Multispectral Imaging Using Fluorescent Properties of Indocyanine Green and Methylene Blue in Colorectal Surgery-Initial Experience.

Wojciech Polom,Jaroslaw Skokowski,Karol Polom,Marcin Migaczewski,Marcin Matuszewski,Leszek Kalinowski,Michal Pedziwiatr,Maciej Swierblewski,Tomasz Cwalinski

doi:10.3390/jcm11020368

Wojciech Polom, Jaroslaw Skokowski + Show 7 more

Open Access

https://doi.org/10.3390/jcm11020368

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Abstract

Introduction: Image-guided surgery is becoming a new tool in colorectal surgery. Intraoperative visualisation of different structures using fluorophores helps during various steps of operations. In our report, we used two fluorophores—indocyanine green (ICG), and methylene blue (MB)—during different steps of colorectal surgery, using one camera system for two separate near-infrared wavelengths. Material and methods: Twelve patients who underwent complex open or laparoscopic colorectal surgeries were enrolled. Intravenous injections of MB and ICG at different time points were administered. Visualisation of intraoperative ureter position and fluorescent angiography for optimal anastomosis was performed. A retrospective analysis of patients treated in our departments during 2020 was performed, and data about ureter injury and anastomotic site complications were collected. Results: Intraoperative localisation of ureters with MB under fluorescent light was possible in 11 patients. The mean signal-to-background ratio was 1.58 ± 0.71. Fluorescent angiography before performing anastomosis using ICG was successful in all 12 patients, and none required a change in position of the planned colon resection for anastomosis. The median signal-to-background ratios was 1.25 (IQR: 1.22–1.89). Across both centres, iatrogenic injury of the ureter was found in 0.4% of cases, and complications associated with anastomosis was found in 5.5% of cases. Conclusions: Our study showed a substantial opportunity for using two different fluorophores in colorectal surgery, whereby the visualisation of one will not change the possible quantification analysis of the other. Using two separate dyes during one procedure may help in optimisation of the fluorescent properties of both dyes when using them for different applications. Visualisation of different structures by different fluorophores seems to be the future of image-guided surgery, and shows progress in optical technologies used in image-guided surgery.

Highlights

IntroductionDuring different steps of colorectal surgery, using one camera system for two separate near-infrared wavelengths
Image-guided surgery is becoming a new tool in colorectal surgery
Since the first publication of Kitai et al showed the practical use of indocyanine green (ICG) fluorescence in the detection of breast cancer sentinel node biopsy, countless applications have been available for this fluorophore [5]

Summary

Introduction

During different steps of colorectal surgery, using one camera system for two separate near-infrared wavelengths. A separate camera system is required for individual fluorophores, as each must be excited and detected by a specific wavelength of light. Intraoperative angiography, tumour detection, sentinel node biopsy, and ureter visualisation are just some of its practical applications in colorectal cancer surgery [6]. Near-infrared fluorescence visualisation needs a fluorophore that presents a specific characterization: an excitation wavelength of 665 nm, with an emission of 686 nm [7]. This is one of the reasons why MB has less tissue penetration, and more autofluorescence of the background tissue

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