Work

Perioperative splanchnic perfusion variation around colorectal surgery using both indocyanine green spectrophotometry and fluorescence angiography

Year: 2026

Type: article

Abstract: BACKGROUND: Indocyanine green (ICG) fluorescence enables validated clinical assessment of both global splanchnic perfusion, via specialised peripheral pulse spectrophotometry, and local intestinal perfusion, via near-infrared fluorescence angiography (ICGFA). This exploratory study investigated perioperative variations and correlations in measurements by these technologies, including their possible relevance with outcomes, in patients undergoing colorectal surgery. METHODS: In consenting patients, plasma disappearance rate (PDR) and percentage of residual ICG at 15 min (ICGR15) were measured preoperatively, intraoperatively and on postoperative day four using ICG-pulse spectrophotometry (LiMON, Getinge). ICGFA (Pinpoint, Stryker) was visually judged by an experienced surgeon concurrently with LiMON assessment intraoperatively and with quantitative analysis of fluorescence intensity-time curves in a subgroup of recorded procedures. RESULTS: Twenty-eight patients were included, of whom 22 (79%) underwent segmental colorectal resection with primary anastomosis in 19 (68%). While no significant within-subject variation in LiMON-derived perfusion indices evidenced across measurement time points, there was substantial inter-subject variation (notably with age > 65 years and distal resections), especially intraoperatively. Patients having distal resections tended towards greater postoperative rebound. Although patients who developed complications exhibited relatively reduced ICGR15 intraoperatively (p = 0.041), there was no significant association with severe complications. Exploratory regression analyses found a modest association between spectrophotometric PDR values and fluorescence-derived parameters, including maximum intensity and time to peak intensity. CONCLUSION: Intraoperative splanchnic perfusion varies substantially, particularly during distal colorectal resections. Although qualitative ICGFA may not reflect global hypoperfusion, quantitative fluorescence analysis shows concordance with spectrophotometric findings, supporting its potential as a complementary intraoperative perfusion-monitoring tool in colorectal surgery.

Source: Surgical Endoscopy