Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 715 - файл
.pdf
188
https://t.me/medicina_free
19. Alander JT, Kaartinen I, Laakso A, Pätilä T, Spillmann T, Tuchin VV,
etal. A review of indocyanine green uorescent imaging in surgery. Int J
Biomed Imaging. 2012;2012:940585. https://doi.
org/10.1155/2012/940585.
20. Desmettre T, Devoisselle JM, Mordon S. Fluorescence properties and
metabolic features of indocyanine green (ICG) as related to angiography.
Surv Ophthalmol. 2000;45(1):15–27. https://doi.org/10.1016/s0039-
6257(00)00123- 5.
21. Dudley NE.Methylene blue for rapid identication of the parathyroids.
Br Med J. 1971;3(5776):680–1. https://doi.org/10.1136/bmj.3.5776.680.
22. Khan MA, North AP, Chadwick DR. Prolonged postoperative altered
mental status after methylene blue infusion during parathyroidectomy: a
case report and review of the literature. Ann R Coll Surg Engl.
2007;89(2):W9–11. https://doi.org/10.1308/147870807x160434.
23. Enny L, Ramakant P, Singh KR, Rana C, Garg S, Mishra AK.Efcacy of
uorescein green dye in assessing intra-operative parathyroid gland vascularity and predicting Post-thyroidectomy hypocalcaemia- a novel prospective cohort study. Indian J Endocrinol Metab. 2020;24(5):446–51.
https://doi.org/10.4103/ijem.IJEM_499_20.
24. Prosst RL, Weiss J, Hupp L, Willeke F, Post S.Fluorescence-guided minimally invasive parathyroidectomy: clinical experience with a novel intraoperative detection technique for parathyroid glands. World J Surg.
2010;34(9):2217–22. https://doi.org/10.1007/s00268- 010- 0621- 2.
25. Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP.Systematic
review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014;101(4):307–20. https://doi.org/10.1002/bjs.9384.
26. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, etal.
Complications of thyroid surgery: analysis of a multicentric study on
14,934 patients operated on in Italy over 5 years. World J Surg.
2004;28(3):271–6. https://doi.org/10.1007/s00268- 003- 6903- 1.
27. Pepe J, Colangelo L, Biamonte F, Sonato C, Danese VC, Cecchetti V,
et al. Diagnosis and management of hypocalcemia. Endocrine.
2020;69(3):485–95. https://doi.org/10.1007/s12020- 020- 02324- 2.
28. Bove-Fenderson E, Mannstadt M. Hypocalcemic disorders. Best Pract
Res Clin Endocrinol Metab. 2018;32(5):639–56. https://doi.org/10.1016/j.
beem.2018.05.006.
29. Hujoel IA.The association between serum calcium levels and Chvostek
sign: a population-based study. Neurol Clin Pract. 2016;6(4):321–8.
https://doi.org/10.1212/cpj.0000000000000270.
30. Falco J, Dip F, Quadri P, de la Fuente M, Rosenthal R.Cutting edge in
thyroid surgery: autouorescence of parathyroid glands. J Am Coll Surg.
2016;223(2):374–80. https://doi.org/10.1016/j.jamcollsurg.2016.04.049.
31. Dip F, Falco J, Verna S, Prunello M, Loccisano M, Quadri P, et al.
Randomized controlled trial comparing White light with near-infrared
autouorescence for parathyroid gland identication during Total thy-
J. Matson et al.
6 Use ofFluorescence Guidance inEndocrine Surgery
https://t.me/medicina_free
roidectomy. J Am Coll Surg. 2019;228(5):744–51. https://doi.
org/10.1016/j.jamcollsurg.2018.12.044.
32. Benmiloud F, Godiris-Petit G, Gras R, Gillot JC, Turrin N, Penaranda G,
etal. Association of Autouorescence-Based Detection of the parathyroid
glands during Total thyroidectomy with postoperative hypocalcemia risk:
results of the PARAFLUO multicenter randomized clinical trial. JAMA
Surg. 2020;155(2):106–12. https://doi.org/10.1001/jamasurg.2019.4613.
33. Kim YS, Erten O, Kahramangil B, Aydin H, Donmez M, Berber E.The
impact of near infrared uorescence imaging on parathyroid function
after total thyroidectomy. J Surg Oncol. 2020;122(5):973–9. https://doi.
org/10.1002/jso.26098.
