title: Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study.
abstract: BACKGROUND
  Our primary objective was to demonstrate the utility and feasibility of the intraoperative assessment of colon and rectal perfusion using fluorescence angiography (FA) during left-sided colectomy and anterior resection. Anastomotic leak (AL) after colorectal resection increases morbidity, mortality, and, in cancer cases, recurrence rates. Inadequate perfusion may contribute to AL. The PINPOINT Endoscopic Fluorescence Imaging System allows for intraoperative assessment of anastomotic perfusion.
  
  
  METHODS
  This is a prospective, multicenter, open-label, clinical trial that assessed the feasibility and utility of FA for intraoperative perfusion assessment during left-sided colectomy and anterior resection at 11 centers in the United States.
  
  
  RESULTS
  A total of 147 patients were enrolled, of whom 139 were eligible for analysis. Diverticulitis (44%), rectal cancer (25%), and colon cancer (21%) were the most prevalent indications for surgery. The mean level of anastomosis was 10 ± 4 cm from the anal verge. Splenic-flexure mobilization was performed in 81% and high ligation of the inferior mesenteric artery in 61.9% of patients. There was a 99% success rate for FA, and FA changed surgical plans in 11 (8%) patients, with the majority of changes occurring at the time of transection of the proximal margin (7%). Overall morbidity rates were 17%. The anastomotic leak rate was 1.4% (n = 2). There were no anastomotic leaks in the 11 patients who had a change in surgical plan based on intraoperative perfusion assessment with FA.
  
  
  CONCLUSIONS
  PINPOINT is a safe and feasible tool for intraoperative assessment of tissue perfusion during colorectal resection. There were no anastomotic leaks in patients in whom the anastomosis was revised based on inadequate perfusion with FA.
authors.affiliation: Department of Surgery, University of California, Irvine Medical Center, Orange, CA.
authors.forename: Mehraneh D
authors.initials: MD
authors.lastname: Jafari
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Wexner
authors.affiliation: Department of Surgery, Beth Israel Medical Center, New York, NY.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Martz
authors.affiliation: Department of Surgery, University of California San Diego Medical Center, La Jolla, CA.
authors.forename: Elisabeth C
authors.initials: EC
authors.lastname: McLemore
authors.affiliation: Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: David A
authors.initials: DA
authors.lastname: Margolin
authors.affiliation: Department of Surgery, Maimonides Medical Center, Brooklyn, NY.
authors.forename: Danny A
authors.initials: DA
authors.lastname: Sherwinter
authors.affiliation: Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.
authors.forename: Sang W
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Surgical Disciplines, Central Michigan University, College of Medicine, Saginaw, MI.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
authors.affiliation: Department of Surgery, University of California, Irvine Medical Center, Orange, CA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Phelan
authors.affiliation: Department of Surgery, University of California, Irvine Medical Center, Orange, CA. Electronic address: mstamos@uci.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control*; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000098:blood supply* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D007208:Indocyanine Green; D007430:Intraoperative Care / Q000295:instrumentation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D012007:Rectum / Q000098:blood supply* / Q000601:surgery; D019265:Spectroscopy, Near-Infrared / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green