The use of indocyanine green fluorescence angiography to assess anastomotic perfusion following bowel resection in surgery for gynecologic malignancies - A report of 100 consecutive anastomoses

Julie M V Nguyen; Liat Hogen; Stephane Laframboise; Genevieve Bouchard-Fortier; Sarah E Ferguson; Marcus Q Bernardini; Taymaa May

doi:10.1016/j.ygyno.2020.05.008

The use of indocyanine green fluorescence angiography to assess anastomotic perfusion following bowel resection in surgery for gynecologic malignancies - A report of 100 consecutive anastomoses

Gynecol Oncol. 2020 Aug;158(2):402-406. doi: 10.1016/j.ygyno.2020.05.008. Epub 2020 May 15.

Authors

Julie M V Nguyen¹, Liat Hogen², Stephane Laframboise², Genevieve Bouchard-Fortier², Sarah E Ferguson², Marcus Q Bernardini², Taymaa May³

Affiliations

¹ Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.
² Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.
³ Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada. Electronic address: taymaa.may@uhn.ca.

PMID: 32423604
DOI: 10.1016/j.ygyno.2020.05.008

Abstract

Objective: Real-time intraoperative assessment of anastomotic perfusion with indocyanine green fluorescence angiography (ICG-FA) is a recent technique that is found to assist intraoperative decision-making and decrease risk of anastomotic leak in the General Surgery literature. No studies to date evaluate its use in Gynecologic Oncology. Our objectives were to assess the safety and feasibility of ICG-FA use and to describe the intraoperative assessment of anastomotic perfusion with ICG-FA.

Methods: A retrospective study of a prospectively-collected database of patients with a gynecologic malignancy who underwent a bowel resection at Princess Margaret Cancer Centre in Toronto, Canada, between November 1, 2017 and December 15, 2019 was conducted. ICG-FA was administered intravenously, and a near infrared imaging system (Pinpoint, Novadaq, Canada; SPY-PHI, Stryker, USA) was used to objectively assess bowel perfusion.

Results: ICG-FA was used to assess a total of 100 bowel anastomoses in 82 consecutive surgeries: 56 low anterior resections, 19 small bowel resections, 15 right hemi-colectomies, 6 left hemi-colectomies, 3 transverse colectomies, and 1 total colectomy. Fifty-five end-to end, 44 side-to-side and 1 end-to-side anastomoses were assessed. ICG angiography was successful in all patients, allowing complete visualization of anastomotic perfusion in all cases. Hypoperfusion detected by ICG-FA resulted in change in operative plan for three patients (two anastomotic revisions and one diverting ileostomy). There were no adverse reactions to ICG. In this cohort, there was one postoperative anastomotic leak.

Conclusions: ICG-FA enables objective and accurate intraoperative evaluation of anastomotic perfusion in surgeries for gynecologic malignancies. Its implementation and routine use were found to be safe and well-tolerated without side effects in our study cohort. ICG-FA can be used with other risk-assessment strategies to guide operative decision-making in Gynecologic Oncology.

Keywords: Anastomotic perfusion; Bowel resection; Gynecologic malignancies; Indocyanine green.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Anastomosis, Surgical / methods*
Digestive System Surgical Procedures / methods
Female
Fluorescein Angiography / methods*
Genital Neoplasms, Female / surgery*
Humans
Indocyanine Green*
Intraoperative Care / methods
Middle Aged
Retrospective Studies
Young Adult

Substances

Indocyanine Green