34. Di Marco AN, Palazzo FF.Near-infrared autouorescence in thyroid and
parathyroid surgery. Gland Surg. 2020;9(Suppl 2):S136–s46. https://doi.
org/10.21037/gs.2020.01.04.
35. DiMarco A, Chotalia R, Bloxham R, McIntyre C, Tolley N, Palazzo
FF. Does uoroscopy prevent inadvertent parathyroidectomy in thyroid
surgery? Ann R Coll Surg Engl. 2019;101(7):508–13. https://doi.
org/10.1308/rcsann.2019.0065.
36. Vidal Fortuny J, Belfontali V, Sadowski SM, Karenovics W, Guigard S,
Triponez F.Parathyroid gland angiography with indocyanine green uorescence to predict parathyroid function after thyroid surgery. Br J Surg.
2016;103(5):537–43. https://doi.org/10.1002/bjs.10101.
37. Jin H, Dong Q, He Z, Fan J, Liao K, Cui M.Application of a uorescence
imaging system with Indocyanine green to protect the parathyroid gland
intraoperatively and to predict postoperative Parathyroidism. Adv Ther.
2018;35(12):2167–75. https://doi.org/10.1007/s12325- 018- 0834- 6.
38. Zaidi N, Bucak E, Yazici P, Soundararajan S, Okoh A, Yigitbas H, etal.
The feasibility of indocyanine green uorescence imaging for identifying
and assessing the perfusion of parathyroid glands during total thyroidectomy. J Surg Oncol. 2016;113(7):775–8. https://doi.org/10.1002/
jso.24237.
39. Spartalis E, Ntokos G, Georgiou K, Zografos G, Tsourouis G,
Dimitroulis D, etal. Intraoperative Indocyanine green (ICG) angiography
for the identication of the parathyroid glands: current evidence and
future perspectives. In Vivo. 2020;34(1):23–32. https://doi.org/10.21873/
invivo.11741.
40. Vidal Fortuny J, Sadowski SM, Belfontali V, Guigard S, Poncet A, Ris F,
etal. Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green uorescence predicting parathyroid
function after thyroid surgery. Br J Surg. 2018;105(4):350–7. https://doi.
org/10.1002/bjs.10783.
41. Rudin AV, McKenzie TJ, Thompson GB, Farley DR, Lyden
ML. Evaluation of parathyroid glands with Indocyanine green uorescence angiography after thyroidectomy. World J Surg. 2019;43(6):1538–
43. https://doi.org/10.1007/s00268- 019- 04909- z.
189
190
https://t.me/medicina_free
42. Razavi AC, Ibraheem K, Haddad A, Saparova L, Shalaby H, Abdelgawad
M, etal. Efcacy of indocyanine green uorescence in predicting parathyroid vascularization during thyroid surgery. Head Neck.
2019;41(9):3276–81. https://doi.org/10.1002/hed.25837.
43. Hartl DOR, Guerlain J, Breuskin I, Abbaci M, Laplace-Builhé
C.Intraoperative parathyroid gland identication using autouorescence:
pearls and pitfalls. World J Surg Surg Res. 2019;2(1):1166.
44. Demarchi MS, Seeliger B, Lifante JC, Alesina PF, Triponez
F.Fluorescence image-guided surgery for thyroid cancer: utility for preventing hypoparathyroidism. Cancers (Basel). 2021;13(15):3792. https://
doi.org/10.3390/cancers13153792.
45. Matson J, Lwin TM, Bouvet M.Rapid intraoperative perfusion assessment of parathyroid adenomas with ICG using a wide-eld portable
hand-held uorescence imaging system. Am J Surg. 2021;223:686.
https://doi.org/10.1016/j.amjsurg.2021.07.027.
46. Barbieri D, Indelicato P, Vinciguerra A, Di Marco F, Formenti AM,
Trimarchi M, etal. Autouorescence and Indocyanine green in thyroid
surgery: a systematic review and meta-analysis. Laryngoscope.
2021;131(7):1683–92. https://doi.org/10.1002/lary.29297.
47. Bunch PM, Kelly HR.Preoperative imaging techniques in primary hyperparathyroidism: a review. JAMA Otolaryngol Head Neck Surg.
2018;144(10):929–37. https://doi.org/10.1001/jamaoto.2018.1671.
