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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2021; 27(38): 6374-6386
Published online Oct 14, 2021. doi: 10.3748/wjg.v27.i38.6374
Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art
Roberto Peltrini, Mauro Podda, Simone Castiglioni, Maria Michela Di Nuzzo, Michele D'Ambra, Ruggero Lionetti, Maurizio Sodo, Gaetano Luglio, Felice Mucilli, Salomone Di Saverio, Umberto Bracale, Francesco Corcione
Roberto Peltrini, Maria Michela Di Nuzzo, Michele D'Ambra, Ruggero Lionetti, Maurizio Sodo, Gaetano Luglio, Umberto Bracale, Francesco Corcione, Department of Public Health, University of Naples Federico II, Napoli 80131, Italy
Mauro Podda, Department of Emergency Surgery, Cagliari University Hospital "Duilio Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari 09100, Italy
Simone Castiglioni, Felice Mucilli, Department of Medical, Oral and Biotechnological Sciences, University G. D’Annunzio Chieti-Pescara, Pescara 65100, Italy
Salomone Di Saverio, Department of General Surgery, University of Insubria, ASST Sette Laghi, Varese 21100, Italy
Author contributions: Peltrini R, Castiglioni S, Di Nuzzo MM, Bracale U, Crocione F designed the study; Peltrini R, Castiglioni S, Di Nuzzo MM, Podda M, D’Ambra M, Lionetti R, Sodo M, Luglio acquired and interpreted the data; Peltrini R, Podda M, Castiglioni S, Di Nuzzo MM wrote the manuscript; Peltrini R, Podda M, Sodo M, Luglio G, Mucilli F, Di Saverio S, Bracale U, Corcione F made critical revisions; All authors approved the final version.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Roberto Peltrini, MD, Surgeon, Department of Public Health, University of Naples Federico II, Via Pansini 5, Napoli 80131, Italy. roberto.peltrini@gmail.com
Received: April 18, 2021
Peer-review started: April 18, 2021
First decision: June 30, 2021
Revised: June 30, 2021
Accepted: August 18, 2021
Article in press: August 18, 2021
Published online: October 14, 2021
Abstract

Indocyanine green (ICG) fluorescence imaging is widely used in abdominal surgery. The implementation of minimally invasive rectal surgery using new methods like robotics or a transanal approach required improvement of optical systems. In that setting, ICG fluorescence optimizes intraoperative vision of anatomical structures by improving blood and lymphatic flow. The purpose of this review was to summarize all potential applications of this upcoming technology in rectal cancer surgery. Each type of use has been separately addressed and the evidence was investigated. During rectal resection, ICG fluorescence angiography is mainly used to evaluate the perfusion of the colonic stump in order to reduce the risk of anastomotic leaks. In addition, ICG fluorescence imaging allows easy visualization of organs such as the ureter or urethra to protect them from injury. This intraoperative technology is a valuable tool for conducting lymph node dissection along the iliac lymphatic chain or to better identifying the rectal dissection planes when a transanal approach is performed. This is an overview of the applications of ICG fluorescence imaging in current surgical practice and a synthesis of the results obtained from the literature. Although further studies are need to investigate the real clinical benefits, these findings may enhance use of ICG fluorescence in current clinical practice and stimulate future research on new applications.

Keywords: Indocyanine green, Fluorescence imaging, Near infrared, Rectal cancer, Total mesorectal excision, Anastomotic leakage

Core Tip: There is growing interest in real-time fluorescence-guided surgery. The intraoperative use of indocyanine green (ICG) during rectal cancer surgery has found many applications over time. Given the wide availability in current practice, it is important for clinicians to be aware of all potential uses of ICG fluorescence technology in order to facilitate the procedures, limit injuries, and improve outcomes. Herein, we provide a concise overview of the literature regarding the use of ICG fluorescence imaging in this setting.