The utilization of indocyanine green fluorescence angiography for anastomotic perfusion assessment following bowel resection for gynecologic malignancies: A pan-Canadian survey (545)

Abstract

Objectives: Bowel resection is an important component of surgical management of women with advanced gynecologic malignancies. Real-time intraoperative assessment of anastomotic perfusion with indocyanine green fluorescence angiography (ICG-FA) is a recent technique that has been shown to effectively evaluate perfusion of large and small bowel anastomoses. The objective of this study was to capture national practice patterns, characterize facilitators and barriers to ICG-FA utilization for bowel perfusion assessment, and identify opportunities for further education across Canada. Methods: A needs assessment survey was developed with a focus group of key stakeholders in the field, as well as a methodologist, and piloted in advance to distribution. The survey captured basic sociodemographics, work history, facilitators and barriers to use of ICG-FA for bowel perfusion assessment, and modalities for further education (e.g., peer-reviewed article, surgical video, national/ international conference, local grand rounds, and invited experts for practical training). On July 1, 2021, the survey was distributed to 115 gynecologic oncologists registered through the Society of Gynecologic Oncology of Canada. Responses were collected until September 1, 2021. Results: The response rate was 31% (n=37), with respondents from all Canadian provinces. Approximately three-quarters (78%) of respondents identified as women, and the majority (60%) have been practicing gynecologic oncology for less than ten years. Of the respondents, 81% (n=30) performed bowel resection, and 67% (n=20) used ICG-FA for anastomotic perfusion assessment after bowel surgery. The three most reported barriers to integrating ICG-FA into routine clinical practice were the lack of training (30%), knowledge (27%), and equipment (27%). Surgical videos were the highest-ranked educational modality, followed by national/international conferences and peer- reviewed articles. Conclusions: ICG-FA for bowel perfusion assessment is a valuable tool that can be used with other risk-assessment strategies to guide operative decision-making in gynecologic oncology. However, further training across multiple educational modalities is needed to build knowledge among the Canadian gynecologic oncologic community, with surgical videos serving as the preferred educational modality. Additionally, more funding for necessary equipment will facilitate the uptake of this tool. This represents a national practice improvement opportunity. Objectives: Bowel resection is an important component of surgical management of women with advanced gynecologic malignancies. Real-time intraoperative assessment of anastomotic perfusion with indocyanine green fluorescence angiography (ICG-FA) is a recent technique that has been shown to effectively evaluate perfusion of large and small bowel anastomoses. The objective of this study was to capture national practice patterns, characterize facilitators and barriers to ICG-FA utilization for bowel perfusion assessment, and identify opportunities for further education across Canada. Methods: A needs assessment survey was developed with a focus group of key stakeholders in the field, as well as a methodologist, and piloted in advance to distribution. The survey captured basic sociodemographics, work history, facilitators and barriers to use of ICG-FA for bowel perfusion assessment, and modalities for further education (e.g., peer-reviewed article, surgical video, national/ international conference, local grand rounds, and invited experts for practical training). On July 1, 2021, the survey was distributed to 115 gynecologic oncologists registered through the Society of Gynecologic Oncology of Canada. Responses were collected until September 1, 2021. Results: The response rate was 31% (n=37), with respondents from all Canadian provinces. Approximately three-quarters (78%) of respondents identified as women, and the majority (60%) have been practicing gynecologic oncology for less than ten years. Of the respondents, 81% (n=30) performed bowel resection, and 67% (n=20) used ICG-FA for anastomotic perfusion assessment after bowel surgery. The three most reported barriers to integrating ICG-FA into routine clinical practice were the lack of training (30%), knowledge (27%), and equipment (27%). Surgical videos were the highest-ranked educational modality, followed by national/international conferences and peer- reviewed articles. Conclusions: ICG-FA for bowel perfusion assessment is a valuable tool that can be used with other risk-assessment strategies to guide operative decision-making in gynecologic oncology. However, further training across multiple educational modalities is needed to build knowledge among the Canadian gynecologic oncologic community, with surgical videos serving as the preferred educational modality. Additionally, more funding for necessary equipment will facilitate the uptake of this tool. This represents a national practice improvement opportunity.