TY - JOUR
T1 - Use of fluorescence imaging and indocyanine green during colorectal surgery
T2 - Results of an intercontinental Delphi survey
AU - Wexner, Steven
AU - Abu-Gazala, Mahmoud
AU - Boni, Luigi
AU - Buxey, Kenneth
AU - Cahill, Ronan
AU - Carus, Thomas
AU - Chadi, Sami
AU - Chand, Manish
AU - Cunningham, Chris
AU - Emile, Sameh Hany
AU - Fingerhut, Abe
AU - Foo, Chi Chung
AU - Hompes, Roel
AU - Ioannidis, Argyrios
AU - Keller, Deborah S.
AU - Knol, Joep
AU - Lacy, Antonio
AU - de Lacy, F. Borja
AU - Liberale, Gabriel
AU - Martz, Joseph
AU - Mizrahi, Ido
AU - Montroni, Isacco
AU - Mortensen, Neil
AU - Rafferty, Janice F.
AU - Rickles, Aaron S.
AU - Ris, Frederic
AU - Safar, Bashar
AU - Sherwinter, Danny
AU - Sileri, Pierpaolo
AU - Stamos, Michael
AU - Starker, Paul
AU - van den Bos, Jacqueline
AU - Watanabe, Jun
AU - Wolf, Joshua H.
AU - Yellinek, Shlomo
AU - Zmora, Oded
AU - White, Kevin P.
AU - Dip, Fernando
AU - Rosenthal, Raul J.
N1 - Funding Information: Luigi Boni, Danny Sherwinter, Fernando Dip, Raul Rosenthal, Kevin White, and Steven Wexner are members of the ISFGS Advisory Board. None of the industry sponsors were actively involved in any process of the Delphi consensus or drafting, review, or revision of the manuscript. All companies are sponsors/Corporate Council members of the ISFGS. Funding Information: This article is published as part of a supplement supported by the International Society for Fluorescence Guided Surgery (ISFGS) with funding from Arthrex, Diagnostic Green, Intuitive, Medtronic, Olympus, Karl Storz Endoscopy, Stryker, and Richard Wolf. Publisher Copyright: © 2022 The Authors
PY - 2022/12/1
Y1 - 2022/12/1
N2 - BACKGROUND: Fluorescence imaging with indocyanine green is increasingly being used in colorectal surgery to assess anastomotic perfusion, and to detect sentinel lymph nodes. METHODS: In this 2-round, online, Delphi survey, 35 international experts were asked to vote on 69 statements pertaining to patient preparation and contraindications to fluorescence imaging during colorectal surgery, indications, technical aspects, potential advantages/disadvantages, and effectiveness versus limitations, and training and research. Methodological steps were adopted during survey design to minimize risk of bias. RESULTS: More than 70% consensus was reached on 60 of 69 statements, including moderate-strong consensus regarding fluorescence imaging's value assessing anastomotic perfusion and leak risk, but not on its value mapping sentinel nodes. Similarly, although consensus was reached regarding most technical aspects of its use assessing anastomoses, little consensus was achieved for lymph-node assessments. Evaluating anastomoses, experts agreed that the optimum total indocyanine green dose and timing are 5 to 10 mg and 30 to 60 seconds pre-evaluation, indocyanine green should be dosed milligram/kilogram, lines should be flushed with saline, and indocyanine green can be readministered if bright perfusion is not achieved, although how long surgeons should wait remains unknown. The only consensus achieved for lymph-node assessments was that 2 to 4 injection points are needed. Ninety-six percent and 100% consensus were reached that fluorescence imaging will increase in practice and research over the next decade, respectively. CONCLUSION: Although further research remains necessary, fluorescence imaging appears to have value assessing anastomotic perfusion, but its value for lymph-node mapping remains questionable.
AB - BACKGROUND: Fluorescence imaging with indocyanine green is increasingly being used in colorectal surgery to assess anastomotic perfusion, and to detect sentinel lymph nodes. METHODS: In this 2-round, online, Delphi survey, 35 international experts were asked to vote on 69 statements pertaining to patient preparation and contraindications to fluorescence imaging during colorectal surgery, indications, technical aspects, potential advantages/disadvantages, and effectiveness versus limitations, and training and research. Methodological steps were adopted during survey design to minimize risk of bias. RESULTS: More than 70% consensus was reached on 60 of 69 statements, including moderate-strong consensus regarding fluorescence imaging's value assessing anastomotic perfusion and leak risk, but not on its value mapping sentinel nodes. Similarly, although consensus was reached regarding most technical aspects of its use assessing anastomoses, little consensus was achieved for lymph-node assessments. Evaluating anastomoses, experts agreed that the optimum total indocyanine green dose and timing are 5 to 10 mg and 30 to 60 seconds pre-evaluation, indocyanine green should be dosed milligram/kilogram, lines should be flushed with saline, and indocyanine green can be readministered if bright perfusion is not achieved, although how long surgeons should wait remains unknown. The only consensus achieved for lymph-node assessments was that 2 to 4 injection points are needed. Ninety-six percent and 100% consensus were reached that fluorescence imaging will increase in practice and research over the next decade, respectively. CONCLUSION: Although further research remains necessary, fluorescence imaging appears to have value assessing anastomotic perfusion, but its value for lymph-node mapping remains questionable.
UR - http://www.scopus.com/inward/record.url?scp=85142940404&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.surg.2022.04.016
DO - https://doi.org/10.1016/j.surg.2022.04.016
M3 - Article
C2 - 36427929
SN - 0039-6060
VL - 172
SP - S38-S45
JO - Surgery
JF - Surgery
IS - 6
ER -