48. Feo MLD, Colagrande S, Biagini C, Tonarelli A, Bisi G, Vaggelli L, etal.
Parathyroid glands: combination of 99mTc MIBI scintigraphy and US for
demonstration of parathyroid glands and nodules. Radiology.
2000;214(2):393–402. https://doi.org/10.1148/
radiology.214.2.r00fe04393.
49. Haber RS, Kim CK, Inabnet WB.Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism:
comparison with (99m)technetium sestamibi scintigraphy. Clin
Endocrinol (Oxf). 2002;57(2):241–9. https://doi.
org/10.1046/j.1365- 2265.2002.01583.x.
50. Hamidi M, Sullivan M, Hunter G, Hamberg L, Cho NL, Gawande AA,
etal. 4D-CT is superior to ultrasound and Sestamibi for localizing recurrent parathyroid disease. Ann Surg Oncol. 2018;25(5):1403–9. https://
doi.org/10.1245/s10434- 018- 6367- z.
51. McWade MA, Sanders ME, Broome JT, Solórzano CC, MahadevanJansen A.Establishing the clinical utility of autouorescence spectroscopy for parathyroid detection. Surgery. 2016;159(1):193–202. https://
doi.org/10.1016/j.surg.2015.06.047.
52. Norlén O, Wang KC, Tay YK, Johnson WR, Grodski S, Yeung M, et al.
No need to abandon focused parathyroidectomy: a multicenter study of
long-term outcome after surgery for primary hyperparathyroidism. Ann
Surg. 2015;261(5):991–6. https://doi.org/10.1097/
sla.0000000000000715.
J. Matson et al.
6 Use ofFluorescence Guidance inEndocrine Surgery
https://t.me/medicina_free
53. Demarchi MS, Karenovics W, Bédat B, De Vito C, Triponez
F. Autouorescence pattern of parathyroid adenomas. BJS Open.
2021;5(1):zraa047. https://doi.org/10.1093/bjsopen/zraa047.
54. Chakedis JM, Maser C, Brumund KT, Bouvet M. Indocyanine green
uorescence- guided redo parathyroidectomy. BMJ Case Rep.
2015;2015:bcr2015211778. https://doi.org/10.1136/bcr- 2015- 211778.
55. DeLong JC, Ward EP, Lwin TM, Brumund KT, Kelly KJ, Horgan S, etal.
Indocyanine green uorescence-guided parathyroidectomy for primary
hyperparathyroidism. Surgery. 2018;163(2):388–92. https://doi.
org/10.1016/j.surg.2017.08.018.
56. Di Meo G, Karampinis I, Gerken A, Lammert A, Pellicani S, Nowak
K.Indocyanine green uorescence angiography can guide intraoperative
localization during parathyroid surgery. Scand J Surg.
2019;110:1457496919877581. https://doi.
org/10.1177/1457496919877581.
57. Sound S, Okoh A, Yigitbas H, Yazici P, Berber E.Utility of Indocyanine
green uorescence imaging for intraoperative localization in reoperative
parathyroid surgery. Surg Innov. 2019;26(6):774–9. https://doi.
org/10.1177/1553350615613450.
58. Zaidi N, Bucak E, Okoh A, Yazici P, Yigitbas H, Berber E.The utility of
indocyanine green near infrared uorescent imaging in the identication
of parathyroid glands during surgery for primary hyperparathyroidism. J
Surg Oncol. 2016;113(7):771–4. https://doi.org/10.1002/jso.24240.
59. Cui L, Gao Y, Yu H, Li M, Wang B, Zhou T, etal. Intraoperative parathyroid localization with near-infrared uorescence imaging using
Indocyanine green during total parathyroidectomy for secondary hyperparathyroidism. Sci Rep. 2017;7(1):8193. https://doi.org/10.1038/
s41598- 017- 08347- 6.
60. Vidal Fortuny J, Guigard S, Diaper J, Karenovics W, Triponez F.Subtotal
parathyroidectomy under Indocyanine green angiography.
VideoEndocrinology. 2016;3(1):ve.2015.0056. https://doi.org/10.1089/
ve.2015.0056.
61. Coste T, Caiazzo R, Torres F, Vantyghem MC, Carnaille B, Pattou F, etal.
Laparoscopic adrenalectomy by transabdominal lateral approach: 20
years of experience. Surg Endosc. 2017;31(7):2743–51. https://doi.
org/10.1007/s00464- 016- 4830- 0.
