ABSTRACT
AIM: In colorectal cancer surgery, the efficacy of intestinal blood flow evaluation with the indocyanine green (ICG) fluorescence method using the VISERA ELITE2 system was investigated. PATIENTS AND METHODS: Participants in this study comprised 50 patients who underwent elective laparoscopic colorectal cancer surgery at the Department of Surgery, the Jikei Daisan Hospital. With the ICG fluorescence method, whether it was necessary to change the intestinal transection line for anastomosis was evaluated. RESULTS: For three cases of rectal cancer, the oral transection line determined from macroscopic observation was judged to offer insufficient blood flow according to the ICG fluorescence method. The transection line for anastomosis was changed according to fluorescence. None of these cases showed complications. CONCLUSION: The ICG fluorescence method may allow safe anastomosis in colorectal surgery for cancer.
Subject(s)
Colorectal Surgery , Indocyanine Green/chemistry , Laparoscopy , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical , Colorectal Surgery/adverse effects , Female , Fluorescence , Humans , Male , Middle Aged , Postoperative Complications/etiologyABSTRACT
BACKGROUND/AIM: Indocyanine green (ICG) fluorescence technique is known to help visualize blood vessels. The efficacy of real-time fluorescence vessel navigation (FVN) using ICG for ligation of the inferior mesenteric vein (IMV) and left colic artery (LCA) during laparoscopic left colorectal cancer surgery was investigated. PATIENTS AND METHODS: Participants were 59 patients who underwent laparoscopic left colorectal cancer surgery from February 2017 to November 2018, and were divided into groups: i) with FVN (FVN+, n=21) and ii) without FVN (FVN-, n=38). Groups were compared for the time it took to ligate their IMV and LCA. RESULTS: The results are expressed as median values. The time to ligate the IMV and LCA was significantly shorter for FVN+ (230 seconds; range 126-346) than for FVN- (417.5 seconds; range 137-1327) (p<0.001). CONCLUSION: Real-time FVN using ICG shortened the times for IMV and LCA ligation. This was enabled by clear visualization of the direction of the bloodstream flow inside the vessels. This technique simplifies vessel ligation and safer laparoscopic surgery for left colorectal cancer.