T, Raza A, Reddy A, Refky B, Regusci L, Reissman P, Rems M, Reyes-Diaz ML, Riccardo R, Richiteanu G, Richter F, Rios A, Ris F, Rodriguez FL, Rodriguez Garcia P, Rojo Lopez JA, Romaniszyn M, Romano GM, Romero AS, Romero-Simó M, Roshan Lal A, Rossi B, Ruano Poblador A, Rubbini M, Rubio-Perez I, Ruiz H, Rullier E, Ryska O, Sabia D, Sacchi M, Saffaf N, Sakr A, Saladzinskas Z, Sales I, Salomon M, Salvans S, Samalavicius NE, Sammarco G, Sampietro GM, Samsonov D, Sanchez-Garcia JL, Sánchez-Guillén L, Sanchiz E, Šantak G, Santos Torres J, Saraceno F, Sarici IS, Sarmah PB, Savino G, Scabini S, Schafmayer C, Schiltz B, Schofield A, Scurtu R, Segalini E, Segelman J, Segura Sampedro JJ, Seicean R, Sekulic A, Selwyn D, Serrano Paz P, Shabbir J, Shaikh IA, Shalaby M, Sharma A, Shukla A, Shussman N, Siddiqui ZA, Siironen P, Sileri P, Silva-Vaz P, Simoes JF, Sinan H, Singh B, Sivins A, Skroubis G, Skrovina M, Skull AJ, Slavchev M, Slavin M, Slesser AAP, Smart CJ, Smart NJ, Smedh K, Smolarek S, Sokolov M, Sotona O, Spacca D, Spinelli A, Stanojevic G, Stearns A, Stefan S, Stift A, Stijns J, Stoyanov V, Straarup D, Strouhal R, Stubbs BM, Suero Rodríguez C, Sungurtekin U, Svagzdys S, Svastics I, Syk I, Tabares MJM, Tamelis A, Tamhane RG, Tamini N, Tamosiunas A, Tan SA, Tanis PJ, Tate SJ, Tercioti Junior V, Terzi C, Testa V, Thaha MA, Tham JC, Thavanesan N, Theodore JE, Tinoco C, Todorovic M, Tomazic A, Tomulescu V, Tonini V, Toorenvliet BR, Torkington J, Torrance A, Toscano MJ, Tóth I, Trampus S, Travaglio E, Trostchanky I, Truan N, Tulchinsky H, Turrado-Rodriguez V, Tutino R, Tzivanakis A, Tzovaras GA, Unger LW, Vaccari S, Vaizey CJ, Valero-Navarro G, Valverde Nuñez I, Van Belle K, Van Belle K, van den Berg I, van Geloven AAW, Van Loon YT, van Steensel L, Varcada M, Vardanyan AV, Varpe P, Velchuru VR, Vencius J, Venskutonis D, Vermaas M, Vertruyen M, Vicente-Ruiz M, Vignali A, Vigorita V, Vila Tura M, Vimalachandran D, Vincenti L, Viso L, Visschers RGJ, Voronin YS, Walega P, Wan Zainira WZ, Wang JH, Wang X, Wani R, Warusavitarne J, Warwick A, Wasserberg N, Weiss DJ, Westerduin E, Wheat JR, White I, Williams G, Williams GL, Wilson TR, Wilson JM, Winter D, Wolthuis AM, Wong MPK, Worsøe J, Xynos E, Yahia S, Yamamoto T, Yanishev A, Zaidi Z, Zairul Azwan MA, Zaman S, Zaránd A, Zarco A, Zawadzki M, Zelic M, Žeromskas P, Zilvetti M, Zmora O. Anastomotic leak after manual circular stapled left-sided bowel surgery: analysis of technology-, disease-, and patient-related factors. BJS Open 2024; 8:zrae089. [PMID: 39441693 PMCID: PMC11498054 DOI: 10.1093/bjsopen/zrae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 06/09/2024] [Accepted: 07/09/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Anastomotic leak rates after colorectal surgery remain high. In most left-sided colon and rectal resection surgeries, a circular stapler is utilized to create the primary bowel anastomosis. However, it remains unclear whether a relationship between circular stapler technology and anastomotic leak in left-sided colorectal surgery exists. METHODS A post-hoc analysis was conducted using a prospectively collected data set of patients from the 2017 European Society of Coloproctology snapshot audit who underwent elective left-sided resection (left hemicolectomy, sigmoid colectomy, or rectal resection) with a manual circular stapled anastomosis. Rates of anastomotic leak and unplanned intensive care unit stay in association with manual circular stapling were assessed. Patient-, disease-, geographical-, and surgeon-related factors as well as stapler brand were explored using multivariable regression models to identify predictors of adverse outcomes. RESULTS Across 3305 procedures, 8.0% of patients had an anastomotic leak and 2.1% had an unplanned intensive care unit stay. Independent predictors of anastomotic leak were male sex, minimal-access surgery converted to open surgery, and anastomosis height C11 (lower third rectum) (all P < 0.050). Independent predictors of unplanned intensive care unit stay were minimal-access surgery converted to open surgery and American Society of Anesthesiologists grade IV (all P < 0.050). Stapler device brand was not a predictor of anastomotic leak or unplanned intensive care unit stay in multivariable regression analysis. There were no differences in rates of anastomotic leak and unplanned intensive care unit stay according to stapler head diameter, geographical region, or surgeon experience. CONCLUSION In patients undergoing left-sided bowel anastomosis, choice of manual circular stapler, in terms of manufacturer or head diameter, is not associated with rates of anastomotic leak and unplanned intensive care unit stay.
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Mahgoub S, Saad RM, Vashisht A, Mabrouk M. "The Green Peace" How ICG can prevent complications in endometriosis surgery? Best Pract Res Clin Obstet Gynaecol 2024; 96:102505. [PMID: 38964989 DOI: 10.1016/j.bpobgyn.2024.102505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/29/2024] [Accepted: 05/19/2024] [Indexed: 07/06/2024]
Abstract
This literature review summarises the investigation into using Indocyanine Green (ICG) in the surgical management of endometriosis, focusing mainly on its application in Deep Endometriosis (DE). The study reviews the development, fluorescence characteristics, and clinical usage of ICG in enhancing the precision of identifying endometrial lesions during surgery. Emphasizing the technology's contribution to improved lesion visualisation, the paper discusses how ICG facilitates increased diagnostic accuracy, potentially reducing recurrence rates and the necessity for subsequent interventions. Additionally, it explores ICG's role in minimizing the risk of iatrogenic injuries, especially in ureteral endometriosis, and its utility in surgical decision-making for rectosigmoid endometriosis by evaluating bowel perfusion. Conclusively, while acknowledging the clear benefits of ICG integration in endometriosis surgical procedures, the abstract calls for more extensive research to validate its efficacy and cost-efficiency in the broader context of endometriosis treatment.
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Affiliation(s)
- S Mahgoub
- Cambridge University Hospitals (CUH), Department of Gynaecology, United Kingdom.
| | - R M Saad
- University College London Hospitals Foundation Trust (UCLH), Department of Gynaecology, United Kingdom.
| | - A Vashisht
- University College London Hospitals Foundation Trust (UCLH) & Cleveland Clinic London (CCL), United Kingdom.
| | - M Mabrouk
- University College London Hospitals Foundation Trust (UCLH) & Cleveland Clinic London (CCL), United Kingdom.
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Christofi A, Traska T, Dimitroulis D. Near-infrared indocyanine green angiography in recognizing bowel ischemia in emergency surgery: game changer or overrated? Innov Surg Sci 2024; 9:113-121. [PMID: 39309192 PMCID: PMC11415940 DOI: 10.1515/iss-2024-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/21/2024] [Indexed: 09/25/2024] Open
Abstract
Assessing bowel perfusion in emergency intestinal surgery can prove challenging even for experienced surgeons. The necessity of a technological tool assisting clinicians is undisputed. Near-infrared indocyanine green (NIR-ICG) angiography has been increasingly used in elective colorectal surgery to evaluate intestinal perfusion with promising results. This review aims to answer whether a similar outcome can be observed in acute cases of bowel ischemia. We conducted online research of the literature using keywords such as "indocyanine green", "bowel", "emergency" and "ischemia", to identify articles concerning the use of ICG-angiography in evaluating bowel perfusion during emergency operations. PubMed was the primary database. 11 articles were included in this systematic review with a total of 358 patients. Most papers showed a positive effect after using NIR-ICG-angiography, whereas one study indicated the limitations of the method by exhibiting increased reoperation and mortality rates. Moreover, a significant variation in indocyanine green (ICG) dose and fluorescence identification systems was observed. NIR-ICG-angiography has the potential to become a fundamental tool in emergency intestinal operations. Nevertheless, additional research, especially high-quality, randomized studies, as well as quantification techniques are still needed to support these preliminary observations.
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Affiliation(s)
- Anastasia Christofi
- Department of General, Visceral and Vascular Surgery, Agaplesion Bethesda Hospital Wuppertal, Wuppertal, Germany
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Thilo Traska
- Department of General, Visceral and Vascular Surgery, Agaplesion Bethesda Hospital Wuppertal, Wuppertal, Germany
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Second Department of Propedeutic Surgery, Laiko Hospital, Athens, Greece
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Catarci M, Guadagni S, Masedu F, Guercioni G, Ruffo G, Viola MG, Borghi F, Scatizzi M, Patriti A, Baiocchi GL. Intraoperative left-sided colorectal anastomotic testing in clinical practice: a multi-treatment machine-learning analysis of the iCral3 prospective cohort. Updates Surg 2024; 76:1715-1727. [PMID: 38767835 DOI: 10.1007/s13304-024-01883-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Current evidence about intraoperative anastomotic testing after left-sided colorectal resections is still controversial. The aim of this study was to analyze the impact of Indocyanine Green fluorescent angiography (ICG-FA) and air-leak test (ALT) over standard assessment on anastomotic leakage (AL) rates according to surgeon's perception of anastomosis perfusion and/or integrity in clinical practice. METHODS A database of 2061 patients who underwent left-sided colorectal resections was selected from patients enrolled in a prospective multicenter study. It was retrospectively analyzed through a multi-treatment machine-learning model considering standard visual assessment (NW; No. = 899; 43.6%) as the reference treatment arm, compared to ICG-FA alone (WP; No. = 409; 19.8%), ALT alone (WI; No. = 420; 20.4%) or both (WPI; No. = 333; 16.2%). Twenty-four covariates potentially affecting the outcomes were included and balanced into the model within the subgroups. The primary endpoint was AL, the secondary endpoints were overall morbidity (OM), major morbidity (MM), reoperation for AL, and mortality. All the results were reported as odds ratio (OR) with 95% confidence intervals (95%CI). RESULTS The WPI subgroup showed significantly higher AL risk (OR 1.91; 95% CI 1.02-3.59; p 0.043), MM risk (OR 2.35; 95% CI 1.39-3.97; p 0.001), and reoperation for AL risk (OR 2.44; 95% CI 1.12-5.31; p 0.025). No other significant differences were recorded. CONCLUSIONS This study showed that the surgeons' perception of both anastomotic perfusion and integrity (WPI subgroup) was associated to a significantly higher risk of AL and related morbidity, notwithstanding the extensive use of both ICG-FA and ALT testing.