62. Sommerey S, Foroghi Y, Chiapponi C, Baumbach SF, Hallfeldt KK,
Ladurner R, etal. Laparoscopic adrenalectomy—10-year experience at a
teaching hospital. Langenbecks Arch Surg. 2015;400(3):341–7. https://
doi.org/10.1007/s00423- 015- 1287- x.
63. Obermeyer RJ, Knauer EM, Millie MP, Ojeda H, Peters MB Jr, Sweeney
JF. Intravenous methylene blue as an aid to intraoperative localization
and removal of the adrenal glands during laparoscopic adrenalectomy.
Am J Surg. 2003;186(5):531–4. https://doi.org/10.1016/j.amj-
surg.2003.07.011.
191
192
https://t.me/medicina_free
64. Manny TB, Pompeo AS, Hemal AK.Robotic partial adrenalectomy using
indocyanine green dye with near-infrared imaging: the initial clinical
experience. Urology. 2013;82(3):738–42. https://doi.org/10.1016/j.urol-
ogy.2013.03.074.
65. Ashitate Y, Levitz A, Park MH, Hyun H, Venugopal V, Park G, et al.
Endocrine-specic NIR uorophores for adrenal gland targeting. Chem
Commun (Camb). 2016;52(67):10305–8. https://doi.org/10.1039/
c6cc03845j.
66. Moore EC, Berber E.Fluorescence techniques in adrenal surgery. Gland
Surg. 2019;8(Suppl 1):S22–s7. https://doi.org/10.21037/gs.2019.03.01.
67. DeLong JC, Chakedis JM, Hosseini A, Kelly KJ, Horgan S, Bouvet
M.Indocyanine green (ICG) uorescence-guided laparoscopic adrenalectomy. J Surg Oncol. 2015;112(6):650–3. https://doi.org/10.1002/
jso.24057.
68. Colvin J, Zaidi N, Berber E. The utility of indocyanine green uorescence imaging during robotic adrenalectomy. J Surg Oncol.
2016;114(2):153–6. https://doi.org/10.1002/jso.24296.
69. Arora E, Bhandarwar A, Wagh A, Gandhi S, Patel C, Gupta S, etal. Role
of indo-cyanine green (ICG) uorescence in laparoscopic adrenalectomy:
a retrospective review of 55 cases. Surg Endosc. 2018;32(11):4649–57.
https://doi.org/10.1007/s00464- 018- 6309- 7.
70. Kahramangil B, Kose E, Berber E.Characterization of uorescence patterns exhibited by different adrenal tumors: determining the indications
for indocyanine green use in adrenalectomy. Surgery. 2018;164(5):972–
7. https://doi.org/10.1016/j.surg.2018.06.012.
71. Lerchenberger M, Gündogar U, Al Arabi N, Gallwas JKS, Stepp H,
Hallfeldt KKJ, etal. Indocyanine green uorescence imaging during partial adrenalectomy. Surg Endosc. 2020;34(5):2050–5. https://doi.
org/10.1007/s00464- 019- 06985- 7.
72. Crawford KL, Pacheco FV, Lee YJ, Hom M, Rosenthal EL, Nguyen QT,
etal. A scoping review of ongoing uorescence-guided surgery clinical
trials in otolaryngology. Laryngoscope. 2021;132:36. https://doi.
org/10.1002/lary.29891.
J. Matson et al.
Use ofFluorescence
https://t.me/medicina_free
Guidance inBariatric Surgery
EdmundB.Chen, MarkA.Burroughs,
AndreaTrinh, SachinKukreja,
andKeriA.Seymour
Introduction
Bariatric surgery is a durable treatment for morbid obesity with
long-term resolution of obesity-related diseases. In the United
States, the recommendations for bariatric surgery are based on the
National Institutes of Health guidelines from 1991. The indication
for surgery is a body mass index (BMI) greater or equal to 35kg/
m2 with an associated obesity-related comorbidity, or a BMI of
greater or equal to 40kg/m2 [1]. The Roux-en-Y gastric bypass
Supplementary Information The online version contains supplementary
material available at
https://doi.org/10.1007/978- 3- 031- 40685- 0_7.
