Near infrared imaging in colorectal surgery

Abstract

Introduction: Near infrared imaging technologies are developing quickly. The injection of a dye with the use of a near infrared scope allow to identify structures that are not visible on the regular spectrum. We describe in this work the main applications for colorectal surgery, one for the study of the microvacularisation of the anastomosis and the second on lymphnode mapping for colorectal cancer. Method Indocyanine green(ICG) is the dye used for this application, it is very safe. A stimulation of the dye after its injection by a near infrared light allows to see it with the use of the appropriate scope. Three scope are currently used for this application in minimally invasive surgery, the Pinpoint (Novadaq), the Olympus prototype and the D-Light (Storz) . Results: The use of this technology allowed to see the microvascularisation of an anastomosis in real time, this could potentially lead to a decrease in leak rate or anastomotic trouble. The use of the NIR technology is at the early beginning for lymphnode mapping, but seems very promising if we can prove the concept of sentinel lymphnode in laparoscopic colorectal surgery. Early results show the possibility to identify primary lymphnodes in the lymphatic route in real time, shortly after injection. Conclusion: The use of ICG and the near infrared technology allows to increase reality in a way that was never possible before. Both indications (microcirculation assessment and lymphnode mapping) are relevant from a clinical point of view and should therefore be further investigated