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Affiliation(s)
- Marco Catarci
- General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Via dei Monti Tiburtini, 385, 00157, Rome, Italy.
| | - Stefano Guadagni
- General Surgery Unit, University of L'Aquila, L'Aquila, Italy
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | | | - Giacomo Ruffo
- General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | | | - Felice Borghi
- Oncologic Surgery Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - Marco Scatizzi
- General Surgery Unit, Santa Maria Annunziata & Serristori Hospital, Florence, Italy
| | - Alberto Patriti
- Department of Surgery, S. Salvatore Hospital, AST Marche 1, Pesaro e Fano, PU, Italy
| | - Gian Luca Baiocchi
- General Surgical Unit, Department of Clinical and Experimental Sciences, University of Brescia at the ASST Cremona, Cremona, Italy
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16
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Liu Z, Ali M, Sun Q, Zhang Q, Wei C, Wang Y, Tang D, Li X. Current status and future trends of real-time imaging in gastric cancer surgery: A literature review. Heliyon 2024; 10:e36143. [PMID: 39253259 PMCID: PMC11381608 DOI: 10.1016/j.heliyon.2024.e36143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 07/23/2024] [Accepted: 08/09/2024] [Indexed: 09/11/2024] Open
Abstract
Technological advances are crucial for the optimization of gastric cancer surgery, and the success of any gastric cancer surgery is based on the correct and precise anatomical determination of the primary tumour and tissue structures. Real-time imaging-guided surgery is showing increasing potential and utility, mainly because it helps to aid intraoperative decision-making. However, intraoperative imaging faces many challenges in the field of gastric cancer. This article summarizes and discusses the following clinical applications of real-time optical imaging and fluorescence-guided surgery for gastric cancer: (1) the potential of quantitative fluorescence imaging in assessing tissue perfusion, (2) vascular navigation and determination of tumour margins, (3) the advantages and limitations of lymph node drainage assessment, and (4) identification of peritoneal metastases. In addition, preclinical study of tumour-targeted fluorescence imaging are discussed.
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Affiliation(s)
- Zhu Liu
- The Yangzhou Clinical Medical College of Nanjing Medical University, Yangzhou, 225001, China
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, China
| | - Muhammad Ali
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, China
| | - Qiannan Sun
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, China
| | - Qi Zhang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, China
| | - Chen Wei
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, China
| | - Yong Wang
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, China
| | - Dong Tang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, China
| | - Xin Li
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
- Department of Pharmacy, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
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Sozzi A, Bona D, Yeow M, Habeeb TAAM, Bonitta G, Manara M, Sangiorgio G, Biondi A, Bonavina L, Aiolfi A. Does Indocyanine Green Utilization during Esophagectomy Prevent Anastomotic Leaks? Systematic Review and Meta-Analysis. J Clin Med 2024; 13:4899. [PMID: 39201041 PMCID: PMC11355508 DOI: 10.3390/jcm13164899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/06/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Indocyanine Green (ICG) is a promising technique for the assessment of gastric conduit and anastomosis perfusion during esophagectomy. ICG integration may be helpful in minimizing the risk of anastomotic leak (AL). Literature evidence is sparse, while the real effect of ICG assessment on AL minimization remains unsolved. The aim of this systematic review and meta-analysis was to compare short-term outcomes between ICG-guided and non-ICG-guided (nICG) esophagogastric anastomosis during esophagectomy for cancer. Materials and Methods: PubMed, MEDLINE, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were queried up to 25 April 2024. Studies that reported short-term outcomes for ICG versus non-ICG-guided (nICG) anastomosis in patients undergoing esophagectomy were considered. Primary outcome was AL. Risk ratio (RR) and standardized mean difference (SMD) were utilized as effect size measures, whereas to assess relative inference we used 95% confidence intervals (95% CI). Results: Overall, 1399 patients (11 observational studies) were included. Overall, 576 (41.2%) underwent ICG gastric conduit assessment. The patients' ages ranged from 22 to 91 years, with 73% being male. The cumulative incidence of AL was 10.4% for ICG and 15.4% for nICG. Compared to nICG, ICG utilization was related to a reduced risk for postoperative AL (RR 0.48; 95% CI 0.23-0.99; p = 0.05). No differences were found in terms of pulmonary complications (RR 0.83), operative time (SMD -0.47), hospital length of stay (SMD -0.16), or 90-day mortality (RR 1.70). Conclusions: Our study seems to indicate a potential impact of ICG in reducing post-esophagectomy AL. However, because of limitations in the design of the included studies, allocation/reporting bias, variable definitions of AL, and heterogeneity in ICG use, caution is required to avoid potential overestimation of the ICG effect.
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Affiliation(s)
- Andrea Sozzi
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Department of Biomedical Science for Health, Division of General Surgery, University of Milan, 20122 Milano, Italy; (A.S.); (D.B.); (G.B.); (M.M.)
| | - Davide Bona
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Department of Biomedical Science for Health, Division of General Surgery, University of Milan, 20122 Milano, Italy; (A.S.); (D.B.); (G.B.); (M.M.)
| | - Marcus Yeow
- Department of Surgery, National University Hospital, National University Health System, 1E, Kent Ridge Road, NUHS Tower Block, Level 8, Singapore 119228, Singapore;
| | - Tamer A. A. M. Habeeb
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig 7120001, Egypt;
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Department of Biomedical Science for Health, Division of General Surgery, University of Milan, 20122 Milano, Italy; (A.S.); (D.B.); (G.B.); (M.M.)
| | - Michele Manara
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Department of Biomedical Science for Health, Division of General Surgery, University of Milan, 20122 Milano, Italy; (A.S.); (D.B.); (G.B.); (M.M.)
| | - Giuseppe Sangiorgio
- Department of General Surgery and Medical Surgical Specialties, Surgical Division, G. Rodolico Hospital, University of Catania, 95131 Catania, Italy; (G.S.); (A.B.)
| | - Antonio Biondi
- Department of General Surgery and Medical Surgical Specialties, Surgical Division, G. Rodolico Hospital, University of Catania, 95131 Catania, Italy; (G.S.); (A.B.)
| | - Luigi Bonavina
- I.R.C.C.S. Policlinico San Donato, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, University of Milan, 20097 Milan, Italy;
| | - Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Department of Biomedical Science for Health, Division of General Surgery, University of Milan, 20122 Milano, Italy; (A.S.); (D.B.); (G.B.); (M.M.)
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18
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Jessernig A, Anthis AH, Vonna E, Rosendorf J, Liska V, Widmer J, Schlegel AA, Herrmann IK. Early Detection and Monitoring of Anastomotic Leaks via Naked Eye-Readable, Non-Electronic Macromolecular Network Sensors. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2400673. [PMID: 38775058 PMCID: PMC11304232 DOI: 10.1002/advs.202400673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/22/2024] [Indexed: 08/09/2024]
Abstract
Anastomotic leakage (AL) is the leaking of non-sterile gastrointestinal contents into a patient's abdominal cavity. AL is one of the most dreaded complications following gastrointestinal surgery, with mortality rates reaching up to 27%. The current diagnostic methods for anastomotic leaks are limited in sensitivity and specificity. Since the timing of detection directly impacts patient outcomes, developing new, fast, and simple methods for early leak detection is crucial. Here, a naked eye-readable, electronic-free macromolecular network drain fluid sensor is introduced for continuous monitoring and early detection of AL at the patient's bedside. The sensor array comprises three different macromolecular network sensing elements, each tailored for selectivity toward the three major digestive enzymes found in the drainage fluid during a developing AL. Upon digestion of the macromolecular network structure by the respective digestive enzymes, the sensor produces an optical shift discernible to the naked eye. The diagnostic efficacy and clinical applicability of these sensors are demonstrated using clinical samples from 32 patients, yielding a Receiver Operating Characteristic Area Under the Curve (ROC AUC) of 1.0. This work has the potential to significantly contribute to improved patient outcomes through continuous monitoring and early, low-cost, and reliable AL detection.
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Affiliation(s)
- Alexander Jessernig
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zurich8092Switzerland
- Particles‐Biology Interactions LaboratoryDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Alexandre H.C. Anthis
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zurich8092Switzerland
- Particles‐Biology Interactions LaboratoryDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Emilie Vonna
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zurich8092Switzerland
| | - Jachym Rosendorf
- Department of SurgeryFaculty of Medicine in PilsenCharles UniversityAlej Svobody 923/80Pilsen32300Czech Republic
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
| | - Vaclav Liska
- Department of SurgeryFaculty of Medicine in PilsenCharles UniversityAlej Svobody 923/80Pilsen32300Czech Republic
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
| | - Jeannette Widmer
- Department of Surgery and TransplantationSwiss HPB CentreUniversity Hospital ZurichZürich8091Switzerland
| | - Andrea A. Schlegel
- Transplantation CenterDigestive Disease and Surgery Institute and Department of Immunity and InflammationLerner Research InstituteCleveland Clinic9620 Carnegie AveClevelandOH44106USA
| | - Inge K. Herrmann
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zurich8092Switzerland
- Particles‐Biology Interactions LaboratoryDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
- The Ingenuity LabUniversity Hospital BalgristBalgrist CampusForchstrasse 340Zurich8008Switzerland
- Faculty of MedicineUniversity of ZurichRämistrasse 74Zürich8006Switzerland
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19
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Taha-Mehlitz S, Wentzler L, Angehrn F, Hendie A, Ochs V, Wolleb J, Staartjes VE, Enodien B, Baltuonis M, Vorburger S, Frey DM, Rosenberg R, von Flüe M, Müller-Stich B, Cattin PC, Taha A, Steinemann D. Machine learning-based preoperative analytics for the prediction of anastomotic leakage in colorectal surgery: a swiss pilot study. Surg Endosc 2024; 38:3672-3683. [PMID: 38777894 PMCID: PMC11219450 DOI: 10.1007/s00464-024-10926-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Anastomotic leakage (AL), a severe complication following colorectal surgery, arises from defects at the anastomosis site. This study evaluates the feasibility of predicting AL using machine learning (ML) algorithms based on preoperative data. METHODS We retrospectively analyzed data including 21 predictors from patients undergoing colorectal surgery with bowel anastomosis at four Swiss hospitals. Several ML algorithms were applied for binary classification into AL or non-AL groups, utilizing a five-fold cross-validation strategy with a 90% training and 10% validation split. Additionally, a holdout test set from an external hospital was employed to assess the models' robustness in external validation. RESULTS Among 1244 patients, 112 (9.0%) suffered from AL. The Random Forest model showed an AUC-ROC of 0.78 (SD: ± 0.01) on the internal test set, which significantly decreased to 0.60 (SD: ± 0.05) on the external holdout test set comprising 198 patients, including 7 (3.5%) with AL. Conversely, the Logistic Regression model demonstrated more consistent AUC-ROC values of 0.69 (SD: ± 0.01) on the internal set and 0.61 (SD: ± 0.05) on the external set. Accuracy measures for Random Forest were 0.82 (SD: ± 0.04) internally and 0.87 (SD: ± 0.08) externally, while Logistic Regression achieved accuracies of 0.81 (SD: ± 0.10) and 0.88 (SD: ± 0.15). F1 Scores for Random Forest moved from 0.58 (SD: ± 0.03) internally to 0.51 (SD: ± 0.03) externally, with Logistic Regression maintaining more stable scores of 0.53 (SD: ± 0.04) and 0.51 (SD: ± 0.02). CONCLUSION In this pilot study, we evaluated ML-based prediction models for AL post-colorectal surgery and identified ten patient-related risk factors associated with AL. Highlighting the need for multicenter data, external validation, and larger sample sizes, our findings emphasize the potential of ML in enhancing surgical outcomes and inform future development of a web-based application for broader clinical use.
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Affiliation(s)
- Stephanie Taha-Mehlitz
- Clarunis, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Larissa Wentzler
- Medical Faculty, University Basel, 4056, Basel, Switzerland
- Center for Gastrointestinal and Liver Diseases, Cantonal Hospital Basel-Landschaft, 4410, Liestal, Switzerland
| | - Fiorenzo Angehrn
- Clarunis, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Ahmad Hendie
- Department of Computer Engineering, McGill University, Montreal, H3A 0E9, Canada
| | - Vincent Ochs
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Hegenheimermattweg 167C Allschwil, 4123, Basel, Switzerland
| | - Julia Wolleb
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Hegenheimermattweg 167C Allschwil, 4123, Basel, Switzerland
| | - Victor E Staartjes
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Bassey Enodien
- Department of Surgery, GZO-Hospital, 8620, Wetzikon, Switzerland
| | - Martinas Baltuonis
- Department of Surgery, Emmental Teaching Hospital, 3400, Burgdorf, Switzerland
| | - Stephan Vorburger
- Department of Surgery, Emmental Teaching Hospital, 3400, Burgdorf, Switzerland
| | - Daniel M Frey
- Department of Surgery, GZO-Hospital, 8620, Wetzikon, Switzerland
| | - Robert Rosenberg
- Center for Gastrointestinal and Liver Diseases, Cantonal Hospital Basel-Landschaft, 4410, Liestal, Switzerland
| | | | - Beat Müller-Stich
- Clarunis, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Hegenheimermattweg 167C Allschwil, 4123, Basel, Switzerland
| | - Anas Taha
- Center for Gastrointestinal and Liver Diseases, Cantonal Hospital Basel-Landschaft, 4410, Liestal, Switzerland.
