Utility of indocyanine-green fluorescent imaging during robot-assisted sphincter-saving surgery on rectal cancer patients

Abstract

Background: There have been few studies describing the use of indocyanine green (ICG) fluorescent imaging during robot-assisted (RA) sphincter-saving operations (SSOs) and assessing its potential role in reducing anastomotic leak (AL).

Methods: A consecutive cohort of 436 rectal cancer patients who underwent curative RA SSOs were prospectively enrolled during 2010-2014, including 123 patients with ICG imaging (ICG⁺ group) and 313 patients without ICG imaging (ICG^- group).

Results: ICG imaging appeared to be helpful in identifying competent perfusion of the bowel adjacent to the anastomosis in 13 patients (10.6%) who might be susceptible to bowel ischaemia, including restrictive mesocolon. AL was remarkably greater in the ICG^- group compared with the ICG⁺ group (5.4% vs 0.8%; p = 0.031).

Conclusions: ICG imaging during RA SSO provides accurate real-time knowledge of the perfusion status at or near the anastomosis, specifically reducing AL in patients who may incur bowel ischaemia. Copyright © 2015 John Wiley & Sons, Ltd.

Keywords: fluorescence; indocyanine green; rectal cancer; robot-assisted; sphincter-saving operation.