P346 The application of indocyanine green during robotic surgery for IBD

Abstract

Background: Despite many technological advances the anastomotic leak after low anterior rectal resection (LAR) occur in 1-39% of cases, nullifying the benefits of mininvasive approach. An insufficient bowel perfusion represents the main factor for an anastomotic failure, but unfortunately until now its evaluation is based on the subjective impression of the surgeon. The use of Indocyanine Green (ICG) can be useful to obtain a real-time guided surgery evaluating both the macroscopic vascular anatomy and the perfusion of microcirculation. Methods: We performed a retrospective case-control analysis of 55 patients (28 males; 27 females) who underwent to robotic LAR between 1 September 2016 and 1 February 2017. We divided them into two groups according the use (30) or not (25) of the fluorescence imaging. In order to evaluate the effect of ICG fluorescence on post-operative anastomotic fistula rate we injected before the rectal transection 0.1 mg/kg of ICG intravenously, in both groups an air leak test was performed after the anastomosis. Results: Some high-risk condition (diabetes, obesity, cardiac and Crohn's disease) were more prevalent in the ICG group than control (25 vs. 12%). The median level of anastomosis was 4 cm for the ICG group and 4.5 for the no-ICG group. No difference was observed in the ileostomy confection rate, as well as in intraoperative blood loss and overall operative time (260 vs. 272 min). The activation of fluorescence imaging lead to change the transection line in 10/30(30%) of patients. We observed a reduction of postoperative fistula rate (3/30 10% vs. 5/25 20%) in the ICG group, with a single event occurred in a patient older than 70 who underwent to preoperative radiation therapy and therefore treated by percutaneous drainage. The overall risk of leak in the ICG patients was reduced by 10%, as well as the length of hospital stay (8 vs. 13 days). Conclusions: The ICG application can reduce significantly the postoperative fistula rate caused by hypoperfusion. Further investigations regarding new possible clinical applications are strongly required.