Application value of indocyanine green fluorescence imaging in assessing blood supply during laparoscopic radical resection of rectal cancer

Abstract

The aim of the present study was to explore the application value of indocyanine green (ICG) fluorescence imaging in laparoscopic radical resection for rectal cancer. The clinical and pathological data of 12 patients with rectal cancer admitted to the Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Fujian Medical University (Quanzhou, China) between January and May 2024 were retrospectively analyzed. Laparoscopic surgery was performed on these patients. ICG was injected prior to anastomosis, before blood supply to the proximal and distal intestinal segments was observed using a fluorescence laparoscope. If the blood supply was poor, the ischaemic bowel was further resected before anastomosis. After anastomosis, the same dose of ICG was injected to assess the blood supply at the anastomotic site. Surgical and postoperative recovery data were then statistically analyzed. Procedures were successfully performed in all 12 patients, including in 2 patients undergoing extended resection and re-anastomosis due to poor blood supply in the proximal intestinal segment according to ICG fluorescence imaging. The initial imaging time after ICG injection was 44 sec (range, 31-69 sec), whereas the imaging duration was 4 min (range, 3-6 min). The operation duration was 146 min (range, 112-193 min), intraoperative blood loss was 26.5 ml (range, 21.0-39.0 ml) and the length of the resected bowel was 18 cm (range, 9.0-25.5 cm). The time to first postoperative flatus was 2 days (range, 1-3 days), the time to first liquid food intake was 4 days (range, 3-5 days) and the postoperative length of hospital stay was 8 days (range, 7-9 days). The patients exhibited no postoperative complications. These data suggest that the use of ICG fluorescence imaging to assess blood supply during laparoscopic surgery for rectal cancer is safe and effective. This possibly allows for the intraoperative evaluation of blood supply, reducing postoperative anastomotic leaks.

Keywords: anastomotic fistula; blood supply; indocyanine green; laparoscopy; rectal cancer.

Figure 1

Conventional laparoscopy showing good blood supply to the intestines before anastomosis (scale bar, 1 cm).

Figure 2

ICG fluorescence imaging 3 min after ICG injection, demonstrating poor blood supply in the proximal intestinal segment, necessitating extended resection. ICG, indocyanine green (scale bar, 1 cm).

Figure 3

ICG fluorescence imaging 3 min after ICG injection. Following anastomosis, the same dose of ICG was injected and fluorescence imaging confirmed adequate blood supply to the anastomosis site (scale bar, 1 cm). ICG, indocyanine green.