Fluorescent ICG angiography in laparoscopic rectal resection – 
a randomized controlled trial. Preliminary report

Tomasz Gach; Paweł Bogacki; Zofia Orzeszko; Beata Markowska; Jan Krzak; Maciej Szura; Rafał Solecki; Mirosław Szura

doi:10.5114/wiitm.2023.129545

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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3/2023
vol. 18

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General surgery

abstract:

Randomized controlled trial

Fluorescent ICG angiography in laparoscopic rectal resection – a randomized controlled trial. Preliminary report

Tomasz Gach

^{1, 2}

,

Paweł Bogacki

^{1, 2}

,

Zofia Orzeszko

¹

,

Beata Markowska

^{1, 2}

,

Jan M. Krzak

³

,

Maciej Szura

²

,

Rafał Solecki

^{1, 2}

,

Mirosław Szura

^{1, 2}

Department of General and Oncological Surgery, Hospital of Brothers Hospitallers of St. John of God, Krakow, Poland
Department of Surgery, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
Department of General Surgery, South Jutland Hospital, Aabenraa, Denmark

Videosurgery Miniinv 2023; 18 (3): 410–417

DOI: https://doi.org/10.5114/wiitm.2023.129545

Online publish date: 2023/07/17

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Introduction
Anastomotic leakage is one of the most dangerous complications after rectal surgery. It can cause systemic complications, reduce the quality of life and worsen the results of oncological treatment. One of the causes of anastomotic leak is insufficient blood supply to the anastomosis. Intraoperative infrared angiography with indocyanine green (ICG) is expected to improve the assessment of intestinal perfusion and thus prevent anastomotic leakage.

Aim
To present the results of the use of ICG intraoperative angiography during rectal surgery in the prevention of anastomotic leakage.

Material and methods
The study included 76 patients undergoing rectal cancer surgery. Patients were randomized to 2 groups: Group I – 41 patients with ICG intraoperative angiography; and Group II – 35 patients without ICG imaging. Anastomotic leak, length of hospitalization, and complication rate were compared.

Results
Group I patients received intravenous ICG before the anastomosis. Average time of intestinal wall contrasting was 42 s (22–65 s). Average ICG procedure time was 4 min (3.2% of total time of surgery). Three (7.3%) patients after angiography revealed intestinal ischemia requiring widened resection. No anastomotic leak was found post-operatively, and no side effects were observed after administration of ICG. In group II, 3 (8.6%) anastomotic leakages were diagnosed, 2 of which required reoperation.

Conclusions
Intraoperative angiography with ICG in near-infrared light is a safe and effective method of assessing intestinal perfusion. ICG angiography may change the surgical plan and reduce the risk of anastomotic leakage. It is necessary to continue the study until the assumed number of patients is reached.

keywords:

Fluorescent ICG angiography in laparoscopic rectal resection – a randomized controlled trial. Preliminary report

Tomasz Gach 1, 2 , Paweł Bogacki 1, 2 , Zofia Orzeszko 1 , Beata Markowska 1, 2 , Jan M. Krzak 3 , Maciej Szura 2 , Rafał Solecki 1, 2 , Mirosław Szura 1, 2

anastomotic leak, colorectal resection, intraoperative indocyanine-green angiography, anastomosis perfusion

Tomasz Gach

^{1, 2}

,

Paweł Bogacki

^{1, 2}

,

Zofia Orzeszko

¹

,

Beata Markowska

^{1, 2}

,

Jan M. Krzak

³

,

Maciej Szura

²

,

Rafał Solecki

^{1, 2}

,

Mirosław Szura

^{1, 2}