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USE OF INDOCYANINE GREEN (ICG) FLUORESCENCE IN MINIMALLY INVASIVE ESOPHAGECTOMY TO ASSESS CONDUIT VASCULARITY
Ian Yu Hong Wong*, Siu Y. Chan, Daniel King Hung Tong, Kwan Kit Chan, Claudia Wong, Tsz Ting Law, Simon Law
Surgery, The University of Hong Kong, Hong Kong, Hong Kong
Introduction: Poor perfusion of the organ used to restore intestinal continuity after esophagectomy can lead to anastomotic leaks and even conduit necrosis. Intraoperative assessment of vascularity by visual inspection alone may not be adequate. Indocyanine green (ICG) florescence imaging may be useful in aiding this assessment. This is a study investigating the utility of this method as applied in minimally invasive esophagectomy.
Methods: Patients who underwent esophagectomy with stomach or right ileo-colonic conduit used to restore intestinal continuity were recruited. In addition to visual inspection of the gastric or ileo-colonic conduit intraoperatively, ICG florescence imaging was used as an additional adjunct to assess vascularity. This was correlated with postoperative outcome. Other morbidities were also captured.
Results: From October 2014 to December 2015, 33 patients were recruited in the study; 29 of whom had gastric conduits and 4 had right ileo-colonic loops. Eight gastric conduits had suboptimal blood supply judged on ICG fluorescence imaging. With subsequent resection of the relatively ischemic portion of the gastric conduit before construction of the esophageal anastomosis, good postoperative outcome was achieved. Only one patient had an anastomotic leak, which was minor and easily managed. The reason for leak was most likely related to anastomotic technique rather than poor vascularity. No patient had conduit necrosis. There was no postoperative mortality. Using software to analyze conduit perfusion, gastric conduits with poor perfusion had reduced rates of ICG ingress and egress, as shown by fluorescence measurements.
Conclusions: ICG fluorescence imaging is a potentially useful intraoperative adjunct in assessment of vascularity of the conduit used for esophageal replacement. More objective numerical criteria should be developed in the future in addition to simple visual assessment.
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