Manipal Hospitals, Bangalore, India.
Aware Global Hospitals, Hyderabad, India.
J Robot Surg. 2021 Jun;15(3):369-374. doi: 10.1007/s11701-020-01095-2. Epub 2020 Jun 30.
Colorectal cancer is the second most common cancer in women and the third most common cancer in men in the world. Surgical resection is the gold standard treatment and minimally invasive surgery remains the standard of care. Anastomotic leakage is one of the most feared postoperative complications in colorectal surgery. Although several factors have been identified as possible causes of anastomotic leakage (i.e., surgical techniques, patient risk factors, suture material or devices), the complete pathogenesis is still unclear. The reported leak rate ranges from 1 to 30% and increases as the anastomosis is more distal. To date the most widely used methods to assess tissue perfusion includes the surgeon intraoperative visual judgement based on the colour; bleeding edges of resected margins; pulsation and temperature, thereby resulting in either excess or insufficient colonic resection. Earlier studies in colorectal surgery have suggested that assessment of tissue perfusion by the clinical judgment of the operating surgeon underestimated the risk of anastomotic leakage. Indocyanine green (ICG) is a intravenous dye which has shown promise in identifying the bowel vascularity real time. Earlier studies on colorectal cancer have shown that ICG based detection of bowel vascularity is technically possible and has reduced the anastomotic leak rates in 16.7% of patients. We conducted a prospective study on patients with ICG guided bowel perfusion during robotic colorectal cancer surgery. The method is technically easy, reproducible and safe. This technique has changed the intraoperative decision in 88% of patients. Larger studies are needed before this can become the standard of care.
结直肠癌是全世界女性中第二常见的癌症，男性中第三常见的癌症。手术切除是金标准治疗方法，微创手术仍然是护理标准。吻合口漏是结直肠手术后最可怕的并发症之一。尽管已经确定了几个可能导致吻合口漏的因素（即手术技术、患者风险因素、缝线材料或器械），但完整的发病机制仍不清楚。报道的漏率为 1%至 30%，并且随着吻合部位的更远端而增加。迄今为止，评估组织灌注最广泛使用的方法包括外科医生根据颜色进行的术中视觉判断；切除边缘的出血边缘；搏动和温度，从而导致结肠切除过多或不足。结直肠手术的早期研究表明，手术医生的临床判断评估组织灌注会低估吻合口漏的风险。吲哚菁绿（ICG）是一种静脉染料，已显示出实时识别肠血管的潜力。早期的结直肠癌研究表明，基于 ICG 的肠血管检测在技术上是可行的，并且将吻合口漏的发生率降低了 16.7%。我们对接受机器人结直肠癌手术中 ICG 引导肠灌注的患者进行了一项前瞻性研究。该方法技术简单、可重复且安全。这项技术改变了 88%的患者的术中决策。在这成为护理标准之前，还需要进行更大的研究。