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, Hegenheimermattweg 167C Allschwil, 4123, Basel, Switzerland.
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
| | - Daniel Steinemann
- Clarunis, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
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20
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Heuvelings DJI, Scheepers MHMC, Al-Difaie Z, Okamoto N, Diana M, Stassen LPS, Bouvy ND, Al-Taher M. Quantitative analysis of intestinal perfusion with indocyanine green (ICG) and methylene blue (MB) using a single clinically approved fluorescence imaging system: a demonstration in a porcine model. Surg Endosc 2024; 38:3556-3563. [PMID: 38727831 PMCID: PMC11219451 DOI: 10.1007/s00464-024-10864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/14/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Near-infrared fluorescence (NIRF) angiography with intraoperative administration of indocyanine green (ICG) has rapidly disseminated in clinical practice. Another clinically approved, and widely available dye, methylene blue (MB), has up to now not been used for this purpose. Recently, we demonstrated promising results for the real-time evaluation of intestinal perfusion using this dye. The primary aim of this study was to perform a quantitative analysis of bowel perfusion assessment for both ICG and MB. METHODS Four mature female Landrace pigs underwent laparotomy under general anesthesia. An ischemic bowel loop with five regions of interest (ROIs) with varying levels of perfusion was created in each animal. An intravenous (IV) injection of 0.25 mg/kg-0.50 mg/kg MB was administered after 10 min, followed by NIRF imaging in MB mode and measurement of local lactate levels in all corresponding ROIs. This procedure was repeated in ICG mode (IV dose of 0.2 mg/kg) after 60 min. The quest spectrum fluorescence camera (Quest Medical Imaging, Middenmeer, The Netherlands) was used for NIRF imaging of both MB and ICG. RESULTS Intraoperative NIRF imaging of bowel perfusion assessment with MB and ICG was successful in all studied animals. Ingress (i/s) levels were calculated and correlated with local lactate levels. Both MB and ICG ingress values showed a significant negative correlation (r = - 0.7709; p = < 0.001; r = - 0.5367, p = 0.015, respectively) with local lactate levels. This correlation was stronger for MB compared to ICG, although ICG analysis showed higher absolute ingress values. CONCLUSION Our fluorescence quantification analysis validates the potential to use MB for bowel perfusion assessment besides the well-known and widely used ICG. Further human studies are necessary to translate our findings to clinical applications.
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Affiliation(s)
- Danique J I Heuvelings
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Max H M C Scheepers
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Zaid Al-Difaie
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nariaki Okamoto
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Mahdi Al-Taher
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
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21
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Amati AL, Ebert R, Maier L, Panah AK, Schwandner T, Sander M, Reichert M, Grau V, Petzoldt S, Hecker A. Reduced preoperative serum choline esterase levels and fecal peritoneal contamination as potential predictors for the leakage of intestinal sutures after source control in secondary peritonitis. World J Emerg Surg 2024; 19:21. [PMID: 38840189 PMCID: PMC11151556 DOI: 10.1186/s13017-024-00550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The high rate of stoma placement during emergency laparotomy for secondary peritonitis is a paradigm in need of change in the current fast-track surgical setting. Despite growing evidence for the feasibility of primary bowel reconstruction in a peritonitic environment, little data substantiate a surgeons' choice between a stoma and an anastomosis. The aim of this retrospective analysis is to identify pre- and intraoperative parameters that predict the leakage risk for enteric sutures placed during source control surgery (SCS) for secondary peritonitis. METHODS Between January 2014 and December 2020, 497 patients underwent SCS for secondary peritonitis, of whom 187 received a primary reconstruction of the lower gastro-intestinal tract without a diverting stoma. In 47 (25.1%) patients postoperative leakage of the enteric sutures was directly confirmed during revision surgery or by computed tomography. Quantifiable predictors of intestinal suture outcome were detected by multivariate analysis. RESULTS Length of intensive care, in-hospital mortality and failure of release to the initial home environment were significantly higher in patients with enteric suture leakage following SCS compared to patients with intact anastomoses (p < 0.0001, p = 0.0026 and p =0.0009, respectively). Reduced serum choline esterase (sCHE) levels and a high extent of peritonitis were identified as independent risk factors for insufficiency of enteric sutures placed during emergency laparotomy. CONCLUSIONS A preoperative sCHE < 4.5 kU/L and generalized fecal peritonitis associate with a significantly higher incidence of enteric suture insufficiency after primary reconstruction of the lower gastro-intestinal tract in a peritonitic abdomen. These parameters may guide surgeons when choosing the optimal surgical procedure in the emergency setting.
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Affiliation(s)
- A L Amati
- Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital of Giessen, Justus-Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany.
| | - R Ebert
- Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital of Giessen, Justus-Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - L Maier
- Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital of Giessen, Justus-Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - A K Panah
- Department of General, Visceral and Transplant Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - T Schwandner
- Department of General and Visceral Surgery, Asklepios Clinic Lich, Goethestrasse 4, 35423, Lich, Germany
| | - M Sander
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Justus-Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - M Reichert
- Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital of Giessen, Justus-Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - V Grau
- Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital of Giessen, Justus-Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - S Petzoldt
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Justus-Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - A Hecker
- Department of General, Visceral, Thoracic and Transplant Surgery, University Hospital of Giessen, Justus-Liebig University Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
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22
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Almutairi FM. Role of Biomarkers in the Diagnosis of Anastomotic Leakage After Colorectal Surgery: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e62432. [PMID: 39011204 PMCID: PMC11249052 DOI: 10.7759/cureus.62432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/11/2024] [Indexed: 07/17/2024] Open
Abstract
Due to its diverse presentation, anastomotic leakage (AL) following colorectal surgery is challenging to detect and frequently discovered when the patient becomes critically ill. When diagnosing AL in its early stages, biomarkers play a large role. This review was conducted to evaluate the diagnostic value of biomarkers in AL after colorectal surgeries. A literature search was undertaken electronically in major search engines such as Medline (PubMed), Google Scholar, ScienceDirect, EMBASE, and CENTRAL (Cochrane Library) databases. Observational studies of both retrospective and prospective nature were included. Origin Pro 2022 (Origin Labs) software was used to assess the prevalence of AL and generate the forest plot. A total of 13 articles fulfilled the eligibility criteria. A pooled prevalence of 9.19% was noted for AL in colorectal surgeries. In the present review, the observed sensitivity for C-reactive protein (CRP) was 80.5% and the specificity was 84% (postoperative day three). In contrast, these were 100% and 83.9% for procalcitonin on postoperative day five. CRP showed the highest diagnostic accuracy and excels at eliminating AL, but combining biomarkers can increase the diagnostic precision of early detection of AL.
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Affiliation(s)
- Farooq M Almutairi
- Clinical Laboratories Sciences, College of Applied Medical Sciences, University of Hafr Al-Batin, Hafr Al-Batin, SAU
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23
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Pattou M, Fuks D, Guilbaud T, Le Floch B, Lelièvre O, Tribillon E, Jeddou H, Marchese U, Birnbaum DJ, Soubrane O, Sulpice L, Tzedakis S. Predictive value of C-reactive protein for postoperative liver-specific surgical site infections. Surgery 2024; 175:1337-1345. [PMID: 38413303 DOI: 10.1016/j.surg.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/07/2024] [Accepted: 01/21/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND C-reactive protein is a useful biological tool to predict infectious complications, but its predictive value in detecting organ-specific surgical site infection after liver resection has never been studied. We aimed to evaluate the predictive value of c-reactive protein and determine the cut-off values to detect postoperative liver resection-surgical site infection. METHODS A multicentric analysis of consecutive patients with liver resection between 2018 and 2021 was performed. The predictive value of postoperative day 1, postoperative day 3, and postoperative day 5 C-reactive protein levels was evaluated using the area under the receiver operating characteristic curve. Cut-off values were determined using the Youden index in a 500-fold bootstrap resampling of 500 patients treated at 3 centers, who comprised the development cohort and were tested in an external independent validation cohort of 166 patients at a fourth center. RESULTS Among the 500 patients who underwent liver resection of the development cohort, liver resection-surgical site infection occurred in 66 patients (13.2%), and the median time to diagnosis was 6.0 days (interquartile range, 4.0-9.0) days. Median C-reactive protein levels were significantly higher on postoperative day 1, postoperative day 3, and postoperative day 5 in the liver resection-surgical site infection group compared with the non-surgical site infection group (50.5 vs 34.5 ng/mL, 148.0 vs 72.5 ng/mL, and 128.4 vs 35.2 ng/mL, respectively; P < .001). Postoperative day 3 and postoperative day 5 C-reactive protein-level area under the curve values were 0.76 (95% confidence interval, 0.64-0.88, P < .001) and 0.82 (95% confidence interval, 0.72-0.92, P < .001), respectively. Postoperative day 3 and postoperative day 5 optimal cut-off values of 100 mg/L and 87.0 mg/L could be used to rule out liver resection-surgical site infection, with a negative predictive value of 87.0% (interquartile range, 70.2-93.8) and 76.0% (interquartile range, 65.0-88.0), respectively, in the validation cohort. CONCLUSION Postoperative day 3 and postoperative day 5 C-reactive protein levels may be valuable predictive tools for liver resection-surgical site infection and aid in hospital discharge decision-making in the absence of other liver-related complications.
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Affiliation(s)
- Maxime Pattou
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France; Université Paris Cité, Faculté de Médecine, France
| | - David Fuks
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France; Université Paris Cité, Faculté de Médecine, France
| | - Theophile Guilbaud
- Department of Digestive and Visceral Surgery, North Hospital, Assistance Publique-Hopitaux de Marseille, France
| | - Bastien Le Floch
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Pontchaillou Hospital, CHU Rennes, France
| | - Oceane Lelièvre
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France; Université Paris Cité, Faculté de Médecine, France
| | - Ecoline Tribillon
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Heithem Jeddou
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Pontchaillou Hospital, CHU Rennes, France
| | - Ugo Marchese
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France; Université Paris Cité, Faculté de Médecine, France
| | - David Jeremie Birnbaum
- Department of Digestive and Visceral Surgery, North Hospital, Assistance Publique-Hopitaux de Marseille, France
| | - Olivier Soubrane
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Laurent Sulpice
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Pontchaillou Hospital, CHU Rennes, France
| | - Stylianos Tzedakis
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France; Université Paris Cité, Faculté de Médecine, France.
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Tueme-de la Peña D, Salgado-Gamboa EA, Ortiz de Elguea-Lizárraga JI, Zambrano Lara M, Rangel-Ríos HA, Chapa-Lobo AF, Salgado-Cruz LE. Indocyanine green fluorescence angiography in colorectal surgery: A retrospective case-control analysis in Mexico. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:186-193. [PMID: 36890063 DOI: 10.1016/j.rgmxen.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/09/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION AND AIMS An anastomotic leak is one of the most dreaded complications in colorectal surgery because it increases postoperative morbidity and mortality. The aim of the present study was to identify whether indocyanine green fluorescence angiography (ICGFA) reduced the anastomotic dehiscence rate in colorectal surgery. MATERIAL AND METHODS A retrospective study on patients that underwent colorectal surgery with colonic resection or low anterior resection and primary anastomosis, within the time frame of January 2019 and September 2021, was conducted. The patients were divided into the case group, in which ICGFA was performed for the intraoperative evaluation of blood perfusion at the anastomosis site, and the control group, in which ICGFA was not utilized. RESULTS A total of 168 medical records were reviewed, resulting in 83 cases and 85 controls. Inadequate perfusion that required changing the surgical site of the anastomosis was identified in 4.8% of the case group (n = 4). A trend toward reducing the leak rate with ICGFA was identified (6% [n = 5] in the cases vs 7.1% in the controls [n = 6] [p = 0.999]). The patients that underwent anastomosis site change due to inadequate perfusion had a 0% leak rate. CONCLUSIONS ICGFA as a method to evaluate intraoperative blood perfusion showed a trend toward reducing the incidence of anastomotic leak in colorectal surgery.
