The Use of Near-Infrared Fluorescence in Sleeve Gastrectomy

  • Leonard K. Welsh
  • Jin S. Yoo
  • A. Daniel GuerronEmail author


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.


Bariatric surgery Sleeve gastrectomy Indocyanine green Fluorescent imaging Leak prevention 

Supplementary material

Video 10.1

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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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Leonard K. Welsh
    • 1
  • Jin S. Yoo
    • 1
  • A. Daniel Guerron
    • 1
    Email author
  1. 1.Department of Surgery, Division of Metabolic and Weight Loss SurgeryDuke UniversityDurhamUSA

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