Fluorescence Angiography in Colorectal Resection

BACKGROUND:Intraoperative laser fluorescence angiography is a relatively new tool that can be used by colorectal surgeons to ensure adequate perfusion to bowel that remains after resection. It has been used mostly to determine an appropriate point of transection of the proximal bowel, as well as to ensure perfusion after the anastomosis has been constructed. We propose a different use of the technology in complex cases to ensure the ability to safely transect a major vascular pedicle and to ensure that perfusion will remain adequate. OBJECTIVE:The purpose of this article is to describe a new use for fluorescence angiography technology. DESIGN:This is a technical note. SETTINGS:The work was conducted at a tertiary care military medical center. PATIENTS:Patients included individuals requiring oncologic colorectal resection where the status of 1 major vascular pedicle was unknown or impaired. MAIN OUTCOME MEASURES:We assessed perfusion after occlusion of a major vascular pedicle for the short term in hospital outcomes. RESULTS:Adequate studies were obtained, and perfusion was maintained in both patients. Oncologic resections were performed, and short-term outcomes were comparable with any individual undergoing these procedures. LIMITATIONS:This study was limited because it is early experience that was not performed in the setting of a scientific investigation. CONCLUSIONS:Application of intraoperative fluorescence angiography in this setting appears to be safe and may assist the surgeon in estimating reliable vascular perfusion in patients such as these who require oncologic colorectal resection.