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Affiliation(s)
- D Tueme-de la Peña
- Hospital Christus Muguerza Alta Especialidad - UDEM, Monterrey, Nuevo León, Mexico
| | - E A Salgado-Gamboa
- Coloncare, Hospital Ángeles Valle Oriente, San Pedro Garza García, Nuevo León, Mexico
| | | | - M Zambrano Lara
- Escuela de Medicina y Ciencias de la Salud del Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico
| | - H A Rangel-Ríos
- Coloncare, Hospital Ángeles Valle Oriente, San Pedro Garza García, Nuevo León, Mexico
| | - A F Chapa-Lobo
- Coloncare, Hospital Ángeles Valle Oriente, San Pedro Garza García, Nuevo León, Mexico
| | - L E Salgado-Cruz
- Hospital Christus Muguerza Alta Especialidad - UDEM, Monterrey, Nuevo León, Mexico; Coloncare, Hospital Ángeles Valle Oriente, San Pedro Garza García, Nuevo León, Mexico; Escuela de Medicina y Ciencias de la Salud del Tecnológico de Monterrey, Monterrey, Nuevo León, Mexico.
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25
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Ding R, He M, Cen H, Chen Z, Su Y. Clinical risk factors and Risk assessment model for Anastomotic leakage after Rectal cancer resection. Indian J Cancer 2024; 61:244-252. [PMID: 38155439 DOI: 10.4103/ijc.ijc_903_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 05/15/2021] [Indexed: 12/30/2023]
Abstract
BACKGROUND Anastomotic leakage (AL) is the most serious complication after rectal cancer surgery. Risk factors associated with AL have been documented in previous studies; however, the consensus is still lacking. In this retrospective study, we aimed to identify risk factors for AL after rectal cancer resection and to create an accurate and effective tool for predicting the risk of this complication. METHODS The study cohort comprised of 276 patients with rectal cancer who had undergone anterior resection between 2015 and 2020. Twenty-four selected variables were assessed by univariate and multivariate logistic regression analyses to identify independent risk factors of AL. A risk assessment model for predicting the risk of AL was established on the basis of the regression coefficients of each identified independent risk factor. RESULTS Anastomotic leakage occurred in 20 patients (7.2%, 20/276). Multivariate analysis identified the following variables as independent risk or protective factors of AL: perioperative ileus ( P < 0.001, odds ratio [OR] = 14.699), tumor size ≥5 cm ( P = 0.025, OR = 3.925), distance between tumor and anal verge <7.5 cm ( P = 0.045, OR = 3.512), obesity ( P = 0.032, OR = 7.256), and diverting stoma ( P = 0.008, OR = 0.143). A risk assessment model was constructed and patients were allocated to high-, medium-, and low-risk groups on the basis of risk model scores of 5-7, 2-4, and 0-1, respectively. The incidences of AL in these three groups were 61.5%, 11.9%, and 2.0%, respectively ( P < 0.001). CONCLUSIONS Our risk assessment model accurately and effectively identified patients at high risk of AL and could be useful in aiding decision-making aimed at minimizing adverse outcomes associated with leakage.
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Affiliation(s)
- Rui Ding
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
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26
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Liu Y, Ma X, Zhao L, Yang X. Shaping an ileostomy over the original abdominal midline incision using the full-thickness skin bridging flap. Asian J Surg 2024; 47:1895-1896. [PMID: 38182509 DOI: 10.1016/j.asjsur.2023.12.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/25/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Yijun Liu
- The First Clinical Medical College of Gansu University of Chinese Medicine, 730000, China
| | - Xiaolong Ma
- The First Clinical Medical College of Gansu University of Chinese Medicine, 730000, China
| | - Lixia Zhao
- The First Clinical Medical College of Gansu University of Chinese Medicine, 730000, China
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Fransvea P, Chiarello MM, Fico V, Cariati M, Brisinda G. Indocyanine green: The guide to safer and more effective surgery. World J Gastrointest Surg 2024; 16:641-649. [PMID: 38577071 PMCID: PMC10989327 DOI: 10.4240/wjgs.v16.i3.641] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/15/2024] [Accepted: 02/08/2024] [Indexed: 03/22/2024] Open
Abstract
In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal Surgery. The authors present an interesting review on the use of indocyanine green fluorescence in different aspects of abdominal surgery. They also highlight future perspectives of the use of indocyanine green in mini-invasive surgery. Indocyanine green, used for fluorescence imaging, has been approved by the Food and Drug Administration and is safe for use in humans. It can be administered intravenously or intra-arterially. Since its advent, there have been several advancements in the applications of indocyanine green, especially in the surgical field, such as intraoperative mapping and biopsy of sentinel lymph node, measurement of hepatic function prior to resection, in neurosurgical cases to detect vascular anomalies, in cardiovascular cases for patency and assessment of vascular abnormalities, in predicting healing following amputations, in helping visualization of hepatobiliary anatomy and blood vessels, in reconstructive surgery, to assess flap viability and for the evaluation of tissue perfusion following major trauma and burns. For these reasons, the intraoperative use of indocyanine green has become common in a variety of surgical specialties and transplant surgery. Colorectal surgery has just lately begun to adopt this technique, particularly for perfusion visualization to prevent anastomotic leakage. The regular use of indocyanine green coupled with fluorescence angiography has recently been proposed as a feasible tool to help improve patient outcomes. Using the best available data, it has been shown that routine use of indocyanine green in colorectal surgery reduces the rates of anastomotic leak. The use of indocyanine green is proven to be safe, feasible, and effective in both elective and emergency scenarios. However, additional robust evidence from larger-scale, high-quality studies is essential before incorporating indocyanine green guided surgery into standard practice.
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Affiliation(s)
- Pietro Fransvea
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | | | - Valeria Fico
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Maria Cariati
- Department of Surgery, Azienda Sanitaria Provinciale di Crotone, Crotone 88900, Italy
| | - Giuseppe Brisinda
- Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
- Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
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Simpson FH, Kulendran K, Yerkovich S, Beatty A, Flynn D, Mao D, Brooks T, Wood P, Chandrasegaram MD. Perioperative Blood Transfusions and Anastomotic Leak After Colorectal Surgery for Cancer in an Australian Hospital. J Gastrointest Cancer 2024; 55:219-226. [PMID: 37335436 PMCID: PMC11096243 DOI: 10.1007/s12029-023-00947-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Peri-operative blood transfusion has been identified as a risk factor for anastomotic leak in recent studies, but little is known about which patients are at risk for blood transfusion. This study aims to assess the relationship between blood transfusion and anastomotic leak and factors predisposing to leak in patients undergoing colorectal cancer surgery. METHODS This retrospective cohort study was conducted in a tertiary hospital in Brisbane, Australia, between 2010 and 2019. A total of 522 patients underwent resection of colorectal cancer with primary anastomosis with no covering stoma and the prevalence of anastomotic leak was compared between those who had had perioperative blood transfusion(s) and those who had not. RESULTS A total of 19 of 522 patients undergoing surgery for colorectal cancer had developed an anastomotic leak (3.64%). 11.3% of patients who had had a perioperative blood transfusion developed an anastomotic leak whereas 2.2% of patients who had not had a blood transfusion developed an anastomotic leak (p = 0.0002). Patients undergoing procedure on their right colon had proportionally more blood transfusions and this approached statistical significance (p = 0.06). Patients who received a greater quantity of units of blood transfusion prior to their diagnosis of anastomotic leak were more likely to develop an anastomotic leak (p = 0.001). CONCLUSION Perioperative blood transfusions are associated with a significantly increased risk of an anastomotic leak following bowel resection with primary anastomosis for colorectal cancer.
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Affiliation(s)
- Fraser Hugh Simpson
- Department of General Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia.
- Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Krish Kulendran
- Department of General Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Stephanie Yerkovich
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Andrew Beatty
- Department of General Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - David Flynn
- Department of General Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Derek Mao
- Department of General Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Taylor Brooks
- Department of General Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Phoebe Wood
- Department of General Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Manju D Chandrasegaram
- Department of General Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia
- Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Nusrath S, Kalluru P, Shukla S, Dharanikota A, Basude M, Jonnada P, Abualjadayel M, Alabbad S, Mir TA, Broering DC, Raju KVVN, Rao TS, Vashist YK. Current status of indocyanine green fluorescent angiography in assessing perfusion of gastric conduit and oesophago-gastric anastomosis. Int J Surg 2024; 110:1079-1089. [PMID: 37988405 PMCID: PMC10871664 DOI: 10.1097/js9.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
Anastomotic leak (AL) remains a significant complication after esophagectomy. Indocyanine green fluorescent angiography (ICG-FA) is a promising and safe technique for assessing gastric conduit (GC) perfusion intraoperatively. It provides detailed visualization of tissue perfusion and has demonstrated usefulness in oesophageal surgery. GC perfusion analysis by ICG-FA is crucial in constructing the conduit and selecting the anastomotic site and enables surgeons to make necessary adjustments during surgery to potentially reduce ALs. However, anastomotic integrity involves multiple factors, and ICG-FA must be combined with optimization of patient and procedural factors to decrease AL rates. This review summarizes ICG-FA's current applications in assessing esophago-gastric anastomosis perfusion, including qualitative and quantitative analysis and different imaging systems. It also explores how fluorescent imaging could decrease ALs and aid clinicians in utilizing ICG-FA to improve esophagectomy outcomes.
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Affiliation(s)
| | - Prasanthi Kalluru
- Clinical Research, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | | | | | | | | | - Muayyad Abualjadayel
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Saleh Alabbad
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | | | - Dieter C. Broering
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | | | | | - Yogesh Kumar Vashist
- Departrments of Surgical Oncology
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
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Kashchenko VA, Dzhemilova ZN, Zavrazhnov AA, Ratnikov VA, Bogatikov AA, Petrova VV, Guschina OB. [Prospects of qualitative and quantitative assessment of bowel perfusion by fluorescent angiography with indocyanine green in colorectal surgery. First experience]. Khirurgiia (Mosk) 2024:82-92. [PMID: 38634589 DOI: 10.17116/hirurgia202404182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To assess the possibilities of fluorescent detection system in qualitative and quantitative assessment of bowel perfusion in colorectal resections. MATERIAL AND METHODS From May to August 2023, a single-center pilot cross-sectional unblinded study with inclusion of 18 patients with colon cancer (of left-sided - 12, of right-sided - 6, mean age - 72.9 years, m/w - 61/39%) was conducted. All patients underwent laparoscopic colorectal resections with extracorporeal stage of bowel transection. The evaluation of the bowel's ICG perfusion was conducted to assist in decision making about the level of its resection. Qualitative (visual) assessment was carried out in all 18 patients, in one patient twice, quantitative assessment of perfusion was conducted in 8 patients (left-sided resections - 6, right-sided hemicolectomy - 2). The qualitative evaluation was performed in real time on the analysis of the color gradient. The time parameters and fluorescence intensity at different level proximally and distally from the resection line were quantitatively estimated: Tstart - time of occurrence of minimal fluorescence in the areas of interest after the ICG injection (sec); Tmax - time to achieve maximum fluorescence intensity after the ICG injection (sec); Tmax-start - time interval between Tstart and Tmax, Imax - level of maximum fluorescence intensity (I). RESULTS Visual qualitative analysis of fluorescence revealed unsatisfactory perfusion characteristics (black, dark-gray color) in the area planned by the surgeon to anastomose the bowel in 3 of 18 patients (16.6%). When analyzing the quantitative data of this group of patients, there was a 2-6-fold decrease in Imax level, and one patient had an increase in Tmax-start at the level of intended resection compared to the bowel's sections in the favorable zone. In all cases, the final bowel transection was conducted in the area of good perfusion. There was no clinical evidence of anastomotic dehiscence in the study group. CONCLUSION Intraoperative evaluation of bowel perfusion is an important component of safe anastomosis formation in colorectal surgery. The use of ICG-FA allows to conduct qualitative and quantitative assessment of tissue perfusion of the bowel in order to assist in making intraoperative decisions. Quantitative evaluation of fluorescence provides more objective information about perfusion parameters. Imax and Tmax-start are the most promising quantitative indicators of local bowel's perfusion. Nevertheless, the precise interpretation of the quantitative indicators of ICG perfusion needs to be clarified.
