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      • A PROSPECTIVE STUDY OF REAL TIME IDENTIFICATION OF LINE OF TRANSECTION IN ROBOTIC RECTAL CANCER SURGERY BY ICG

        Priya Kapoor,Somashekhar SP,Shabber Zaveri,Amit Rauthan,Poonam Patil,Ashwin KR,Rohit Kumar 대한종양외과학회 2021 대한임상종양학회 학술대회지 Vol.2021 No.6

        Background/Aims Colorectal anastomosis carries a high risk of leak from 1 to 30 %. Of the many risk factors, lack of anastomotic blood supply is a correctable cause during surgery. With the development of ICG enhanced fluorescence guided imaging system capable of real time monitoring, objective assessment of blood flow to colon has become possible. We believed not only surgical experts but also beginners would be able to draw safe transection lines during surgery Methods Prospective study – October 2018 to August 2019. After distal transection, the line of proximal transection of the bowel was subjectively assessed by the surgical team and marked point B. Volume injected - 3 ml of ICG in a concentration of 2.5mg/ml IV followed by 10ml of distilled water flush. The line of demarcation was identified in the firefly mode and marked point A if it was proximal to clinical judgement point (point B) and as point C if it moved distally. The perfusion images were recorded and assessed in real time. Results Total number of patients was 50. The average Age of the patients was 54years. 32 were male and 18 were female. Line of transection moved proximally in 3 patients, distally in 41 patients and remained the same in 6 patients. Intraoperative decision changed in 88% of our patients Conclusions It has changed the intra operative decision in 88% of our patients. Can avoid anastomotic failure. Splenic flexure mobilisation could have been avoided in 82% of patients. This resolves the ambiguity of precarious blood supply of sigmoid. It is technically easy, reproducible and safe and larger studies are needed to provide evidence for its routine use in robotic rectal cancer surgery.

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