Colorectal anastomosis

This video shows the application of the Quest Spectrum Platform for the assessment of the perfusion in an anastomosis:

In this procedure the perfusion of the anastomosis created in a colorectal surgery is assessed using ICG as a fluorescent marker.

In the assesment of the intestinal perfusion of a colorectal anastomosis the Quest Spectrum Platform can provide additional information to the surgeon to support his decision making.

colorectal anastomosis

The left image, shows an image that is similar to what the surgeon sees with the naked eye. This image shows a closed suture without any leakages. However, one cannot estimate the perfusion of the suture based on this image.

The image in the middle shows the overlay between the visible image and the fluorescent image. This image allows the surgeon to assess the fluorescent signal regarding the anatomical structures he or she is familiar with.

The right image shows the response of the fluorescent tracer that is used during this procedure. This image shows that the intensity of the fluorescent response is lower at the center of the image compared to the surrounding tissue, indicating a lower perfusion.

Colorectal anastomosis is a complex and time-consuming surgical procedure where a new connection is made between the colon and the rectum. In this procedure it is imperative to assure a closed suture between the two structures to minimize the chance of possible leakage of the intra-colon or intra-rectum fluids. Postoperatively these leakages could induce major complications requiring revision. Besides a closed suture, it is also important that de suture is perfused for optimal recovery. In case the suture is not perfused, the cells might undergo necrosis as a result of ischemia.

Links to supporting literature:

Role of Indocyanine Green in Fluorescence Imaging with Near-Infrared Light to Identify Sentinel Lymph Nodes, Lymphatic Vessels and Pathways Prior to Surgery – A Critical Evaluation of Options
Hackethal et al.
Geburtshilfe und Frauenheilkunde. 2018; 78(1):54-62

Clinical role of fluorescence imaging in colorectal surgery – a review
Mazrahi & Wexner
Expert Rev Med Devices. 2017 Jan; 14(1):75-82.

Motivations to choose ICG in case of perfusion assessment:

  • Decreased blood perfusion is an important risk factor that can lead to devastating complications like anastomotic leakage
  • Imaging of ICG in tissue can provide the surgeon with a real-time objective assessment of the intestinal perfusion

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