Maione Francesco, Manigrasso Michele, Chini Alessia, Vertaldi Sara, Anoldo Pietro, D'Amore Anna, Marello Alessandra, Sorrentino Carmen, Cantore Grazia, Maione Rosa, Gennarelli Nicola, D'Angelo Salvatore, D'Alesio Nicola, De Simone Giuseppe, Servillo Giuseppe, Milone Marco, De Palma Giovanni Domenico
Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Front Surg. 2022 May 20;9:886478. doi: 10.3389/fsurg.2022.886478. eCollection 2022.
The aim of this study was to evaluate the importance of Indocyanine Green in control of anastomosis perfusion and on anastomotic leakage rates during laparoscopic and robotic colorectal procedures.
A retrospective review of patients who underwent elective minimally invasive surgery for colorectal cancer from 1 January 2018 to 31 December 2020 was performed. All patients underwent Near-Infrared Fluorescence-Indocyanine Green system in two moments: before performing the anastomosis and after completing the anastomotic procedure. Primary outcomes were the rate of intraoperative change in the surgical resection due to an inadequate vascularization and the rate of postoperative anastomotic leakage. Secondary outcomes were the postoperative complications, both medical and surgical (intra-abdominal bleeding, anastomotic leakage).
Our analysis included 93 patients. Visible fluorescence was detected in 100% of the cases. In 7 patients (7.5%), the planned site of resection was changed due to inadequate perfusion. The mean extension of the surgical resection in these 7 patients was 2.2 ± 0.62. Anastomotic leakage occurred in 2 patients (2.1%). Other complications included 8 postoperative bleedings (8.6%) and 1 pulmonary thromboembolism.
The intraoperative use of Near-Infrared Fluorescence-Indocyanine Green in colorectal surgery is safe, feasible, and associated with a substantial reduction in postoperative anastomotic leakage rate.
本研究旨在评估吲哚菁绿在腹腔镜和机器人结直肠手术中控制吻合口灌注及吻合口漏发生率方面的重要性。
对2018年1月1日至2020年12月31日期间接受择期微创结直肠癌手术的患者进行回顾性研究。所有患者在两个时间点接受近红外荧光 - 吲哚菁绿系统检查：在进行吻合术前和完成吻合术后。主要结局是由于血管化不足导致手术切除术中改变的发生率以及术后吻合口漏的发生率。次要结局是术后并发症，包括内科和外科并发症（腹腔内出血、吻合口漏）。
我们的分析纳入了93例患者。100%的病例检测到可见荧光。7例患者（7.5%）因灌注不足改变了计划的切除部位。这7例患者手术切除的平均范围为2.2±0.62。2例患者（2.1%）发生吻合口漏。其他并发症包括8例术后出血（8.6%）和1例肺血栓栓塞。
结直肠手术中术中使用近红外荧光 - 吲哚菁绿是安全、可行的，且与术后吻合口漏发生率的大幅降低相关。
