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The Use of Near-Infrared Fluorescence in Sleeve Gastrectomy

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Video Atlas of Intraoperative Applications of Near Infrared Fluorescence Imaging

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Abstract

Obesity is the most prevalent chronic disease in the United States and bariatric surgery stands as the best treatment. Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric operation performed in the United States. Leaks after LSG are rare but represent the most serious complication. The majority of leaks occur in the proximal third of the stomach near the angle of His, and ischemia is the most likely etiology. Indocyanine green (ICG) is an ideal compound to assess tissue perfusion intraoperatively, and ICG fluorescence angiography during LSG can be used to identify blood supply patterns. Confirming adequate perfusion of the remnant sleeve stomach minimizes perfusion compromise and prevents potential serious postoperative complications including leaks and strictures. ICG can also be used in anastomotic operations such as gastric bypass and biliopancreatic diversion with duodenal switch with many potential future applications.

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Authors and Affiliations

  1. Department of Surgery, Division of Metabolic and Weight Loss Surgery, Duke University, Durham, NC, USA

    Leonard K. Welsh, Jin S. Yoo & A. Daniel Guerron

Authors
  1. Leonard K. Welsh
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  2. Jin S. Yoo
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  3. A. Daniel Guerron
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Corresponding author

Correspondence to A. Daniel Guerron .

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Editors and Affiliations

  1. Department of General Surgery, Digestive Disease and Surgery Institute Cleveland Clinic Foundation, Cleveland, OH, USA

    Essa M. Aleassa

  2. Division of General Surgery Division of Surgical Oncology MetroHealth System, Cleveland, OH, USA

    Kevin M. El-Hayek

Electronic Supplementary Material

Near-infrared fluorescence in laparoscopic sleeve gastrectomy. An initial dose of 1–2 mL of indocyanine green solution dose is given and cardiac enhancement (first red arrow) should be seen followed by enhancement of the left inferior phrenic artery (second red arrow). The gastrohepatic ligament is inspected for accessory arteries (red circle). Sleeve construction is performed with care to not injure the identified inferior phrenic artery (red arrow). A repeat dose of 3–5 mL of solution is given to verify artery preservation (red arrow). Right-side dominant variant: the left gastric is seen enhancing first (red circle) briefly followed by the left inferior phrenic artery (red arrow) (MP4 657578 kb)

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Welsh, L.K., Yoo, J.S., Guerron, A.D. (2020). The Use of Near-Infrared Fluorescence in Sleeve Gastrectomy. In: Aleassa, E., El-Hayek, K. (eds) Video Atlas of Intraoperative Applications of Near Infrared Fluorescence Imaging. Springer, Cham. https://doi.org/10.1007/978-3-030-38092-2_10

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  • DOI: https://doi.org/10.1007/978-3-030-38092-2_10

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