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Affiliation(s)
- V A Kashchenko
- North-Western District Scientific and Clinical Center named after L.G. Sokolov of the Federal Medical-Biological Agency, St. Petersburg, Russia
- Saint Petersburg State University, St. Petersburg, Russia
- High Technology Clinic «Beloostrov» (MMC), Leningrad Region, Russia
| | - Z N Dzhemilova
- National Medical Research Center for Endocrinology, Moscow, Russia
| | - A A Zavrazhnov
- High Technology Clinic «Beloostrov» (MMC), Leningrad Region, Russia
| | - V A Ratnikov
- North-Western District Scientific and Clinical Center named after L.G. Sokolov of the Federal Medical-Biological Agency, St. Petersburg, Russia
- Saint Petersburg State University, St. Petersburg, Russia
| | - A A Bogatikov
- North-Western District Scientific and Clinical Center named after L.G. Sokolov of the Federal Medical-Biological Agency, St. Petersburg, Russia
- Saint Petersburg State University, St. Petersburg, Russia
| | - V V Petrova
- Saint Petersburg State University, St. Petersburg, Russia
| | - O B Guschina
- North-Western District Scientific and Clinical Center named after L.G. Sokolov of the Federal Medical-Biological Agency, St. Petersburg, Russia
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Die X, Cui M, Feng W, Hou J, Chen P, Liu W, Wu F, Guo Z. Applications of indocyanine greenenhanced fluorescence in the laparoscopic treatment of colonic stricture after necrotizing enterocolitis. BMC Pediatr 2023; 23:635. [PMID: 38102599 PMCID: PMC10724931 DOI: 10.1186/s12887-023-04458-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The status of anastomotic blood perfusion is associated with the occurrence of anastomotic leakage after intestinal anastomosis. Fluorescence angiography (FA) with indocyanine green (ICG) can objectively assess intestinal blood perfusion. This study aims to investigate whether anastomotic perfusion assessment with ICG influences surgical decision-making during laparoscopic intestinal resection and primary anastomosis for colonic stricture after necrotizing enterocolitis. METHODS Patients who underwent laparoscopic intestinal resection and primary anastomosis between January 2022 and December 2022 were retrospectively analyzed. Before intestinal anastomosis, the ICG fluorescence technology was used to evaluate the blood perfusion of intestinal tubes on both sides of the anastomosis. After the completion of primary anastomosis, the anastomotic blood perfusion was assessed again. RESULTS Of the 13 cases, laparoscopy was used to determine the extent of the diseased bowel to be excised, and the normal bowel was preserved for anastomosis. The anastomosis was established under the guidance of ICG fluorescence technology, and FA was performed after anastomosis to confirm good blood flow in the proximal bowel. The anastomotic intestinal tube was changed in one case because FA showed a difference between the normal range of intestinal blood flow and the macroscopic prediction. There was no evidence of ICG allergy, anastomotic leakage, anastomotic stricture, or other complications. The median follow-up was 6 months, and all patients recovered well. CONCLUSIONS The ICG fluorescence technology is helpful in precisely and efficiently determining the anastomotic intestinal blood flow during stricture resection and in avoiding anastomotic leakage caused by poor anastomotic intestinal blood flow to some extent, with satisfactory short-term efficacy.
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Affiliation(s)
- Xiaohong Die
- Department of General & Neonatal Surgery, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Mengying Cui
- Department of General & Neonatal Surgery, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Feng
- Department of General & Neonatal Surgery, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jinfeng Hou
- Department of General & Neonatal Surgery, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Pengfei Chen
- Department of General & Neonatal Surgery, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Liu
- Department of General & Neonatal Surgery, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Fang Wu
- Department of General & Neonatal Surgery, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhenhua Guo
- Department of General & Neonatal Surgery, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.
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Heeman W, Calon J, van der Bilt A, Pierie JPEN, Pereboom I, van Dam GM, Boerma EC. Dye-free visualisation of intestinal perfusion using laser speckle contrast imaging in laparoscopic surgery: a prospective, observational multi-centre study. Surg Endosc 2023; 37:9139-9146. [PMID: 37814165 PMCID: PMC10709216 DOI: 10.1007/s00464-023-10493-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/23/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Intraoperative perfusion imaging may help the surgeon in creating the intestinal anastomoses in optimally perfused tissue. Laser speckle contrast imaging (LSCI) is such a perfusion visualisation technique that is characterized by dye-free, real-time and continuous imaging. Our aim is to validate the use of a novel, dye-free visualization tool to detect perfusion deficits using laparoscopic LSCI. METHODS In this multi-centre study, a total of 64 patients were imaged using the laparoscopic laser speckle contrast imager. Post-operatively, surgeons were questioned if the additional visual feedback would have led to a change in clinical decision-making. RESULTS This study suggests that the laparoscopic laser speckle contrast imager PerfusiX-Imaging is able to image colonic perfusion. All images were clear and easy to interpret for the surgeon. The device is non-disruptive of the surgical procedure with an average added surgical time of 2.5 min and no change in surgical equipment. The potential added clinical value is accentuated by the 17% of operating surgeons indicating a change in anastomosis location. Further assessment and analysis of both white light and PerfusiX perfusion images by non-involved, non-operating surgeons showed an overall agreement of 80%. CONCLUSION PerfusiX-Imaging is a suitable laparoscopic perfusion imaging system for colon surgery that can visualize perfusion in real-time with no change in surgical equipment. The additional visual feedback could help guide the surgeons in placing the anastomosis at the most optimal site.
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Affiliation(s)
- Wido Heeman
- Faculty Campus Fryslân, University of Groningen, Wirdumerdijk 34, 8911 CE, Leeuwarden, The Netherlands.
- Department of Surgery, University Medical Centre Groningen, 9713 GZ, Groningen, The Netherlands.
- LIMIS Development BV, 8934 AD, Leeuwarden, The Netherlands.
| | - Joost Calon
- ZiuZ Visual Intelligence BV, 8401 DK, Gorredijk, The Netherlands
| | - Arne van der Bilt
- Department of Surgery, University Medical Centre Groningen, 9713 GZ, Groningen, The Netherlands
| | - Jean-Pierre E N Pierie
- Medical Center Leeuwarden, Department of Surgery, 8934 AD, Leeuwarden, The Netherlands
- Post Graduate School of Medicine, University Medical Center Groningen, 9713 GZ, Groningen, The Netherlands
| | - Ilona Pereboom
- Department of Surgery, Nij Smellinghe Hospital, 9202 NN, Drachten, The Netherlands
| | - Gooitzen M van Dam
- Department of Surgery, University Medical Centre Groningen, 9713 GZ, Groningen, The Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Center Leeuwarden, 8934 AD, Leeuwarden, The Netherlands
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Rutegård M, Svensson J, Segelman J, Matthiessen P, Lydrup ML, Park J. Splenic flexure mobilization and anastomotic leakage in anterior resection for rectal cancer: A multicentre cohort study. Scand J Surg 2023; 112:246-255. [PMID: 37675547 DOI: 10.1177/14574969231181222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Some colorectal surgeons advocate routine splenic flexure mobilization (SFM) when performing anterior resection for rectal cancer to ensure a tension-free anastomosis. Meta-analyses of smaller studies suggest that this approach does not influence anastomotic leakage rates, but larger multicentre studies are needed to confirm the safety of a selective strategy. The aim of this study is to evaluate the impact of SFM on anastomotic leakage. METHODS This is a retrospective multicentre cohort study, comprising 1109 patients operated with anterior resection for rectal cancer in 2014-2018. Exposure was SFM, while anastomotic leakage within a year constituted the outcome. Stratified analyses were performed for type of mesorectal excision and surgical approach, as well as sensitivity analysis considering vascular tie placement. Multivariable Cox regression with hazard ratios (HRs) and 95% confidence intervals (CIs) was employed to adjust for confounding, while multiple imputation was used for missing data. RESULTS SFM was performed in 381 patients (34.4%). Anastomotic leakage occurred in 83 (21.8%) and 123 (20.3%) patients operated with and without SFM, respectively. SFM was neither clearly detrimental nor beneficial regarding anastomotic leakage (adjusted HR = 0.82; 95% CI: 0.59-1.15), with no apparent differences for total or partial mesorectal excision and minimally invasive or open surgery. Concurrent high vascular ligation did not impact these results, and there was no evidence of interaction from centers with a more common use of SFM. CONCLUSIONS SFM did not seem to influence the risk of anastomotic leakage after anterior resection for rectal cancer, regardless of type of mesorectal excision, use of minimally invasive surgery, or high vascular ligation.
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Affiliation(s)
- Martin Rutegård
- Department of Surgical and Perioperative Sciences, SurgeryUmeå UniversitySE-901 85 UmeåSwedenWallenberg Centre for Molecular MedicineUmeå UniversityUmeåSweden
| | - Johan Svensson
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Josefin Segelman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, SwedenDepartment of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Peter Matthiessen
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marie-Louise Lydrup
- Department of Surgery, Skåne University Hospital and Lund University, Lund, Sweden
| | - Jennifer Park
- Department of Surgery, Scandinavian Surgical Outcomes Research Group (SSORG), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Boatman S, Kaiser T, Nalluri-Butz H, Khan MH, Dietz M, Kohn J, Johnson AJ, Gaertner WB, Staley C, Jahansouz C. Diet-induced shifts in the gut microbiota influence anastomotic healing in a murine model of colonic surgery. Gut Microbes 2023; 15:2283147. [PMID: 37990909 PMCID: PMC10730186 DOI: 10.1080/19490976.2023.2283147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
Host diet and gut microbiota interact to contribute to perioperative complications, including anastomotic leak (AL). Using a murine surgical model of colonic anastomosis, we investigated how diet and fecal microbial transplantation (FMT) impacted the intestinal microbiota and if a predictive signature for AL could be determined. We hypothesized that a Western diet (WD) would impact gut microbial composition and that the resulting dysbiosis would correlate with increased rates of AL, while FMT from healthy, lean diet (LD) donors would reduce the risk of AL. Furthermore, we predicted that surgical outcomes would allow for the development of a microbial preclinical translational tool to identify AL. Here, we show that AL is associated with a dysbiotic microbial community characterized by increased levels of Bacteroides and Akkermansia. We identified several key taxa that were associated with leak formation, and developed an index based on the ratio of bacteria associated with the absence and presence of leak. We also highlight a modifiable connection between diet, microbiota, and anastomotic healing, potentially paving the way for perioperative modulation by microbiota-targeted therapeutics to reduce AL.
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Affiliation(s)
- Sonja Boatman
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Thomas Kaiser
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- BioTechnology Institute, University of Minnesota, St. Paul, MN, USA
| | | | - Mohammad Haneef Khan
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- BioTechnology Institute, University of Minnesota, St. Paul, MN, USA
| | - Matthew Dietz
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- BioTechnology Institute, University of Minnesota, St. Paul, MN, USA
| | - Julia Kohn
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Abigail J Johnson
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Wolfgang B Gaertner
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Christopher Staley
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- BioTechnology Institute, University of Minnesota, St. Paul, MN, USA
| | - Cyrus Jahansouz
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA
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Farzaneh C, Uppal A, Jafari MD, Duong WQ, Carmichael JC, Mills SD, Stamos MJ, Pigazzi A. Validation of an endoscopic anastomotic grading score as an intraoperative method for assessing stapled rectal anastomoses. Tech Coloproctol 2023; 27:1235-1242. [PMID: 37184769 DOI: 10.1007/s10151-023-02797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/27/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Anastomotic leak is a dreaded complication of colorectal surgery. An endoscopic grading score of the perianastomotic mucosa has been previously developed at our institution (UCI) to assess colorectal anastomotic integrity. The objective of this study is to validate the UCI anastomotic score and determine its impact in anastomotic failure. METHODS As a follow-up study of the UCI grading score implementation during 2011 to 2014, patients undergoing stapled colorectal anastomoses after sigmoidectomy or proctectomy at a single institution from 2015 to 2018 were retrospectively reviewed. Patients were grouped into three tiers based on endoscopic appearance (grade 1, circumferentially normal mucosa; grade 2, ischemia/congestion < 30% of circumference; grade 3, ischemia/congestion > 30% of circumference). RESULTS On the basis of endoscopic mucosal evaluation, grade 1 anastomosis was observed in 299 patients (94%), grade 2 anastomosis in 14 patients (4.4%), and grade 3 anastomosis in 5 patients (1.6%). All grade 3 classifications were immediately and successfully revised intraoperatively with reclassification as a grade 1 anastomosis. The anastomotic leak rate of the follow-up study period from 2015 to 2018 was 6.4% which was lower compared to the anastomotic leak rate of 12.2% in the original study period from 2011 to 2014 (p = 0.07). Anastomotic leak rate for the entire patient series was 8.5%. A grade 2 anastomosis was associated with higher anastomotic leak rate compared to a grade 1 anastomosis (35.7% vs. 7.4%, p < 0.05). None of the five grade 3 anastomoses resulted in an anastomotic leak upon revision. CONCLUSION This study further validates the anastomotic grading score and suggests that its systematic implementation can result in a reduction in anastomotic leaks.
