The use of indocyanine green fluorescence angiography to assess anastomotic perfusion following bowel resection in surgery for gynecologic malignancies - A report of 100 consecutive anastomoses
| Autor: | Liat Hogen, Julie M.V. Nguyen, Marcus Q. Bernardini, Stephane Laframboise, Sarah E. Ferguson, Taymaa May, Geneviève Bouchard-Fortier |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Adult Indocyanine Green medicine.medical_specialty Colectomies genetic structures Adolescent Genital Neoplasms Female medicine.medical_treatment Gynecologic oncology Anastomosis 03 medical and health sciences chemistry.chemical_compound Young Adult 0302 clinical medicine Medicine Humans Fluorescein Angiography Digestive System Surgical Procedures Aged Retrospective Studies Aged 80 and over Intraoperative Care medicine.diagnostic_test business.industry Anastomosis Surgical Obstetrics and Gynecology Retrospective cohort study Bowel resection Middle Aged Surgery 030104 developmental biology Oncology chemistry 030220 oncology & carcinogenesis Angiography Female business Perfusion Indocyanine green |
| Zdroj: | Gynecologic oncology. 158(2) |
| ISSN: | 1095-6859 |
| Popis: | Objective Real-time intraoperative assessment of anastomotic perfusion with indocyanine green fluorescence angiography (ICG-FA) is a recent technique that is found to assist intraoperative decision-making and decrease risk of anastomotic leak in the General Surgery literature. No studies to date evaluate its use in Gynecologic Oncology. Our objectives were to assess the safety and feasibility of ICG-FA use and to describe the intraoperative assessment of anastomotic perfusion with ICG-FA. Methods A retrospective study of a prospectively-collected database of patients with a gynecologic malignancy who underwent a bowel resection at Princess Margaret Cancer Centre in Toronto, Canada, between November 1, 2017 and December 15, 2019 was conducted. ICG-FA was administered intravenously, and a near infrared imaging system (Pinpoint, Novadaq, Canada; SPY-PHI, Stryker, USA) was used to objectively assess bowel perfusion. Results ICG-FA was used to assess a total of 100 bowel anastomoses in 82 consecutive surgeries: 56 low anterior resections, 19 small bowel resections, 15 right hemi-colectomies, 6 left hemi-colectomies, 3 transverse colectomies, and 1 total colectomy. Fifty-five end-to end, 44 side-to-side and 1 end-to-side anastomoses were assessed. ICG angiography was successful in all patients, allowing complete visualization of anastomotic perfusion in all cases. Hypoperfusion detected by ICG-FA resulted in change in operative plan for three patients (two anastomotic revisions and one diverting ileostomy). There were no adverse reactions to ICG. In this cohort, there was one postoperative anastomotic leak. Conclusions ICG-FA enables objective and accurate intraoperative evaluation of anastomotic perfusion in surgeries for gynecologic malignancies. Its implementation and routine use were found to be safe and well-tolerated without side effects in our study cohort. ICG-FA can be used with other risk-assessment strategies to guide operative decision-making in Gynecologic Oncology. |
| Databáze: | OpenAIRE |
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