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Clinical History:
63 years old, male.
BMI 25.
No significant past medical history other than occasional abdominal pain.
Known for the uncomplicated sigmoid diverticular disease at colonoscopy.
No previous abdominal surgeries.
No familiar history of colonic cancer.
In November 2022 complained of diffuse abdominal pain in the lower abdomen and fever.
Admission to A&E and diagnosis of acute diverticular diseases and pelvic abscess treated with I.V. antibiotic and percutaneous drainage of pelvic abscess.
1/23 - Colonoscopy: Distal sigmoid diverticula with inflammation and stiffness of colonic wall with edema. Histology: mucosal edema with lymphoplasmacytic infiltration.
1/23 - Virtual colonoscopy (CT scan): Presence, at 20 cm from the anus, sigmoid stenosis of 7 cm length with occlusion of the intestinal lumen with diverticula suspicious for “inflammatory pseudotumor”.
1/23 - Oncology Markers: CA19.9 1.2, CEA 1.10, Alpha1fetoprotein 2.48.
Technique description:
Laparoscopic sigmoid resection with fluorescent identification of the left ureter and fluorescent angiography for perfusion control of the anastomosis.
Procedure steps:
Preoperative left ureter catheter insertion by cystoscopy (urology team), injection of 3 cc of ICG (Indocyanine green) diluted in 20 cc.
Standard trocar for laparoscopic sigmoid resection.
Intraoperative visualization of the fluorescent left ureter using the VISERA ELITE III system by Olympus.
Mesenteric division with preservation of the inferior mesenteric artery using an advanced bipolar device (Powerseal by Olympus).
Partial mobilization of the splenic flexure/descending colon.
Division of the upper rectum.
Sigmoid resection and perfusion control of the colon using fluorescent angiography prior to and after performing the anastomosis.
Training Objectives:
Describing all the potential of fluorescence-guided surgery during colonic resection.
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