Timing of indocyanine green injection prior to laparoscopic colorectal surgery for tumor localization: a prospective case series

Tetsuta Satoyoshi,Hiroo Yamano,Akihiro Usui,Toshihiko Nishidate,Masayuki Ishii,Hiroshi Nakase,Emi Akizuki,Atsushi Hamabe,Koichi Okuya,Ichiro Takemasa,Kenji Okita

doi:10.1007/s00464-020-07443-5

Tetsuta Satoyoshi, Hiroo Yamano + Show 9 more

Open Access

https://doi.org/10.1007/s00464-020-07443-5

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Abstract

BackgroundAccurate identification of tumor sites during laparoscopic colorectal surgery helps to optimize oncological clearance. We aimed to assess the timing of the local injection preoperatively and clarify the usefulness and limitation of tumor site marking using indocyanine green (ICG) fluorescence imaging.MethodsConsecutive patients who underwent primary colorectal cancer surgery from September 2017 to January 2019 were included. Preoperatively, lower endoscopy was used to inject the ICG solution into the submucosal layer near the tumor. During laparoscopic surgery, ICG fluorescence marking as the tumor site marking was detected using a laparoscopic near-infrared camera system. The detection rate and factors associated with successful intraoperative ICG fluorescence visualization including the interval between local injection and surgery were evaluated.ResultsOne hundred sixty-five patients were enrolled. Using the laparoscopic near-infrared system, the intraoperative detection rates of ICG marking were 100% for ICG injection within 6 days preoperatively, 60% for injection between 7 and 9 days preoperatively, and 0% for injection earlier than 10 days preoperatively. There were no complications associated with ICG marking. Additionally, this method did not disturb the progress of the surgical procedure because injected ICG in the submucosal layer did not cause any tissue inflammation, and if ICG spilled into the serosa, it was invisible by white light.ConclusionAdvantages of ICG fluorescence tumor site marking were high visibility of infrared imaging during laparoscopic colorectal surgery and minimal adverse events of surgery. One of the most important findings regarding practical use was a rapid decrease in fluorescence marking visibility if one week passed from the time of ICG local injection.

Highlights

Accurate identification of tumor sites during laparoscopic colorectal surgery helps to optimize oncological clearance
The markings using indocyanine green (ICG) fluorescence imaging were visualized with a near-infrared camera during laparoscopic surgery (Fig. 2A–D)
In all 141 patients who underwent ICG marking within 6 days, ICG fluorescence marking was detected with the near-infrared camera

Summary

Introduction

Accurate identification of tumor sites during laparoscopic colorectal surgery helps to optimize oncological clearance. We aimed to assess the timing of the local injection preoperatively and clarify the usefulness and limitation of tumor site marking using indocyanine green (ICG) fluorescence imaging. Lower endoscopy was used to inject the ICG solution into the submucosal layer near the tumor. ICG fluorescence marking as the tumor site marking was detected using a laparoscopic near-infrared camera system. The detection rate and factors associated with successful intraoperative ICG fluorescence visualization including the interval between local injection and surgery were evaluated. There were no complications associated with ICG marking This method did not disturb the progress of the surgical procedure because injected ICG in the submucosal layer did not cause any tissue inflammation, and if ICG spilled into the serosa, it was invisible by white light. Conclusion Advantages of ICG fluorescence tumor site marking were high visibility of infrared imaging during laparoscopic colorectal surgery and minimal adverse events of surgery. One of the most important findings regarding practical use was a rapid decrease in fluorescence marking visibility if one week passed from the time of ICG local injection

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