Perfusion can be visualized during surgery with help of the Quest Spectrum®. During an open or laparoscopic procedure, patients are injected with Indocyanine Green (ICG) which binds to plasma proteins within the vascular system. This tracer flows throughout the cardiovascular system including to the anatomy of interest.


When the Quest Spectrum is used to simultaneously record the visible and near-infrared images, the near-infrared images reveal the location of the fluorescent tracer, while the visible images show the anatomy of interest. When these images are combined one can visualize what anatomy is perfused.

 

colorectal anastomosis

 

The perfusion of the colon during a colorectal anastomosis procedure is shown above using the Quest Spectrum.

  1. The left image shows an image similar to what the surgeon sees with the naked eye. This image shows a closed suture without any leakages. One cannot estimate the perfusion of the suture based on this image.
  2. 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 less perfusion.
  3. The image in the middle shows the overlay between the visible image and the fluorescent image. This image allows the surgeon to assess perfusion in the anatomic structures of concern.


Estimating perfusion in these procedures can enable the surgeon to reduce complications, late effects, morbidity and mortality.

 

Colorectal Anastomosis 

Colorectal anastomosis is a complex and time-consuming surgical procedure during which a new connection is made between the colon and the rectum. In this procedure, it is imperative to ensure a closed suture between the two structures to minimize the chance of leakage of the intra-colon or intra-rectum fluids.


It is important that the suture site remain perfused for optimal recovery. If the suture site is not perfused, the site may undergo necrosis as a result of ischemia. Postoperatively these leakages can induce major complications requiring revision.


 

Links to supporting literature:

Clinical role of fluorescence imaging in colorectal surgery – a review

Mazrahi & Wexner

Expert Rev Med Devices. 2017 Jan; 14(1):75-82.

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