Laparoscopic and Endoscopic Near‐infrared Perfusion Assessment of in situ ileoileal, ileocolic, colocolic, colorectal and ileoanal anastomosis during intestinal operation for benign and malignant disease: A Video Vignette

Abstract

As detailed in this supplement, near-infrared laparoscopy and endoscopy can be used to provide an intraoperative indocyanine green (ICG) perfusion angiogram of the small and large intestine both before and after anastomotic construction 1-3. This may aid efficiency in operative dissection and confirm dynamically and in situ the technical adequacy of the anastomosis providing reassurance about its vascular sufficiency and the absence of significant tension. This series of videos shows it's applicablility and usefulness as an aid to intraoperative decision-making by both laparoscopic and endoscopic (i.e. transanal) access in a variety of anastomosis including ileoileal, ileocolic, colocolic, colorectal and ileoanal. In general, 3–5 ml of ICG (2.5 mg/ml) was administered via a peripheral venous cannula at each intraoperative timepoint of interest usually either or both before intracorporeal intestinal transection or/and immediately after anastomotic construction. A commercially available laparoscope (PINPOINT, Novadaq) was used to assess both white-light (standard) and also near-infrared appearances either laparoscopically or endoscopically with false colour overlay by rapid sequencing allowing dual modality, augmented reality intraoperative visualisation. In addition to the experiences described in the supplement, we ourselves have employed the technique in 25 consectutive patients undergoing ileal, colonic and rectal resection with anastomosis for both benign and malignant disease over the past 6 months. In three cases, the technique encouraged reselection of a more proximal site of transection during anterior resection while all constructed anastomoses were thereafter dynamically shown to be technically satisfactory (as evidenced by observing the anastomosis's fluorescence filling and persistance in comparison to the positive control of that occuring in non-operated intestine). There were no postoperative anastomotic complications. The authors have no conflicts of interest to declare. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.