1037 The Use of Fluorescence Angiography with Indocyanine Green in Colorectal Surgery – A District General Hospital Experience. (19th August 2022) - Adegbola, S
Abstract: Introduction: Indocyanine green (ICG) fluorescence imaging is used in a variety of procedures in in colorectal surgery. It optimises intraoperative vision of anatomical structures by improving blood and lymphatic flow. ﻿Traditionally, the vascularization of the colonic stump is subjectively evaluated by the surgeon based on the colour of the bowel wall, the bleeding of the colonic stump, and pulsation of the terminal artery. ICG aims to improve objectivity of this assessment. Aim: To assess the feasibility and efficacy of ICG in colorectal operations and report on initial experience since introduction in November 2021. Method: Retrospective review of prospectively collected database of all patients undergoing colorectal operations with intraoperative ICG use for any indication. Data collected included patient demographic details including age/gender/comorbidities; operative details including indication/type of surgery, 30day-complications, details/outcome of intraoperative ICG use. Results: During the study period ten patients underwent colorectal surgical procedures with intra-operative use of ICG. Surgical options included resectional surgery (right hemicolectomy/transverse colectomy/anterior resection) and reconstructive surgery (reversal of hartmann's operation). Majority were done for colorectal cancer and one for inflammatory bowel disease. ICG was reported useful in all cases in demonstrating vascularity in anastomoses/resection margins. One notable case demonstrated decreased ability of discerning ICG uptake in the presence of tattoo pigmentation (preoperative tumour marking). No adverse events were reported. Conclusion: The ICG assessment of colonic vascularization was simple, feasible, with no adverse events in our cohort. Our experience suggests caution is required when interpreting ICG readings in the presence of colonic tattoo.