title: The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery.
abstract: BACKGROUND
  Hypoperfusion is an important risk factor for anastomotic leakage in colorectal surgery. This study was designed to evaluate the impact of fluorescence imaging on visualization of perfusion and subsequent change of transection line during left-sided robotic colorectal resections.
  
  
  METHODS
  Patients scheduled for robotic left-sided colon or rectal resections were enrolled in this prospective, multicenter study. Resections were performed as per each surgeon's preference. After complete colorectal mobilization, ligation of blood vessels, and distal transection of the bowel, the mesocolon was completely divided to the planned proximal or distal transection line, which was marked in white light. Indocyanine green was injected intravenously and the transection location(s) and/or distal rectal stump, if applicable, were re-assessed in fluorescent imaging mode. Imaging information, perioperative, and early postoperative outcomes were recorded. An independent video review of the surgeries was performed.
  
  
  RESULTS
  Data for 40 patients (20 female/20 male) with a mean age of 63.9 years and a mean body mass index of 27.6 kg/m(2) were analyzed. Fluorescence imaging resulted in a change of the proximal transection location in 40 % (16/40) of patients. There was one change in the distal transection location in a patient with benign disease. The use of fluorescence imaging took an average of 5.1 min of the mean overall operative room time of 232 min. Two patients (5 %) with a change in transection line developed an anastomotic leak at postoperative days 15 and 40.
  
  
  CONCLUSIONS
  Fluorescence imaging provides additional information during determination of transection location in left-sided colorectal procedures. This results in a significant change of transection location, particularly at the proximal transection site. Further research needs to be conducted with larger patient cohorts and in comparative design to determine actual effect on anastomotic leak rate.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Boonshoft School of Medicine, Wright State University, 2300 Miami Valley Drive, Suite 350, Centerville, OH, 45459, USA, minia.hellan@wright.edu.
authors.forename: Minia
authors.initials: M
authors.lastname: Hellan
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Spinoglio
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Lagares-Garcia
mesh_terms: D057868:Anastomotic Leak / Q000517:prevention & control; D003108:Colonic Diseases / Q000175:diagnosis / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods*; D011446:Prospective Studies; D012002:Rectal Diseases / Q000175:diagnosis / Q000601:surgery*; D015203:Reproducibility of Results; D012371:Robotics / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green