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Affiliation(s)
- C Farzaneh
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - A Uppal
- Division of Surgery, Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M D Jafari
- Department of Surgery, New York Presbyterian Hospital Weill Cornell College of Medicine, 525 E 68th Street, NY, New York, USA
| | - W Q Duong
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - J C Carmichael
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - S D Mills
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - M J Stamos
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - A Pigazzi
- Department of Surgery, New York Presbyterian Hospital Weill Cornell College of Medicine, 525 E 68th Street, NY, New York, USA.
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Farzaneh C, Duong WQ, Stopenski S, Detweiler K, Dekhordi-Vakil F, Carmichael JC, Stamos MJ, Pigazzi A, Jafari MD. Intraoperative Anastomotic Evaluation Methods: Rigid Proctoscopy Versus Flexible Endoscopy. J Surg Res 2023; 290:45-51. [PMID: 37182438 DOI: 10.1016/j.jss.2023.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Rigid proctosigmoidoscopy (RP) and flexible sigmoidoscopy (FS) are two modalities commonly used for intraoperative evaluation of colorectal anastomoses. This study seeks to determine whether there is an association between the endoscopic modality used to evaluate colorectal anastomoses and the rate of anastomotic leak (AL), organ space infection, and overall infectious complication. METHODS The 2012-2018 American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing colorectal anastomoses. Anastomotic evaluation method (RP versus FS) was identified by Current Procedural Terminologycoding and used for group classification. Outcomes measured included AL, organ space infections, and overall infection. Multivariable logistic regression analysis for predicting AL was performed. RESULTS We identified 7100 patients who underwent a colorectal anastomosis with intraoperative endoscopic evaluation. RP was utilized in 3397 (47.8%) and FS in 3703 (52.2%) patients. RP was used more commonly in diverticulitis (44.5% versus 36.2%, P < 0.01), while FS was used more frequently in malignancy (47.5% versus 36.7%, P < 0.01). Anastomotic evaluation with FS was associated with lower rates of organ space infection (3.8% versus 4.8%, P = 0.025) and AL (2.9% versus 3.8%, P = 0.028) compared to RP. On multivariate logistic regression modeling, anastomotic evaluation with RP was associated with a higher risk of AL (odds ratio 1.403, 95% CI 1.028-1.916, P = 0.033) compared to FS. CONCLUSIONS Compared to FS, rigid proctosigmoidoscopic evaluation of a colorectal anastomosis was associated with an increased rate of AL and organ space infection.
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Affiliation(s)
- Cyrus Farzaneh
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, California
| | - William Q Duong
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, California
| | - Stephen Stopenski
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, California
| | - Keri Detweiler
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, California
| | | | - Joseph C Carmichael
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, California
| | - Michael J Stamos
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, California
| | - Alessio Pigazzi
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell College of Medicine, New York, New York
| | - Mehraneh D Jafari
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell College of Medicine, New York, New York.
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Watanabe J, Takemasa I, Kotake M, Noura S, Kimura K, Suwa H, Tei M, Takano Y, Munakata K, Matoba S, Yamagishi S, Yasui M, Kato T, Ishibe A, Shiozawa M, Ishii Y, Yabuno T, Nitta T, Saito S, Saigusa Y, Watanabe M. Blood Perfusion Assessment by Indocyanine Green Fluorescence Imaging for Minimally Invasive Rectal Cancer Surgery (EssentiAL trial): A Randomized Clinical Trial. Ann Surg 2023; 278:e688-e694. [PMID: 37218517 PMCID: PMC10481925 DOI: 10.1097/sla.0000000000005907] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The aim of the present randomized controlled trial was to evaluate the superiority of indocyanine green fluorescence imaging (ICG-FI) in reducing the rate of anastomotic leakage in minimally invasive rectal cancer surgery. BACKGROUND The role of ICG-FI in anastomotic leakage in minimally invasive rectal cancer surgery is controversial according to the published literature. METHODS This randomized, open-label, phase 3, trial was performed at 41 hospitals in Japan. Patients with clinically stage 0-III rectal carcinoma less than 12 cm from the anal verge, scheduled for minimally invasive sphincter-preserving surgery were preoperatively randomly assigned to receive a blood flow evaluation by ICG-FI (ICG+ group) or no blood flow evaluation by ICG-FI (ICG- group). The primary endpoint was the anastomotic leakage rate (grade A+B+C, expected reduction rate of 6%) analyzed in the modified intention-to-treat population. RESULTS Between December 2018 and February 2021, a total of 850 patients were enrolled and randomized. After the exclusion of 11 patients, 839 were subject to the modified intention-to-treat population (422 in the ICG+ group and 417 in the ICG- group). The rate of anastomotic leakage (grade A+B+C) was significantly lower in the ICG+ group (7.6%) than in the ICG- group (11.8%) (relative risk, 0.645; 95% confidence interval 0.422-0.987; P =0.041). The rate of anastomotic leakage (grade B+C) was 4.7% in the ICG+ group and 8.2% in the ICG- group ( P =0.044), and the respective reoperation rates were 0.5% and 2.4% ( P =0.021). CONCLUSIONS Although the actual reduction rate of anastomotic leakage in the ICG+ group was lower than the expected reduction rate and ICG-FI was not superior to white light, ICG-FI significantly reduced the anastomotic leakage rate by 4.2%.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Chuo-ku, Sapporo, Japan
| | - Masanori Kotake
- Department of Surgery, Kouseiren Takaoka Hospital, Takaoka, Toyama, Japan
| | - Shingo Noura
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Kei Kimura
- Department of Lower Gastroenterological Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hirokazu Suwa
- Department of Surgery, Yokosuka Kyosai Hospital, Nakahara-ku, Kawasaki, Kanagawa, Japan
| | - Mitsuyoshi Tei
- Department of Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yoshinao Takano
- Department of Surgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Yatsuyamada, Koriyama, Japan
| | - Koji Munakata
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Osaka, Japan
| | - Shuichiro Matoba
- Department of Gastroenterological Surgery, Toranomon Hospital, Minato City, Tokyo, Japan
| | - Sigeru Yamagishi
- Department of Surgery, Fujisawa City Hospital, Fujisawa, Kanagawa, Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Takeshi Kato
- Department of Surgery, National Hospital Organization Osaka National Hospital, Chuo Ward, Osaka, Japan
| | - Atsushi Ishibe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Manabu Shiozawa
- Department of Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Yoshiyuki Ishii
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Minato City, Tokyo, Japan
| | - Taichi Yabuno
- Department of Surgery, Yokohama Municipal Citizen’s Hospital, Yokohama, Kanagawa, Japan
| | - Toshikatsu Nitta
- Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan
| | - Shuji Saito
- Division of Surgery, Gastrointestinal Center, Yokohama Shin-Midori General Hospital, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Minato City, Tokyo, Japan
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Shi NQ, Cui XY, Zhou C, Tang N, Cui DX. Application of near-infrared fluorescence imaging in theranostics of gastrointestinal tumors. Gastroenterol Rep (Oxf) 2023; 11:goad055. [PMID: 37781571 PMCID: PMC10533422 DOI: 10.1093/gastro/goad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/06/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Gastrointestinal cancers have become an important cause of cancer-related death in humans. Improving the early diagnosis rate of gastrointestinal tumors and improving the effect of surgical treatment can significantly improve the survival rate of patients. The conventional diagnostic method is high-definition white-light endoscopy, which often leads to missed diagnosis. For surgical treatment, intraoperative tumor localization and post-operative anastomotic state evaluation play important roles in the effect of surgical treatment. As a new imaging method, near-infrared fluorescence imaging (NIRFI) has its unique advantages in the diagnosis and auxiliary surgical treatment of gastrointestinal tumors due to its high sensitivity and the ability to image deep tissues. In this review, we focus on the latest advances of NIRFI technology applied in early diagnosis of gastrointestinal tumors, identification of tumor margins, identification of lymph nodes, and assessment of anastomotic leakage. In addition, we summarize the advances of NIRFI systems such as macro imaging and micro imaging systems, and also clearly describe the application process of NIRFI from system to clinical application, and look into the prospect of NIRFI applied in the theranostics of gastrointestinal tumors.
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Affiliation(s)
- Nan-Qing Shi
- Department of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Institute of Nano Biomedicine and Engineering, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - Xin-Yuan Cui
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Cheng Zhou
- Department of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Institute of Nano Biomedicine and Engineering, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - Ning Tang
- Department of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Institute of Nano Biomedicine and Engineering, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - Da-Xiang Cui
- Department of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Institute of Nano Biomedicine and Engineering, Shanghai Jiao Tong University, Shanghai, P. R. China
- National Engineering Center for Nanotechnology, Shanghai, P. R. China
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Faber RA, Tange FP, Galema HA, Zwaan TC, Holman FA, Peeters KCMJ, Tanis PJ, Verhoef C, Burggraaf J, Mieog JSD, Hutteman M, Keereweer S, Vahrmeijer AL, van der Vorst JR, Hilling DE. Quantification of indocyanine green near-infrared fluorescence bowel perfusion assessment in colorectal surgery. Surg Endosc 2023; 37:6824-6833. [PMID: 37286750 PMCID: PMC10462565 DOI: 10.1007/s00464-023-10140-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Indocyanine green near-infrared fluorescence bowel perfusion assessment has shown its potential benefit in preventing anastomotic leakage. However, the surgeon's subjective visual interpretation of the fluorescence signal limits the validity and reproducibility of the technique. Therefore, this study aimed to identify objective quantified bowel perfusion patterns in patients undergoing colorectal surgery using a standardized imaging protocol. METHOD A standardized fluorescence video was recorded. Postoperatively, the fluorescence videos were quantified by drawing contiguous region of interests (ROIs) on the bowel. For each ROI, a time-intensity curve was plotted from which perfusion parameters (n = 10) were derived and analyzed. Furthermore, the inter-observer agreement of the surgeon's subjective interpretation of the fluorescence signal was assessed. RESULTS Twenty patients who underwent colorectal surgery were included in the study. Based on the quantified time-intensity curves, three different perfusion patterns were identified. Similar for both the ileum and colon, perfusion pattern 1 had a steep inflow that reached its peak fluorescence intensity rapidly, followed by a steep outflow. Perfusion pattern 2 had a relatively flat outflow slope immediately followed by its plateau phase. Perfusion pattern 3 only reached its peak fluorescence intensity after 3 min with a slow inflow gradient preceding it. The inter-observer agreement was poor-moderate (Intraclass Correlation Coefficient (ICC): 0.378, 95% CI 0.210-0.579). CONCLUSION This study showed that quantification of bowel perfusion is a feasible method to differentiate between different perfusion patterns. In addition, the poor-moderate inter-observer agreement of the subjective interpretation of the fluorescence signal between surgeons emphasizes the need for objective quantification.
