The impact of indocyanine-green fluorescence imaging on left-sided colonic resection: A prospective study

Abstract

Perfusion is one of the most important factors in colonic anastomotic healing. The near-infrared light (NIR) technology and intravenous injection of fluorescent dye with indocyanine-green (ICG) allow intraoperative assessment of colonic microvascular perfusion. Aim: The objective is to assess the impact of using NIR+ICG in left-sided colonic resections. Method: A prospective study was carried out for patients who had colonic or rectal resections that involve ligation of the inferior mesenteric artery. The primary endpoint was whether there was a change in operative decision: transection site, decision for splenic flexure mobilization and decision for stoma. The secondary endpoint was the anastomotic leakage rate. Results: Thirty patients were recruited. The mean age was 64.5 ± 11.7 years. Approximately 66.7% were male and 33.3% were female. They had either cancer of the descending colon (3.3%), sigmoid colon (26.7%) or rectum (70.0%). Total mesorectal excision was performed in 63.3% of the cases. For the site of transection, there was a change in decision in 53.3% of the cases, in which 50.0% had a more proximal transection, and 3.3% had a more distal transection. When there was a change of transection site, the mean distance between the intended and eventual transection site was 3.90 ± 3.34 cm (range 1-12 cm). In 10.0% of the cases, there was a change in the decision on whether to mobilize the splenic flexure of the colon or not. Defunctioning stoma was performed in 70.0% of the cases. There was no change in the decision in terms of stoma fashioning. There was no clinical anastomotic leak observed. Conclusion: The use of NIR+ICG to assess bowel perfusion in left-sided colonic resection has a major impact on intraoperative decision. There is a role for further studies to evaluate whether it has a positive impact on reducing anastomotic leakage rate.