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Benčurik V, Skrovina M, Martínek L, Bartoš J, Macháčková M, Dosoudil M, Štěpánová E, Přibylová L, Briš R, Anděl P, Hlavíková H. Fluorescent angiography in colorectal surgery, the influence of augmented reality in the operating room on the anastomotic leakage after low rectal resection. Rozhl Chir 2021; 100:543-551. [PMID: 35021848 DOI: 10.33699/pis.2021.100.11.543-551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Near-infrared (NIR) fluorescence angiography (FA) is an augmented reality (AR) technique. When used in the operating room, it allows colorectal surgeons to visualize and evaluate intestinal blood flow in real time, identify lymph nodes, ureters, or peritoneal metastases. Evaluation of perfusion with FA in augmented reality mode has an impact on reducing the ALR (anastomotic leakage rate) in rectal resections. METHODS Data analysis of patients after minimally invasive surgery (MIS) for middle and lower rectal adenocarcinoma with total mesorectal excision (TME) using fluorescent angiography (FA) with indocyanine green (ICG) (100 patients, 20152019) were subsequently compared with a historical control group (100 patients) operated on for the same diagnosis before the introduction of the FA-ICG method (20122015) using minimally invasive approach (MIS). The patients were operated on consequently at one workplace. RESULTS In fifteen patients (15%), the resection line was shifted due to insufficient perfusion detected by FA-ICG. The incidence of AL was lower in the group with FA compared to the group without FA (9% vs. 19%, p=0.042, χ test). A retrospective analysis of the group revealed a significant risk factor (RF) for the anastomotic leak, namely diabetes (p=0.036) and, among others, a protective factor, application of the transanal drain (NoCoil) (p=0.032). CONCLUSION The introduction of new procedures and the use of new technologies, such as the use of the FA method in the AR mode in resections of the rectum with TME for cancer can lead to a reduction in the incidence of anastomotic leakage.
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Benčurik V, Škrovina M, Martínek L, Bartoš J, Macháčková M, Dosoudil M, Štěpánová E, Přibylová L, Briš R, Vomáčková K. Intraoperative fluorescence angiography and risk factors of anastomotic leakage in mini-invasive low rectal resections. Surg Endosc 2020; 35:5015-5023. [PMID: 32970211 DOI: 10.1007/s00464-020-07982-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND One of the prerequisites for proper healing of the anastomosis after a colorectal resection is adequate blood supply to the connected intestinal segments. It has been proposed that adequate visualization of the blood flow using indocyanine green (ICG) could lead to the reduction in the incidence of anastomotic leakage (AL). The aim of this study was to assess the effectiveness of intraoperative fluorescence angiography (FA) in decreasing the incidence of AL after minimally invasive low anterior resection (LAR) with total mesorectal excision (TME) in rectal cancer patients and to determine predictors of anastomotic leak. METHODS From August 2015 to January 2019, data from 100 patients who underwent mini-invasive TME for rectal cancer using FA with indocyanine green (ICG) were prospectively collected and analyzed. They were compared with retrospectively analyzed data from a historical control group operated by one team of surgeons before the introduction of FA from November 2012 to August 2015 (100 patients). All patients from both groups were operated sequentially in one oncological center in Nový Jičín. RESULTS The incidence of AL was significantly lower in the ICG group (19% vs. 9%, p = 0.042, χ2 test). In fifteen patients in the ICG group (15%), the resection line was moved due to insufficient perfusion. Using Pearson's χ2 test, diabetes (p = 0.036) and application of a transanal drain (NoCoil) (p = 0.032) were identified as other risk factors (RFs) for AL. CONCLUSION The use of ICG to visualize tissue perfusion in low rectal resections for cancer can lead to a reduction of AL.
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Affiliation(s)
- Vladimír Benčurik
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic. .,AGEL Research and Training Institute, Prostejov, Czech Republic.
| | - Matej Škrovina
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic.,Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic.,AGEL Research and Training Institute, Prostejov, Czech Republic
| | - Lubomír Martínek
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic.,Department of Surgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Jiří Bartoš
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic
| | - Mária Macháčková
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic
| | - Michal Dosoudil
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic
| | - Erika Štěpánová
- Department of Surgery, Hospital Novy Jicin, Purkyňova 2138/16, Novy Jicin, 74101, Czech Republic
| | - Lenka Přibylová
- Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, Ostrava, Czech Republic
| | - Radim Briš
- Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, Ostrava, Czech Republic
| | - Katherine Vomáčková
- Department of Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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