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The use of indocyanine green fluorescence angiography to assess anastomotic perfusion following bowel resection in surgery for gynecologic malignancies - A report of 100 consecutive anastomoses
The use of indocyanine green fluorescence angiography to assess anastomotic perfusion following bowel resection in surgery for gynecologic malignancies - A report of 100 consecutive anastomoses
- Source :
- Gynecologic oncology. 158(2)
- Publication Year :
- 2020
-
Abstract
- Objective 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. Methods 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. Results 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. Conclusions 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.
- Subjects :
- 0301 basic medicine
Adult
Indocyanine Green
medicine.medical_specialty
Colectomies
genetic structures
Adolescent
Genital Neoplasms, Female
medicine.medical_treatment
Gynecologic oncology
Anastomosis
03 medical and health sciences
chemistry.chemical_compound
Young Adult
0302 clinical medicine
Medicine
Humans
Fluorescein Angiography
Digestive System Surgical Procedures
Aged
Retrospective Studies
Aged, 80 and over
Intraoperative Care
medicine.diagnostic_test
business.industry
Anastomosis, Surgical
Obstetrics and Gynecology
Retrospective cohort study
Bowel resection
Middle Aged
Surgery
030104 developmental biology
Oncology
chemistry
030220 oncology & carcinogenesis
Angiography
Female
business
Perfusion
Indocyanine green
Subjects
Details
- ISSN :
- 10956859
- Volume :
- 158
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Gynecologic oncology
- Accession number :
- edsair.doi.dedup.....48ff99da6c38173a22a47eed288bbd33