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Cassinotti E, Al-Taher M, Antoniou SA, Arezzo A, Baldari L, Boni L, Bonino MA, Bouvy ND, Brodie R, Carus T, Chand M, Diana M, Eussen MMM, Francis N, Guida A, Gontero P, Haney CM, Jansen M, Mintz Y, Morales-Conde S, Muller-Stich BP, Nakajima K, Nickel F, Oderda M, Parise P, Rosati R, Schijven MP, Silecchia G, Soares AS, Urakawa S, Vettoretto N. European Association for Endoscopic Surgery (EAES) consensus on Indocyanine Green (ICG) fluorescence-guided surgery. Surg Endosc 2023; 37:1629-1648. [PMID: 36781468 PMCID: PMC10017637 DOI: 10.1007/s00464-023-09928-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/28/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND In recent years, the use of Indocyanine Green (ICG) fluorescence-guided surgery during open and laparoscopic procedures has exponentially expanded across various clinical settings. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on this topic with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS An expert panel of surgeons has been selected and invited to participate to this project. Systematic reviews of the PubMed, Embase and Cochrane libraries were performed to identify evidence on potential benefits of ICG fluorescence-guided surgery on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by the panel; they were then submitted to all EAES members through a two-rounds online survey and results presented at the EAES annual congress, Barcelona, November 2021. RESULTS A total of 18,273 abstracts were screened with 117 articles included. 22 statements and 16 recommendations were generated and approved. In some areas, such as the use of ICG fluorescence-guided surgery during laparoscopic cholecystectomy, the perfusion assessment in colorectal surgery and the search for the sentinel lymph nodes in gynaecological malignancies, the large number of evidences in literature has allowed us to strongly recommend the use of ICG for a better anatomical definition and a reduction in post-operative complications. CONCLUSIONS Overall, from the systematic literature review performed by the experts panel and the survey extended to all EAES members, ICG fluorescence-guided surgery could be considered a safe and effective technology. Future robust clinical research is required to specifically validate multiple organ-specific applications and the potential benefits of this technique on clinical outcomes.
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Affiliation(s)
- E Cassinotti
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy.
| | - M Al-Taher
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - S A Antoniou
- Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - L Baldari
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - L Boni
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - M A Bonino
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Brodie
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - T Carus
- Niels-Stensen-Kliniken, Elisabeth-Hospital, Thuine, Germany
| | - M Chand
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - M Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - M M M Eussen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - A Guida
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - P Gontero
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - C M Haney
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Y Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
| | - B P Muller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Oderda
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - P Parise
- U.O.C. Chirurgia Generale, Policlinico di Abano Terme, Abano Terme, PD, Italy
| | - R Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - M P Schijven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, North Holland, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
| | - G Silecchia
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A S Soares
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - S Urakawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - N Vettoretto
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Montichiari, Italy
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Vettoretto N, Foglia E, Ferrario L, Gerardi C, Molteni B, Nocco U, Lettieri E, Molfino S, Baiocchi GL, Elmore U, Rosati R, Currò G, Cassinotti E, Boni L, Cirocchi R, Marano A, Petz WL, Arezzo A, Bonino MA, Davini F, Biondi A, Anania G, Agresta F, Silecchia G. Could fluorescence-guided surgery be an efficient and sustainable option? A SICE (Italian Society of Endoscopic Surgery) health technology assessment summary. Surg Endosc 2021; 34:3270-3284. [PMID: 32274626 DOI: 10.1007/s00464-020-07542-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Indocyanine green fluorescence vision is an upcoming technology in surgery. It can be used in three ways: angiographic and biliary tree visualization and lymphatic spreading studies. The present paper shows the most outstanding results from an health technology assessment study design, conducted on fluorescence-guided compared with standard vision surgery. METHODS A health technology assessment approach was implemented to investigate the economic, social, ethical, and organizational implications related to the adoption of the innovative fluorescence-guided view, with a focus on minimally invasive approach. With the support of a multidisciplinary team, qualitative and quantitative data were collected, by means of literature evidence, validated questionnaires and self-reported interviews, considering the dimensions resulting from the EUnetHTA Core Model. RESULTS From a systematic search of literature, we retrieved the following studies: 6 on hepatic, 1 on pancreatic, 4 on biliary, 2 on bariatric, 4 on endocrine, 2 on thoracic, 11 on colorectal, 7 on urology, 11 on gynecology, 2 on gastric surgery. Fluorescence guide has shown advantages on the length of hospitalization particularly in colorectal surgery, with a reduction of the rate of leakages and re-do anastomoses, in spite of a slight increase in operating time, and is confirmed to be a safe, efficacious, and sustainable vision technology. Clinical applications are still presenting a low evidence in the literature. CONCLUSION The present paper, under the patronage of Italian Society of Endoscopic Surgery, based on an HTA approach, sustains the use of fluorescence-guided vision in minimally invasive surgery, in the fields of general, gynecologic, urologic, and thoracic surgery, as an efficient and economically sustainable technology.
