Evaluation of Microcirculation in Colon Wall and Bowel Anastomosis by Laser Induced Fluorescence Video Angiography
Evaluation of Microcirculation in Colon Wall and Bowel Anastomosis by Laser Induced Fluorescence Video Angiography
The aim of the study is to describe utility of dynamic fluorescence videoangiography of
 indocyanine green (ICG) in gastrointestinal surgery, for evaluation of microcirculation in
 colon wall and anastomosis before and after surgical resection; and if this technique can
 guide the surgeon to peroperative decision making considering recreate a new anastomosis or
 stoma for preventing anastomotic failure or stomia necrosis.
In our study the investigators prospectively include patients with colon cancer requiring
 elective surgical operation. All types of colon resection were carried out according to
 standard procedures. Guidelines for preoperative examination according to NGICG (Norwegian
 Gastro-Intestinal Cancer Group) to grade the disease, select the most suitable patients and
 plan further treatment.

 Microcirculation of colon wall was assessed by dynamic
 laser-induced-fluorescence-videoangiography (IC-VIEW, PULSION Medical Systems AG, Munich,
 Germany) of indocyanine green (ICG). ICG is a water-soluble tricarbocyanine dye that binds
 strongly to plasma proteins after intravenous injection and is exclusively distributed in
 intravascular space. Additionally this system houses a laser (energy Pi = 0.16 W, wavelength
 = 780 nm) that causes excitation/illumination of the fluorescence light from intravascular
 plasma bound ICG. This light has a spectral range near-infrared energy (NIR) with a maximum
 at 805 nm and emits fluorescence at 835 nm. It passes through infrared filter on a digital
 video camera and results in recording of real time fluorescent image from perfusion of plasma
 bound ICG within small plexus of blood vessels in the bowel wall. Besides that it also
 demonstrates perfusion from surrounding structures such as appendix epiploic and pericolic
 fat. The maximum penetration of the laser into tissue is 3-5 mm and general normal thickness
 of colon wall is 3-5 mm. This method makes it a presentable tracer for tissue perfusion of
 anterior bowel wall.
Inclusion Criteria:

 -  Patients with colon cancer requiring elective surgical operation.

 Exclusion Criteria:

 -  Pregnancy

 -  Children or patients below the age of 18 years

 -  Advanced renal or hepatic failure

 -  Previous allergic reactions to ICG and iodide

 -  Chronic anemia

 -  Active haematologic disease

 -  Women of fertile age needed a negative pregnancy test to be included

 -  Patients with previous colectomy or anorectal surgery were also excluded due to
 anatomical insult on mesenterial circulation