7
E. B. Chen · K. A. Seymour (*)
Department of Surgery, School of Medicine, Duke University,
Durham, NC, USA
e-mail: keri.seymour@duke.edu
M. A. Burroughs · A. Trinh
Department of Surgery, Methodist Dallas Medical Center,
Dallas, TX, USA
S. Kukreja
Department of Surgery, Methodist Dallas Medical Center,
Dallas, TX, USA
Dallas-Fort Worth Bariatrics and General Surgery, Dallas, TX, USA
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
N. Szoka et al. (eds.), The SAGES Manual of Fluorescence-Guided
Surgery, https://doi.org/10.1007/978-3-031-40685-0_7
193
194
https://t.me/medicina_free
(RYGB) and vertical banded gastroplasty were the two approved
bariatric procedures when these guidelines were rst implemented. According to the American Society for Metabolic and
Bariatric Surgery (ASMBS), an estimated 256,000 bariatric procedures were performed in 2019. Of these procedures, sleeve gastrectomy (SG) comprised 60% of all bariatric surgeries performed,
RYGB was 18%, biliopancreatic diversion with duodenal switch
(BPD/DS) was 1%, and revisional bariatric surgery constituted
17% of all procedures [2]. This chapter will review the indications
and technique of both primary and revisional bariatric surgery and
describe how intraoperative ICG is utilized during these surgeries.
E. B. Chen et al.
Primary Bariatric Surgery
Sleeve Gastrectomy (SG)
The SG was initially performed in 1999 as the rst stage of a
BPD/DS operation for patients with super morbid obesity [3]. The
intestinal bypass was reportedly easier and safer to perform at the
second stage, after patients lost weight. Ultimately, some patients
were able to achieve substantial weight loss with the SG alone.
The SG became a separate procedure and acquired a unique common procedural terminology code in 2011 [4]. The benets of SG
include an average of 55% excess weight loss (%EWL) [5].
Percent EWL is dened as:
%EWL=(Weight loss/Excess weight)×100
Excess weight=Baseline weight−Ideal weight.
The denition of ideal weight can differ, yet a BMI of 2kg/m2
is commonly applied [6].
The SG may be preferable to other primary bariatric surgeries
for specic patients. The International Sleeve Gastrectomy Expert
Panel Consensus Statement recommends SG for transplant candidates, patients with inammatory bowel disease, and elderly
patients. In addition, SG is commonly performed for adolescent
patients undergoing bariatric surgery [7, 8]. The SG results in
7 Use ofFluorescence Guidance inBariatric Surgery
https://t.me/medicina_free
fewer vitamin and mineral deciencies and is technically easier to
perform since there is no anastomosis. There is no risk of marginal ulcers or internal hernias associated with SG like the risk
associated with the RYGB and BPD/DS [9].
A notable disadvantage for SG is the possibility of worsening
gastroesophageal reux disease (GERD), or the incidence of de
novo reux occurring in 5–21% of post-SG patients [10, 11].
Therefore, the International Sleeve Gastrectomy Expert Panel
views the preoperative presence of Barrett’s esophagus as a contraindication to performing SG [7]. In addition, SG may result in
less robust weight loss and weight recidivism, when compared to
other primary bariatric procedures [12, 13].
195
Technique ofSleeve Gastrectomy
After gaining intraperitoneal access, the SG procedure starts with
mobilization of the greater omentum via hemostatic division of
both the gastrocolic and gastrosplenic ligaments. The fundus is
fully mobilized, and the left crus is cleared of peritoneal attachments to expose the angle of His. If encountered, a hiatal hernia is
reduced, and the hiatus is repaired to prevent migration of the
sleeve stomach into the mediastinum. A gastric calibration tube
(typically 34 to 40 French) is then passed into the lumen of the
stomach to prevent narrowing at the incisura and establish symmetry of the SG.Serial staple res create a long staple line starting approximately 3cm to 5cm proximal from the pylorus and
ending lateral to the angle of His. A leak test is performed based
on surgeon preference and may utilize air insufation, methylene
blue, or indocyanine green (ICG) [8].
