PREOPERATIVE TUMOR MARKING WITH INDOCYANINE GREEN (ICG) PRIOR OF ROBOTIC COLORECTAL RESECTION

This prospective case-series study aimed to assess the usefulness of

preoperative colonoscopic marking of colorectal tumors using Indocyanine

Green (ICG) fluorescence in patients that underwent robotic surgical

colorectal resections. Consecutive patients that were eligible for colorectal

resection with intent to cure in a single hospital (Athens Medical Center),

from February 2022 to June 2022, were included. ICG solution was injected

into the submucosal layer at 2 opposite sites (180 degrees apart) distal to the

tumor, without submucosal elevation. Identification of the tumor marking

was then performed after switching to near-infrared (NIR) fluorescence

mode. During the robotic procedure, qualitative evaluation of fluorescence

was performed by the surgical team (primary surgeon, first assistant, second

assistant, research fellow). All 10 patients underwent robotic surgical

approach and operations included right-sided colectomy (n = 1), left-sided

colectomy (n = 6) and low anterior resection (n = 3). Visualisation of this dye

with near-infrared light was very clear with bright intensity in all patients

when the marking was performed one day prior of surgery. Preoperative

tumor marking with ICG was identified intraoperatively in all cases and the

technique was easily reproducible.