Real-Time Fluorescence Vessel Navigation Using Indocyanine Green During Laparoscopic Colorectal Cancer Surgery

Abstract

Background/aim: Indocyanine green (ICG) fluorescence technique is known to help visualize blood vessels. The efficacy of real-time fluorescence vessel navigation (FVN) using ICG for ligation of the inferior mesenteric vein (IMV) and left colic artery (LCA) during laparoscopic left colorectal cancer surgery was investigated.

Patients and methods: Participants were 59 patients who underwent laparoscopic left colorectal cancer surgery from February 2017 to November 2018, and were divided into groups: i) with FVN (FVN+, n=21) and ii) without FVN (FVN-, n=38). Groups were compared for the time it took to ligate their IMV and LCA.

Results: The results are expressed as median values. The time to ligate the IMV and LCA was significantly shorter for FVN+ (230 seconds; range 126-346) than for FVN- (417.5 seconds; range 137-1327) (p<0.001).

Conclusion: Real-time FVN using ICG shortened the times for IMV and LCA ligation. This was enabled by clear visualization of the direction of the bloodstream flow inside the vessels. This technique simplifies vessel ligation and safer laparoscopic surgery for left colorectal cancer.

Keywords: Indocyanine green fluorescence; colorectal cancer; vessel navigation.