Despite advances in surgical techniques, anastomotic leakage (AL) remains a devastating complication following colorectal surgery. The reduction in AL rates through prevention and improved diagnosis and management is the biggest challenge facing colorectal surgeons. Adequate perfusion is an essential requirement for anastomotic integrity and the risk of AL is minimized by intraoperative detection of bowel ischemia. As the mucosa is the most susceptible to ischemia, intraluminal mucosal perfusion assessment may assist surgeons in making decisions.
To date, several intraoperative techniques are used to evaluate anastomotic integrity, including direct visualization of the anastomosis, doughnut examination, air leak test, and, more recently, the use of ICG-NIR fluorescence angiography.
Although the use of fluorescence angiography by colorectal surgeons has increased in recent years, intraluminal ICG-NIR imaging to assess the anastomosis following taTME is not widely reported. This video demonstrates the use of intraluminal ICG-NIR imaging to evaluate perfusion of a handsewn coloanal anastomosis in a 66-year-old man following taTME for low rectal cancer. Using a rigid proctoscope, the transanal ICG-NIR system confirmed excellent perfusion of the proximal conduit and the mucosa along the entire circumference of anastomosis.
Intraluminal assessment of anastomotic perfusion using ICG-NIR imaging is a safe and feasible technique to evaluate anastomotic integrity in real time. It is particularly beneficial for very low and high-risk coloanal anastomoses, such as post-radiation and in the narrow pelvis. Routine use of intraluminal ICG-NIR should be a standard tool to further evaluate high-risk anastomoses.