[Prospects of qualitative and quantitative assessment of bowel perfusion by fluorescent angiography with indocyanine green in colorectal surgery. First experience]. / Perspektivy kachestvennoi i kolichestvennoi otsenki perfuzii kishki metodom flyuorestsentnoi angiografii s indotsianinom zelenym v kolorektal'noi khirurgii. Pervyi opyt.

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.

[Possibilities of tissue perfusion assessment in abdominal surgery: integration into the intraoperative system of safety control points]. / Vozmozhnosti otsenki perfuzii tkanei v abdominal'noi khirurgii: integratsiya v sistemu intraoperatsionnykh kontrol'nykh tochek bezopasnosti.

OBJECTIVE: To evaluate the possibility of integrating tissue perfusion assessment techniques (ICG perfusion and imaging photoplethysmography - iPPG) into the system of intraoperative control points of laparoscopic interventions with a reconstructive component. MATERIALS AND METHODS: Quantitative assessment of ICG fluorescence and iPPG were used during 8 laparoscopically assisted interventions: gastrectomy for gastric cancer (total - 2 and distal - 1) and colorectal resections (left-sided colorectal resections - 4 and right hemicolectomy - 1). RESULTS: Four stages are presented for the assessment of tissue perfusion: initial assessment, before intestine transection, before anastomosis formation, and evaluation of anastomosis. From the point of view of the significance of clinical decision-making, the «before intestine transection¼ stage is of great importance, due to the ease of transferring the resection level to the optimal tissue perfusion zone. CONCLUSION: Integration of tissue perfusion assessment techniques into the system of intraoperative checkpoints is possible and promising.