Yonsei Med J.  2013 Jul;54(4):1066-1069. 10.3349/ymj.2013.54.4.1066.

Intraoperative Near Infrared Fluorescence Imaging in Robotic Low Anterior Resection: Three Case Reports

• Bae SU
• Baek SJ
• Hur H
• Baik SH
• Kim NK
• Min BS

• KMID: 2158248
• DOI: http://doi.org/10.3349/ymj.2013.54.4.1066

Abstract

The recent introduction of an intraoperative near infrared fluorescence (INIF) imaging system installed on the da Vinci Si(R) robotic system has enabled surgeons to identify intravascular NIF signals in real time. This technology is useful in identifying hidden vessels and assessing blood supply to bowel segments. In this study, we report 3 cases of patients with rectal cancer who underwent robotic low anterior resection (LAR) with INIF imaging for the first time in Asia. In September 2012, robotic-assisted rectal resection with INIF imaging was performed on three consecutive rectal cancer patients. LAR was performed in 2 cases, and abdominoperineal resection was performed in the third case. INIF imaging was used to identify the left colic branch of the inferior mesenteric artery and to assess blood supply to the distal rectum. We evaluated the utility of INIF imaging in performing robotic-assisted colorectal procedures. Our preliminary results suggest that this technique is safe and effective, and that INIF imaging may be a useful tool to colorectal surgeons.

Keyword

Robotics; fluorescence; indocyanine green; rectal neoplasms

MeSH Terms

Aged
Digestive System Surgical Procedures/*methods
Female
Fluorescence
Humans
Image Processing, Computer-Assisted/instrumentation/*methods
*Intraoperative Care
Male
Middle Aged
Rectal Neoplasms/*surgery
Rectum/*surgery
Robotics/*methods
Spectroscopy, Near-Infrared/*methods
Treatment Outcome

Figure

• 

  Fig. 1 White light imaging (A) and INIF imaging (B) of dissection around the root of the IMA. Yellow circle demarcates left colic branch from IMA hidden in mesenteric tissue. LCA, left colic artery; IMA, inferior mesenteric artery; INIF, intraoperative near infrared fluorescence.

• 

  Fig. 2 In contrast to standard white light imaging (A), margin (yellow arrows) between fluorescent normal and ischemic rectum was readily apparent (B).

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