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Affiliation(s)
- Robin A Faber
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Floris P Tange
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Hidde A Galema
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Thomas C Zwaan
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Fabian A Holman
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Pieter J Tanis
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jacobus Burggraaf
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Centre of Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Merlijn Hutteman
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Stijn Keereweer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Alexander L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Joost R van der Vorst
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Denise E Hilling
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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Heuvelings DJI, Al-Difaie Z, Scheepers MHMC, Okamoto N, Diana M, Stassen LPS, Bouvy ND, Al-Taher M. Simultaneous fluorescence imaging of bowel perfusion and ureter delineation using methylene blue: a demonstration in a porcine model. Surg Endosc 2023; 37:6779-6790. [PMID: 37253870 PMCID: PMC10462514 DOI: 10.1007/s00464-023-10142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Intraoperative near-infrared fluorescence imaging (NIRF) with preoperative optical dye administration is a promising technique for quick and easy intraoperative visualization of the ureter and for an improved, real-time assessment of intestinal perfusion. During colorectal surgery, there is a need for simultaneous non-invasive ureteral imaging and bowel perfusion assessment, using one single camera system. The purpose of this study is to investigate the feasibility of simultaneous intestinal perfusion and ureteral imaging using a single commercially available NIRF imaging system. METHODS Six Landrace pigs underwent laparotomy under general anesthesia in this experiment. An intravenous (IV) dose of 0.2 mg/kg indocyanine green (ICG) was given to assess bowel perfusion. Two pairs received a methylene blue (MB) iv injection of 0.75, 0.50 or 0.25 mg/kg respectively to investigate ureteral visualization. Quest Spectrum Fluorescence Camera (Quest Medical Imaging, Middenmeer, The Netherlands) was used for NIRF imaging. RESULTS Ureter visualization and bowel perfusion under NIRF imaging was achieved in all animals. All ureters were visible after five to ten minutes and remained clearly visible until the end of every experiment (120-420 min). A mixed model analysis did not show any significant differences neither between the three groups nor over time. Importantly, we demonstrated that bowel perfusion could be visualized with methylene blue (MB) as well. We observed no interference between ICG and MB and a faster washout of MB. CONCLUSION We successfully demonstrated simultaneous fluorescence angiography with ICG and ureteral imaging with MB in the same surgical procedure, with the same commercially available NIRF imaging equipment. More importantly, we showed that the use MB is adequate for bowel perfusion assessment and ureter visualization with this NIRF imaging system. Besides, MB showed an earlier washout time, which can be clinical beneficial as a repeated dye injection may be necessary during a surgical procedure.
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Affiliation(s)
- Danique J I Heuvelings
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Max H M C Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nariaki Okamoto
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Laurents P S Stassen
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nicole D Bouvy
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mahdi Al-Taher
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Hall LA, Jackson R, Soccorso G, Lander AD, Pachl MJ. Assessment of jejunal interposition perfusion using indocyanine green. Photodiagnosis Photodyn Ther 2023; 43:103687. [PMID: 37399912 DOI: 10.1016/j.pdpdt.2023.103687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Jejunal interposition (JI) is an option for oesophageal replacement in children; ensuring good graft perfusion is essential. We report three cases where Indocyanine Green (ICG) with Near-Infrared Fluorescence (NIRF) was used to assess perfusion during graft selection, passage into the chest and anastomotic assessment. This extra assessment may reduce risk of anastomotic leak and/or stricture. METHODS We describe the technique and salient features of all patients who have undergone ICG/NIRF-assisted JI in our centre. Patient demographics, indications for surgery, intra-operative plan, video of NIR perfusion assessment, complications and outcomes were reviewed. RESULTS ICG/NIRF was used in three patients (2M:1F) at a dose of 0.2 mg/kg. ICG/NIRF imaging helped select the jejunal graft and confirmed perfusion after division of segmental arteries. Perfusion was assessed before and after passing the graft through the diaphragmatic hiatus and before and after making the oesophago-jejunal anastomosis. Intrathoracic assessment at the end of the procedure confirmed good perfusion of mesentery and intrathoracic bowel. In two patients, the reassurance contributed to successful procedures. In the third patient, graft selection was satisfactory, but borderline perfusion on clinical assessment after passing the graft to the chest, confirmed by ICG/NIRF meant the graft was abandoned. CONCLUSIONS ICG/NIRF imaging was feasible and augmented our subjective assessment of graft perfusion, giving greater confidence during graft preparation, movement, and anastomosis. In addition, the imaging helped us abandon one graft. This series demonstrates the feasibility and benefit of ICG/NIR use in JI surgery. Further studies are required to optimise ICG use in this setting.
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Affiliation(s)
- Lewis A Hall
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Raef Jackson
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Birmingham, UK
| | - Giampiero Soccorso
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Birmingham, UK
| | - Anthony D Lander
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Birmingham, UK
| | - Max J Pachl
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Birmingham, UK; Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK.
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Mehrotra S, Liu YZ, Nwaiwu CA, Buharin VE, Stolyarov R, Schwaitzberg SD, Kalady MF, Kim PCW. Real-time quantification of bowel perfusion using Laparoscopic Laser Speckle Contrast Imaging (LSCI) in a porcine model. BMC Surg 2023; 23:261. [PMID: 37649010 PMCID: PMC10468884 DOI: 10.1186/s12893-023-02161-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND/PURPOSE Real-time quantification of tissue perfusion can improve intraoperative surgical decision making. Here we demonstrate the utility of Laser Speckle Contrast Imaging as an intra-operative tool that quantifies real-time regional differences in intestinal perfusion and distinguishes ischemic changes resulting from arterial/venous obstruction. METHODS Porcine models (n = 3) consisted of selectively devascularized small bowel loops that were used to measure the perfusion responses under conditions of control/no vascular occlusion, arterial inflow occlusion, and venous outflow occlusion using laser speckle imaging and indocyanine green fluoroscopy. Laser Speckle was also used to assess perfusion differences between small bowel antimesenteric-antimesenteric and mesenteric-mesenteric anastomoses. Perfusion quantification was measured in relative perfusion units calculated from the laser speckle perfusion heatmap. RESULTS Laser Speckle distinguished between visually identified perfused, watershed, and ischemic intestinal segments with both color heatmap and quantification (p < .00001). It detected a continuous gradient of relative intestinal perfusion as a function of distance from the stapled ischemic bowel edge. Strong positive linear correlation between relative perfusion units and changes in mean arterial pressure resulting from both arterial (R2 = .96/.79) and venous pressure changes (R2 = .86/.96) was observed. Furthermore, Laser Speckle showed that the antimesenteric anastomosis had a higher perfusion than mesenteric anastomosis (p < 0.01). CONCLUSIONS Laser Speckle Contrast Imaging provides objective, quantifiable tissue perfusion information in both color heatmap and relative numerical units. Laser Speckle can detect spatial/temporal differences in perfusion between antimesenteric and mesenteric borders of a bowel segment and precisely detect perfusion changes induced by progressive arterial/venous occlusions in real-time.
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Affiliation(s)
- Saloni Mehrotra
- Department of Surgery, University at Buffalo, Buffalo, NY, USA
- Activ Surgical Inc., Boston, MA, USA
| | - Yao Z Liu
- Activ Surgical Inc., Boston, MA, USA
- Department of Surgery, Brown University, Providence, Rhode Island, USA
| | - Chibueze A Nwaiwu
- Activ Surgical Inc., Boston, MA, USA
- Department of Surgery, Brown University, Providence, Rhode Island, USA
| | | | | | | | - Matthew F Kalady
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter C W Kim
- Activ Surgical Inc., Boston, MA, USA.
- Department of Surgery, Brown University, Providence, Rhode Island, USA.
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Venn ML, Hooper RL, Pampiglione T, Morton DG, Nepogodiev D, Knowles CH. Systematic review of preoperative and intraoperative colorectal Anastomotic Leak Prediction Scores (ALPS). BMJ Open 2023; 13:e073085. [PMID: 37463818 PMCID: PMC10357690 DOI: 10.1136/bmjopen-2023-073085] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To systematically review preoperative and intraoperative Anastomotic Leak Prediction Scores (ALPS) and validation studies to evaluate performance and utility in surgical decision-making. Anastomotic leak (AL) is the most feared complication of colorectal surgery. Individualised leak risk could guide anastomosis and/or diverting stoma. METHODS Systematic search of Ovid MEDLINE and Embase databases, 30 October 2020, identified existing ALPS and validation studies. All records including >1 risk factor, used to develop new, or to validate existing models for preoperative or intraoperative use to predict colorectal AL, were selected. Data extraction followed CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies guidelines. Models were assessed for applicability for surgical decision-making and risk of bias using Prediction model Risk Of Bias ASsessment Tool. RESULTS 34 studies were identified containing 31 individual ALPS (12 colonic/colorectal, 19 rectal) and 6 papers with validation studies only. Development dataset patient populations were heterogeneous in terms of numbers, indication for surgery, urgency and stoma inclusion. Heterogeneity precluded meta-analysis. Definitions and timeframe for AL were available in only 22 and 11 ALPS, respectively. 26/31 studies used some form of multivariable logistic regression in their modelling. Models included 3-33 individual predictors. 27/31 studies reported model discrimination performance but just 18/31 reported calibration. 15/31 ALPS were reported with external validation, 9/31 with internal validation alone and 4 published without any validation. 27/31 ALPS and every validation study were scored high risk of bias in model analysis. CONCLUSIONS Poor reporting practices and methodological shortcomings limit wider adoption of published ALPS. Several models appear to perform well in discriminating patients at highest AL risk but all raise concerns over risk of bias, and nearly all over wider applicability. Large-scale, precisely reported external validation studies are required. PROSPERO REGISTRATION NUMBER CRD42020164804.
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Affiliation(s)
- Mary L Venn
- Blizard Institute, Queen Mary University of London, London, UK
| | - Richard L Hooper
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tom Pampiglione
- Blizard Institute, Queen Mary University of London, London, UK
| | - Dion G Morton
- NIHR Global Health Research Unit on Global Surgery, Institute of Translational Medicine, University of Birmingham Edgbaston Campus, Birmingham, UK
| | - Dmitri Nepogodiev
- NIHR Global Health Research Unit on Global Surgery, Institute of Translational Medicine, University of Birmingham Edgbaston Campus, Birmingham, UK
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Chen H, Ye L, Huang C, Shi Y, Lin F, Ye H, Huang Y. Indocyanine green angiography for lower incidence of anastomotic leakage after transanal total mesorectal excision: a propensity score-matched cohort study. Front Oncol 2023; 13:1134723. [PMID: 37361602 PMCID: PMC10289152 DOI: 10.3389/fonc.2023.1134723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background Anastomotic leakage (AL) is the most serious complication that can arise during colorectal surgery. Indocyanine green (ICG) angiography offers an intraoperative assessment of colonic vascular perfusion in real time. We aimed to assess ICG's effects on the AL rate in patients who have undergone transanal total mesorectal excision (TaTME) for rectal cancer. Methods This retrospective cohort study was conducted at our center from October 2018 to March 2022 to analyze the clinical data of patients with rectal cancer who have undergone TaTME after propensity score matching (PSM). The primary outcome was the proximal colonic transection line modification and clinical AL rate. Results A total of 143 patients in the non-ICG group and 143 patients in the ICG group were included after PSM. The proximal colonic transection line of seven patients in the non-ICG group was modified, while 18 were in the ICG group (4.9% vs. 12.5%, p = 0.023). Twenty-three patients (16.1%) in the non-ICG group and five patients (3.5%) in the ICG group were diagnosed with AL (p < 0.001). The ICG group had a less hospital readmission rate than the non-ICG group (0.7% vs. 7.7%, p = 0.003). The between-group differences in basic line and other outcomes were not significant. Conclusions ICG angiography is a safe and feasible method to help surgeons identify potentially poor colonic vascular perfusion and modify the proximal colonic transection line, resulting in a significant reduction in AL and hospital readmission rates.
