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How can ICG fluorescence imaging help to improve the assessment of intestinal perfusion? It can be used for vascular perfusion, a leak test, biliary mapping, lymphatic mapping, and tumor localization.
As many of you will know, anastomotic leaks are frequent and important complications. For fluorescence angiography, the required equipment for a laparoscopic application is needed, 0.2 or 0.3 mg of ICG per kg of body weight intravenously. It is certainly true that fluorescence appears after 30 or 60 seconds.
It is very useful for gastric pull-up during esophagectomy and reconstruction after gastrectomy. A meta-analysis of ICG vs. non-ICG shows that anastomotic leakages are less likely to occur in patients who underwent esophagectomy using ICG, .
When it comes to fluorescence during bariatric surgery, it must be borne in mind that it is an elective surgery with high risk for patients and there should be zero tolerance for complicationa or death.
Another publication states that most leaks occur after negative leak tests due to insufficient blood supply and late staple line failure. In the case of colorectal surgery, the main factor for uncomplicated healing is tension-free and sufficient blood perfusion.
To sum up, visual assessment may underestimate the real perfusion, allowing for real-time visualization of blood flow and it is important for esophageal and colorectal surgery.
The main advantages are intraoperative changes of the procedure before complications occur and it is a useful tool for education of young surgeons. It is certainly true that using fluorescence angiography can reduce the leak rate.