Incidence and Management of Leaks After Sleeve
Gastrectomy
The leak rate after SG is low at 2.4% according to a meta-analysis
of 29 publications, including 4888 patients [14]. Leak after SG is
associated with a varied range of presentations and subsequent
clinical sequala. According to the International Sleeve Gastrectomy
Expert Panel Consensus Statement, leaks after SG are classied
as acute, early, late, and chronic [7]. Acute leaks are recognized
within 7 days of the SG procedure. Early leaks are dened as
196
https://t.me/medicina_free
E. B. Chen et al.
those that occur between 1week and 6weeks after SG.Late leaks
are observed 6weeks after the SG and a chronic leak persists after
12weeks [7]. A gastrointestinal leak that is not well-contained,
with dissemination into the abdominal or pleural (typically left)
cavity, and with major systemic clinical manifestations will
require immediate intervention [7].
Leaks after SG are generally related to mechanical causes or
from tissue ischemia. Mechanical causes for a leak are often
linked to incomplete staple formation. Some surgeons use the
same staple height for the entire sleeve gastrectomy while other
surgeons vary the staple height based on location and tissue characteristics [15]. The International Sleeve Gastrectomy Expert
Panel Consensus Statement stated it is not appropriate to use a
staple height of less than 1.5mm for any portion of the SG [7].
Operative technique is especially important when understanding
the mechanical causes of sleeve leak. A smaller bougie size and
use of buttressing materials are associated with increased rates of
leak after SG [16, 17]. Narrowing the sleeve at the incisura will
also create high intraluminal pressures and lead to disruption of
the staple line. As esophageal tissue lacks serosa, inclusion of
this weaker tissue into the staple line is another potential source
of leak after SG.Depending on the mechanism, leaks that are the
result of mechanical issues may manifest as early postoperative
day 1 or 2 [18].
In contrast, leaks due to tissue ischemia typically occur later,
around the fth to seventh day after surgery [18]. Poor tissue perfusion and resultant ischemia can occur from overly aggressive
dissection and devascularization of the resultant stomach. In addition, inadvertent thermal injury to the stomach during mobilization may also result in tissue ischemia and an eventual leak.
Gastrointestinal leak after SG is an uncommon and challenging complication to manage. Treatment options are individualized to the patient and based on location, timing of
presentation, and systemic signs of illness. Patients may present with signs of fulminant sepsis, diffuse intra-abdominal
uid, well-contained abscesses, an associated stula, or minimal clinical signs [19]. Conversative methods for controlling
SG leak include antimicrobial therapy, percutaneous drainage
7 Use ofFluorescence Guidance inBariatric Surgery
https://t.me/medicina_free
of intra-abdominal collections, and nutritional support often in
the form of parenteral nutrition. Management of SG leaks via
a conservative approach was successful in 82% of patients
[19]. If supportive measures fail, the next step includes endoscopic therapies that use covered stents, clips, endoluminal
vacuum therapy, or internal drainage [19]. In the appropriate
patient, these endoscopic therapies can be highly effective. In
a meta-analysis, endoscopic stent placement had an initial success rate of 62% [19]. Endoscopic internal drainage was successful for 85% of patients [20].
Surgical intervention is the recommended initial management
for toxic and symptomatic patients and necessary if the above
conservative and endoscopic methods fail. Surgery can be performed both via either laparoscopic or open techniques. Peritoneal washout with drain placement is the procedure most often
performed during the management of the acute SG leak [19]. In
the appropriate patients, surgery was successful as the initial management of acute SG leak in 76% cases. Unfortunately, surgical
management was associated with a 9.7% mortality rate [19]. In
the chronic setting for unresolved leak with a chronic stula, surgery often entails resection of the stula tissue and conversion to
RYGB or esophagojejunostomy.
197
Intraoperative Application ofICG During Sleeve
Gastrectomy
Prevention of a leak after SG is of intense interest to bariatric
surgeons, and uorescence imaging using ICG has emerged as a
promising imaging modality. Given the numerous operative techniques that contribute to staple line disruption and leak after SG,
the ability to perform an intraoperative assessment is of high value
to surgeons. ICG is a water-soluble anionic probe, with excitation
and emission wavelengths of around 778nm and 830nm, respectively. When administered intravenously, the molecule binds to
plasma lipoproteins. ICG is then metabolized by the liver and
excreted into the bile. Tests incorporating ICG have elevated sensitivity, as extremely small concentrations of ICG are visible. In
addition, ICG uniquely offers extraordinary contrast versus other
imaging modalities. The target is illuminated, while the back-
Соседние файлы в папке @xirurgi_2025