Fluorescence angiography for blood flow assess during right hemicolectomy. Case study

Fluorescent laparoscopy enables to visualize blood vessels and blood flow in the organs of the gastrointestinal tract, which can be used in colon resection. Laparoscopic right hemiclectomy was performed in a patient aged 55 years with an adenomatous polyp of Bauginia flap without dysplasia. The operation was performed through four trocars: 1 — 10 mm, 1 — 13 mm, 2 — 5 mm. During surgery, the hepatic flexure of the colon was saved due to the expressed a. colica dextra. After intracorporal ileotransversoanastomosis formation of with the device Endo GIA‑60 fluorescence angiography was performed: Indocyanine green in a dose of 0.3 mg/kg of body weight was injected intravenously. After 2 minutes, in near‑infrared survey regime, a satisfactory vascularization of the terminal ileum mesentery and accumulation of the fluorescing substance in the walls of the ileum and the stomach stump, in particular the finite regions of the stump, have been achieved. Regarding the received data, there was no risk of failure of anastomosis and bowel stump. The operation was completed on a planned extension. No technical difficulties with fluorescence angiography were found. Allergic reactions to the administered drug and the failure of anastomosis were not. The first experience of using fluorescence angiography for assessing blood supply in the anastomosis area during resection of the colon demonstrated the convenience and safety of the technique. Fluorescence angiography helped to evaluate the blood supply to intestinal walls and mesentery, which allowed to execute a limited variant of operation with the preservation of hepatic flexure of the colon with blood supply from a. colica dex.