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Affiliation(s)
- Hengkai Chen
- Department of Colorectal Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Colorectal Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Linfang Ye
- Department of Colorectal Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Colorectal Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Medical University, Fuzhou, China
| | | | | | | | | | - Yongjian Huang
- Department of Gastrointestinal Surgery 2 Section, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Gastrointestinal Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Abdelrahman H, El-Menyar A, Peralta R, Al-Thani H. Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients. World J Gastrointest Surg 2023; 15:757-775. [PMID: 37342859 PMCID: PMC10277941 DOI: 10.4240/wjgs.v15.i5.757] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/18/2023] [Accepted: 03/27/2023] [Indexed: 05/26/2023] Open
Abstract
Background: Modern surgical medicine strives to manage trauma while improving outcomes using functional imaging. Identification of viable tissues is crucial for the surgical management of polytrauma and burn patients presenting with soft tissue and hollow viscus injuries. Bowel anastomosis after trauma-related resection is associated with a high rate of leakage. The ability of the surgeon’s bare eye to determine bowel viability remains limited, and the need for a more standardized objective assessment has not yet been fulfilled. Hence, there is a need for more precise diagnostic tools to enhance surgical evaluation and visualization to aid early diagnosis and timely management to minimize trauma-associated complications. Indocyanine green (ICG) coupled with fluorescence angiography is a potential solution for this problem. ICG is a fluorescent dye that responds to near-infrared irradiation. Methods: We conducted a narrative review to address the utility of ICG in the surgical management of patients with trauma as well as elective surgery. Discussion: ICG has many applications in different medical fields and has recently become an important clinical indicator for surgical guidance. However, there is a paucity of information regarding the use of this technology to treat traumas. Recently, angiography with ICG has been introduced in clinical practice to visualize and quantify organ perfusion under several conditions, leading to fewer cases of anastomotic insufficiency. This has great potential to bridge this gap and enhance the clinical outcomes of surgery and patient safety. However, there is no consensus on the ideal dose, time, and manner of administration nor the indications that ICG provides a genuine advantage through greater safety in trauma surgical settings. Conclusions: There is a scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy to facilitate intraoperative decisions and to limit the extent of surgical resection. This review will improve our understanding of the utility of intraoperative ICG fluorescence in guiding and assisting trauma surgeons to deal with the intraoperative challenges and thus improve the patients’ operative care and safety in the field of trauma surgery.
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Affiliation(s)
| | - Ayman El-Menyar
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Ruben Peralta
- Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Hassan Al-Thani
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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Ma Z, Deng J, Ma B, Chen H. Real-time Indocyanine Green Fluorescence Technique Reduces Anastomotic Leakage in Bilioenteric Anastomosis: A Case Report and literature review. Photodiagnosis Photodyn Ther 2023:103609. [PMID: 37187271 DOI: 10.1016/j.pdpdt.2023.103609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Anastomotic leakage is a serious complication that can occur in bilioenteric anastomosis surgery, leading to significant morbidity and mortality. Currently, practitioners rely on subjective measures to determine anastomotic perfusion and mechanical integrity, which have limitations. The use of indocyanine green fluorescence technology has become increasingly widespread in clinical practice, especially in gastrointestinal-related surgery. This technique has a unique role in evaluating the blood perfusion of anastomoses and reducing the incidence of anastomotic leakage. However, there have been no reports of its use in bilioenteric anastomosis surgery. Further research is needed to investigate the potential benefits of indocyanine green fluorescence technology in improving outcomes and reducing complications in this type of surgery. CASE SUMMARY a 50-year-old female patient underwent total laparoscopic radical resection of cholangiocarcinoma. During the surgery, indocyanine green fluorescence technology was used to complete the biliary intestinal anastomosis under full visual and dynamic monitoring. The patient recovered well after the operation without experiencing biliary leakage or other complications. CONCLUSION The present case study underscores the potential advantages associated with the incorporation of intraoperative real-time indocyanine green (ICG) technology in bilioenteric anastomosis surgery. By facilitating enhanced visualization and assessment of anastomotic perfusion and mechanical stability, this state-of-the-art technique may help mitigate the occurrence of anastomotic leaks while simultaneously improving patient outcomes. Notably, intravenous administration of ICG at a dose of 2.5 mg/kg, administered 24 hours prior to surgery, has been found to yield optimal visualization outcomes.
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Affiliation(s)
- Zhen Ma
- Lanzhou University Second Hospital, Lanzhou 730030, China; Department of Surgical Oncology, Lanzhou University Second Hospital, Lanzhou 730030, China; Key Laboratory of the Digestive System tumours of Gansu Province
| | - Junge Deng
- Lanzhou University Second Hospital, Lanzhou 730030, China; Department of Surgical Oncology, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Bin Ma
- Lanzhou University Second Hospital, Lanzhou 730030, China; Department of Surgical Oncology, Lanzhou University Second Hospital, Lanzhou 730030, China; Key Laboratory of the Digestive System tumours of Gansu Province
| | - Hao Chen
- Lanzhou University Second Hospital, Lanzhou 730030, China; Department of Surgical Oncology, Lanzhou University Second Hospital, Lanzhou 730030, China; Key Laboratory of the Digestive System tumours of Gansu Province.
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Xu T, Gao X, Yuan H, Li S, Zhou Z, Gong G, Jia G, Zhao G. Real-time semi-quantitative assessment of anastomotic blood perfusion in mini‑invasive rectal resections by Sidestream Dark Field (SDF) imaging technology: a prospective in vivo pilot study. Langenbecks Arch Surg 2023; 408:186. [PMID: 37160767 DOI: 10.1007/s00423-023-02887-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/04/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Anastomotic leakage (AL) is one of the severe complications after rectal surgery, and anastomotic ischemia is one of the main factors. This prospective in vivo pilot study aimed to evaluate the effectiveness of Sidestream Dark Field (SDF) imaging in quantitative assessment of anastomotic microcirculation and to analyze its correlation with AL. METHODS Thirty-three patients with rectal cancer who underwent laparoscopic low anterior resection from 2019 to 2020 were enrolled. Microcirculation was measured by SDF imaging at the descending colon, the mesocolon transection line (MTL), and 1 cm and 2 cm distal to the MTL. Anastomotic microcirculation was measured at the stapler anvil edge before anastomosis. Quantitative perfusion-related parameters were as follows: microcirculation flow index (MFI), perfused vessel density (PVD), proportion of perfused vessels (PPV), and total vessel density (TVD). RESULTS All patients obtained stable microcirculation images. Functional microcirculation parameters (MFI, PPV, PVD) decreased successively from the descending colon, the colon at MTL, and 1 cm and 2 cm distal to the MTL (all P < 0.01). Extremely poor microcirculation was found at the intestinal segment 2 cm distal to the MTL. Micro-perfusion was significantly lower at the colonic limb of the anastomosis compared with the descending colon (all P < 0.001). Anastomotic leakage occurred in 3 patients (9.1%) whose anastomotic microcirculation was significantly lower than those without AL (all P < 0.01). Blood perfusion at the colonic limb of the anastomosis was significantly higher in patients with left colic artery preservation than in controls. CONCLUSION SDF imaging is a promising technique for evaluating anastomotic microcirculation and has potential clinical significance for risk stratification of AL.
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Affiliation(s)
- Tonghai Xu
- Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan Province, China
- Department of Gastrointestinal Surgery, Mei Shan People's Hospital, Mei Shan, 620010, Sichuan Province, China
| | - Xiang Gao
- Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan Province, China
| | - Hao Yuan
- Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan Province, China
| | - Shuang Li
- Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan Province, China
| | - Zili Zhou
- Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan Province, China
| | - Guojin Gong
- Department of Gastrointestinal Surgery, Xi Chang People's Hospital, Xi Chang, 615000, Sichuan Province, China
| | - Guiqing Jia
- Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan Province, China
| | - Gaoping Zhao
- Department of Gastrointestinal Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, Sichuan Province, China.
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Mullen KM, Regier PJ, Fox-Alvarez WA, Portela D, Londoño L, Colee J. A quantitative evaluation of the effect of foreign body obstruction and enterectomy technique on canine small intestinal microvascular health. Vet Surg 2023; 52:554-563. [PMID: 36882020 DOI: 10.1111/vsu.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/14/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To investigate sidestream dark field (SDF) videomicroscopy as an objective measure of intestinal viability and determine the effects of enterectomy techniques on intestinal microvasculature in dogs with foreign body obstructions. STUDY DESIGN Prospective, randomized, clinical trial. ANIMALS A total of 24 dogs with an intestinal foreign body obstruction and 30 systemically healthy dogs. METHODS An SDF videomicroscope imaged the microvasculature at the site of the foreign body. Subjectively viable intestine received an enterotomy whereas nonviable intestine received an enterectomy using a handsewn (4-0 polydioxanone, simple continuous) or a functional end-to-end stapled technique (GIA 60 blue, TA 60 green) was used on an alternating basis. The microvasculature adjacent to the enterectomy was interrogated. Quantitative measures of microvascular health were calculated for each site and compared with healthy dogs. RESULTS Microvascular density (mean ± SD) at the site of obstruction (140.84 ± 77.40) was lower than healthy controls (251.72 ± 97.10, p < .01). There was no difference in microvascular parameters (density or perfused boundary region, PBR) between obstructed dogs with subjectively viable and nonviable intestine (p > .14). The density (p = .66) and PBR of microvessels (p = .76) adjacent to the sutured enterectomy or TA green staple line did not differ. CONCLUSION Sidestream dark field videomicroscopy can identify obstructed intestine and quantitate the severity of microvascular compromise. Handsewn and stapled enterectomies equally preserve perfusion. CLINICAL SIGNIFICANCE Stapled enterectomies do not lead to greater vascular compromise than handsewn enterectomies.
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Affiliation(s)
- Kaitlyn M Mullen
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Diego Portela
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Leonel Londoño
- Capital Veterinary Specialists, Jacksonville, Florida, USA
| | - James Colee
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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Takemasa I, Hamabe A, Miyo M, Akizuki E, Okuya K. Essential updates 2020/2021: Advancing precision medicine for comprehensive rectal cancer treatment. Ann Gastroenterol Surg 2023; 7:198-215. [PMID: 36998300 PMCID: PMC10043777 DOI: 10.1002/ags3.12646] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2022] Open
Abstract
In the paradigm shift related to rectal cancer treatment, we have to understand a variety of new emerging topics to provide appropriate treatment for individual patients as precision medicine. However, information on surgery, genomic medicine, and pharmacotherapy is highly specialized and subdivided, creating a barrier to achieving thorough knowledge. In this review, we summarize the perspective for rectal cancer treatment and management from the current standard-of-care to the latest findings to help optimize treatment strategy.
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Affiliation(s)
- Ichiro Takemasa
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Atsushi Hamabe
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
- Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversityOsakaJapan
| | - Masaaki Miyo
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Emi Akizuki
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Koichi Okuya
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
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Imaging Photoplethysmography for Noninvasive Anastomotic Perfusion Assessment in Intestinal Surgery. J Surg Res 2023; 283:705-712. [PMID: 36462380 DOI: 10.1016/j.jss.2022.10.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Anastomotic leakage after gastrointestinal surgery has a high impact on patient's quality of life and its origin is associated with inadequate perfusion. Imaging photoplethysmography (iPPG) is a noninvasive imaging technique that measures blood-volume changes in the microvascular tissue bed and detects changes in tissue perfusion. MATERIALS AND METHODS Intraoperative iPPG imaging was performed in 29 patients undergoing an open segment resection of the small intestine or colon. During each surgery, imaging was performed on fully perfused (true positives) and ischemic intestines (true negatives) and the anastomosis (unknowns). Imaging consisted of a 30-s video from which perfusion maps were extracted, providing detailed information about blood flow within the intestine microvasculature. To detect the predictive capabilities of iPPG, true positive and true negative perfusion conditions were used to develop two different perfusion classification methods. RESULTS iPPG-derived perfusion parameters were highly correlated with perfusion-perfused or ischemic-in intestinal tissues. A perfusion confidence map distinguished perfused and ischemic intestinal tissues with 96% sensitivity and 86% specificity. Anastomosis images were scored as adequately perfused in 86% of cases and 14% inconclusive. The cubic-Support Vector Machine achieved 90.9% accuracy and an area under the curve of 96%. No anastomosis-related postoperative complications were encountered in this study. CONCLUSIONS This study shows that noninvasive intraoperative iPPG is suitable for the objective assessment of small intestine and colon anastomotic perfusion. In addition, two perfusion classification methods were developed, providing the first step in an intestinal perfusion prediction model.
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