Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.
Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.
Gynecol Oncol. 2020 Aug;158(2):402-406. doi: 10.1016/j.ygyno.2020.05.008. Epub 2020 May 15.
Real-time intraoperative assessment of anastomotic perfusion with indocyanine green fluorescence angiography (ICG-FA) is a recent technique that is found to assist intraoperative decision-making and decrease risk of anastomotic leak in the General Surgery literature. No studies to date evaluate its use in Gynecologic Oncology. Our objectives were to assess the safety and feasibility of ICG-FA use and to describe the intraoperative assessment of anastomotic perfusion with ICG-FA.
A retrospective study of a prospectively-collected database of patients with a gynecologic malignancy who underwent a bowel resection at Princess Margaret Cancer Centre in Toronto, Canada, between November 1, 2017 and December 15, 2019 was conducted. ICG-FA was administered intravenously, and a near infrared imaging system (Pinpoint, Novadaq, Canada; SPY-PHI, Stryker, USA) was used to objectively assess bowel perfusion.
ICG-FA was used to assess a total of 100 bowel anastomoses in 82 consecutive surgeries: 56 low anterior resections, 19 small bowel resections, 15 right hemi-colectomies, 6 left hemi-colectomies, 3 transverse colectomies, and 1 total colectomy. Fifty-five end-to end, 44 side-to-side and 1 end-to-side anastomoses were assessed. ICG angiography was successful in all patients, allowing complete visualization of anastomotic perfusion in all cases. Hypoperfusion detected by ICG-FA resulted in change in operative plan for three patients (two anastomotic revisions and one diverting ileostomy). There were no adverse reactions to ICG. In this cohort, there was one postoperative anastomotic leak.
ICG-FA enables objective and accurate intraoperative evaluation of anastomotic perfusion in surgeries for gynecologic malignancies. Its implementation and routine use were found to be safe and well-tolerated without side effects in our study cohort. ICG-FA can be used with other risk-assessment strategies to guide operative decision-making in Gynecologic Oncology.
实时术中评估吲哚菁绿荧光血管造影（ICG-FA）吻合口灌注是一项新技术，它有助于术中决策，并降低普通外科文献中吻合口漏的风险。迄今为止，尚无研究评估其在妇科肿瘤学中的应用。我们的目的是评估 ICG-FA 使用的安全性和可行性，并描述 ICG-FA 对吻合口灌注的术中评估。
对 2017 年 11 月 1 日至 2019 年 12 月 15 日期间在加拿大多伦多玛格丽特公主癌症中心接受妇科恶性肿瘤肠切除术的患者前瞻性收集的数据库进行回顾性研究。静脉给予 ICG-FA，并使用近红外成像系统（Pinpoint，Novadaq，加拿大；SPY-PHI，Stryker，美国）客观评估肠道灌注。
共评估了 82 例连续手术中的 100 个肠吻合口：56 例低位前切除术、19 例小肠切除术、15 例右半结肠切除术、6 例左半结肠切除术、3 例横结肠切除术和 1 例全结肠切除术。评估了 55 个端端吻合、44 个侧侧吻合和 1 个端侧吻合。所有患者均成功进行 ICG 血管造影，所有病例均能完全显示吻合口灌注。ICG-FA 检测到的灌注不足导致 3 例患者（2 例吻合口修正术和 1 例旁路性回肠造口术）手术计划发生改变。无 ICG 不良反应。在该队列中，有 1 例术后吻合口漏。
ICG-FA 可实现妇科恶性肿瘤手术中吻合口灌注的客观、准确的术中评估。在我们的研究队列中，其实施和常规使用被发现是安全且耐受良好的，没有副作用。ICG-FA 可与其他风险评估策略一起用于指导妇科肿瘤学中的手术决策。
