Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery

Abstract The quality of mesorectal resection is crucial for resection in rectal cancer, which should be performed by laparoscopy for better outcome. The use of indocyanine green (ICG) fluorescence is now routinely used in some centers to evaluate bowel perfusion. Previous studies have demonstrated i...

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Autores principales:	Christian Heiliger, Jerzy Piecuch, Alexander Frank, Dorian Andrade, Viktor von Ehrlich-Treuenstätt, Dobromira Evtimova, Florian Kühn, Jens Werner, Konrad Karcz
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/64628d73622c4f6fbfdbc3906c5163eb
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spelling	oai:doaj.org-article:64628d73622c4f6fbfdbc3906c5163eb2021-12-02T16:26:23ZLaparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery10.1038/s41598-021-94244-y2045-2322https://doaj.org/article/64628d73622c4f6fbfdbc3906c5163eb2021-07-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-94244-yhttps://doaj.org/toc/2045-2322Abstract The quality of mesorectal resection is crucial for resection in rectal cancer, which should be performed by laparoscopy for better outcome. The use of indocyanine green (ICG) fluorescence is now routinely used in some centers to evaluate bowel perfusion. Previous studies have demonstrated in animal models that selective intra-arterial ICG staining can be used to define and visualize resection margins in rectal cancer. In this animal study, we investigate if laparoscopic intra-arterial catheterization is feasible and the staining of resection margins when performing total mesorectal excision with a laparoscopic medial to lateral approach is possible. In 4 pigs, laparoscopic catheterization of the inferior mesenteric artery (IMA) is performed using a seldinger technique. After a bolus injection of 10 ml ICG with a concentration of 0.25 mg/ml, a continuous intra-arterial perfusion was established at a rate of 2 ml/min. The quality of the staining was evaluated qualitatively. Laparoscopic catheterization was possible in all cases, and the average time for this was 30.25 ± 3.54 min. We observed a significant fluorescent signal in all areas of the IMA supplied, but not in other parts of the abdominal cavity or organs. In addition, the mesorectum showed a sharp border between stained and unstained tissue. Intraoperative isolated fluorescence augmentation of the rectum, including the mesorectum by laparoscopic catheterization, is feasible. Inferior mesenteric artery catheterization and ICG perfusion can provide a fluorescence-guided roadmap to identify the correct plane in total mesorectal excision, which should be investigated in further studies.Christian HeiligerJerzy PiecuchAlexander FrankDorian AndradeViktor von Ehrlich-TreuenstättDobromira EvtimovaFlorian KühnJens WernerKonrad KarczNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-5 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Christian Heiliger Jerzy Piecuch Alexander Frank Dorian Andrade Viktor von Ehrlich-Treuenstätt Dobromira Evtimova Florian Kühn Jens Werner Konrad Karcz Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery
description	Abstract The quality of mesorectal resection is crucial for resection in rectal cancer, which should be performed by laparoscopy for better outcome. The use of indocyanine green (ICG) fluorescence is now routinely used in some centers to evaluate bowel perfusion. Previous studies have demonstrated in animal models that selective intra-arterial ICG staining can be used to define and visualize resection margins in rectal cancer. In this animal study, we investigate if laparoscopic intra-arterial catheterization is feasible and the staining of resection margins when performing total mesorectal excision with a laparoscopic medial to lateral approach is possible. In 4 pigs, laparoscopic catheterization of the inferior mesenteric artery (IMA) is performed using a seldinger technique. After a bolus injection of 10 ml ICG with a concentration of 0.25 mg/ml, a continuous intra-arterial perfusion was established at a rate of 2 ml/min. The quality of the staining was evaluated qualitatively. Laparoscopic catheterization was possible in all cases, and the average time for this was 30.25 ± 3.54 min. We observed a significant fluorescent signal in all areas of the IMA supplied, but not in other parts of the abdominal cavity or organs. In addition, the mesorectum showed a sharp border between stained and unstained tissue. Intraoperative isolated fluorescence augmentation of the rectum, including the mesorectum by laparoscopic catheterization, is feasible. Inferior mesenteric artery catheterization and ICG perfusion can provide a fluorescence-guided roadmap to identify the correct plane in total mesorectal excision, which should be investigated in further studies.
format	article
author	Christian Heiliger Jerzy Piecuch Alexander Frank Dorian Andrade Viktor von Ehrlich-Treuenstätt Dobromira Evtimova Florian Kühn Jens Werner Konrad Karcz
author_facet	Christian Heiliger Jerzy Piecuch Alexander Frank Dorian Andrade Viktor von Ehrlich-Treuenstätt Dobromira Evtimova Florian Kühn Jens Werner Konrad Karcz
author_sort	Christian Heiliger
title	Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery
title_short	Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery
title_full	Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery
title_fullStr	Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery
title_full_unstemmed	Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery
title_sort	laparoscopic intraarterial catheterization with selective icg fluorescence imaging in colorectal surgery
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/64628d73622c4f6fbfdbc3906c5163eb
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Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery

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