Indocyanine Green-enhanced Fluorescence to Assess Bowel Perfusion During Robotic-assisted Rectal Surgery Journal: International Journal of Colorectal Disease

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Abstract Purpose: Anastomotic leakage following rectal surgery is a major complication, which may occur due to insufficient vascular supply. We aimed to evaluate the feasibility and efficacy of using indocyanine green fluorescence angiography for intraoperative assessment of vascular anastomotic perfusion in robotic low anterior resection. Methods: This was a retrospective case-control study that included consecutive patients undergoing robotic low anterior resection for rectal cancer between March 2017 and February 2019. Intra-operative use of indocyanine green fluorescence for assessment of bowel perfusion was performed in patients undergoing rectal surgery after April 2018. Those who underwent the surgery before that comprised the control group. The primary outcome was the occurrence of anastomotic leakage among the two groups. Results:Each group included 48 patients. There were no significant differences between the two groups in terms of demographic data or tumor characteristics. The planned anastomotic site was revised in 1/48 patients who received indocyanine green fluorescence based on the surgeon’s subjective finding of a hypo-perfused distal segment. Postoperative anastomotic leakage was confirmed clinically and radiologically in one patient (2.8%) in the indocyanine green-group compared to two patients (4.16%) in the control group. Conclusion: Indocyanine green fluorescence may be considered a useful intraoperative tool for assessment of vascular perfusion of bowel during robotic rectal surgery. Change in the site of resection and/or anastomosis may be indicated, possibly affecting the incidence of anastomotic leakage.

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