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Affiliation(s)
- N Vettoretto
- Chirurgia Montichiari, Azienda Socio Sanitaria Territoriale Degli Spedali Civili, V.le Ciotti 154, Montichiari, 25018, Brescia, Italy.
| | - E Foglia
- LIUC - Università Cattaneo, Castellanza, VA, Italy
| | - L Ferrario
- LIUC - Università Cattaneo, Castellanza, VA, Italy
| | - C Gerardi
- Centro di Politiche Regolatorie, Istituto di Ricerche Farmacologiche "Mario Negri" IRCCS, Milan, Italy
| | - B Molteni
- Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy
| | - U Nocco
- Ingegneria Clinica, Azienda Socio Sanitaria Territoriale dei Sette Laghi, Varese, Italy
| | - E Lettieri
- School of Management, Department of Management, Economics and Industrial Engineering, Politecnico, Milano, Italy
| | - S Molfino
- Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy
| | - G L Baiocchi
- Department of Clinical and Experimental Surgery, University of Brescia, Brescia, Italy
| | - U Elmore
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - R Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - G Currò
- Department of Human Pathology of Adult and Evolutive Age, University Hospital of Messina, Messina, Italy
| | - E Cassinotti
- Chirurgia Generale, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
| | - L Boni
- Chirurgia Generale, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
| | - R Cirocchi
- Department of Surgical Sciences, University of Perugia, Perugia, Italy
| | - A Marano
- Chirurgia Generale ed Oncologica, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - W L Petz
- Chirurgia, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - M A Bonino
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - F Davini
- Centro multidisciplinare Chirurgia Robotica, Chirurgia Toracica mini-invasiva e Robotica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A Biondi
- Chirurgia Generale, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - G Anania
- Chirurgia Generale, University of Ferrara, Ferrara, Italy
| | - F Agresta
- Chirurgia Generale, Azienda ULSS 5 "Polesana", Hospital of Adria, Adria, RO, Italy
| | - G Silecchia
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome-Polo Pontino, Rome, Italy
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Binda GA, Bonino MA, Siri G, Di Saverio S, Rossi G, Nascimbeni R, Sorrentino M, Arezzo A, Vettoretto N, Cirocchi R. Multicentre international trial of laparoscopic lavage for Hinchey III acute diverticulitis (LLO Study). Br J Surg 2018; 105:1835-1843. [PMID: 30006923 DOI: 10.1002/bjs.10916] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic lavage was proposed in the 1990s to treat purulent peritonitis in patients with perforated acute diverticulitis. Prospective randomized trials had mixed results. The aim of this study was to determine the success rate of laparoscopic lavage in sepsis control and to identify a group of patients that could potentially benefit from this treatment. METHODS This retrospective multicentre international study included consecutive patients from 24 centres who underwent laparoscopic lavage from 2005 to 2015. RESULTS A total of 404 patients were included, 231 of whom had Hinchey III acute diverticulitis. Sepsis control was achieved in 172 patients (74·5 per cent), and was associated with lower Mannheim Peritonitis Index score and ASA grade, no evidence of free perforation, absence of extensive adhesiolysis and previous episodes of diverticulitis. The operation was immediately converted to open surgery in 19 patients. Among 212 patients who underwent laparoscopic lavage, the morbidity rate was 33·0 per cent; the reoperation rate was 13·7 per cent and the 30-day mortality rate 1·9 per cent. Twenty-one patients required readmission for early complications, of whom 11 underwent further surgery and one died. Of the 172 patients discharged uneventfully after laparoscopic lavage, a recurrent episode of acute diverticulitis was registered in 46 (26·7 per cent), at a mean of 11 (range 2-108) months. Relapse was associated with younger age, female sex and previous episodes of acute diverticulitis. CONCLUSION Laparoscopic lavage showed a high rate of successful sepsis control in selected patients with perforated Hinchey III acute diverticulitis affected by peritonitis, with low rates of operative mortality, reoperation and stoma formation.
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Affiliation(s)
- G A Binda
- Department of Surgery, Galliera Hospital, Genoa, Italy
| | - M A Bonino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - G Siri
- Scientific Directorate, Galliera Hospital, Genoa, Italy
| | - S Di Saverio
- Maggiore Hospital Regional Emergency Surgery and Trauma Centre, Bologna Local Health District, Emergency and Trauma Surgery Unit, Bologna, Italy
- Colorectal Surgery and Emergency Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - G Rossi
- Section of Colorectal Surgery, Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - R Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - M Sorrentino
- Department of Surgery, Azienda per l'Assistenza Sanitaria n.2 'Bassa Friulana-Isontina', Hospital of Latisana-Palmanova, Latisana, Italy
| | - A Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - N Vettoretto
- Department of Surgery, Montichiari Hospital, Ospedali civili di Brescia, Montichiari, Italy
| | - R Cirocchi
- Department of General Surgery and Surgical Oncology, Hospital of Terni, University of Perugia, Terni, Italy
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