Live Webinar: ISFGS Round Table 13th August 2020

Defining Standards in Fluorescence Guided Surgery

The International Society for Fluorescence Guided Surgery will host a round table on August 13th 2020, 9.00pm EST Time (US and Canada).

The round table will be facilitated through a live webinar and will feature a discussion from Dr. Raul Rosenthal, Dr. Fernando Dip, Dr. Michael Bouvet and Dr. Eren Berber on the standards of fluorescence guided surgery and the use of Indocyanine Green, ICG in endocrine surgery.

If you wish to register, go to the link here, spaces are limited.

Use of NIFC Cholangiography for the Identification of the Anatomy in Biliary Surgery

Use of Near-infrared Incisionless Fluorescent Cholangiography (NIFC) for Identification of the Anatomy in Biliary Surgery Francisco

Authors: A. Ferri, MD; Felice De Stefano, MD; Vicente J. Cogollo, MD; Alejandro Cracco, MD; Emanuele Lo Menzo, MD, PhD, FACS, FASMBS; Mayank Roy, MD, FACS; Fernando Dip, MD, FACS.
Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida.

Summary: Bile duct injuries during laparoscopic cholecystectomy remain a potentially devastating complications and are responsible for major morbidity and prolonged hospitalization1. Visual misperception, anatomical variations in the extrahepatic biliary tree, combined with inflammatory changes and surgeon inexperience in recognizing the anatomy, are among the most common reasons for these injuries. Near-infrared Incisionless Fluorescent Cholangiography (NIFC) has been shown to improve the visualization and identification of the biliary structures compared to traditional white light.

Patient Background: The following case study discusses a 37 years old, morbidly obese woman (BMI 43 Kg/m2) with impaired fasting glucose and no significant surgical history who presented to the clinic with a 3-month history of right upper quadrant (RUQ) abdominal pain, especially after meals. The physical exam revealed tenderness in the RUQ with a negative Murphy sign and no evidence of peritonitis. An ultrasound showed a 3.8 cm gallstone without gallbladder wall thickening and hepatic steatosis. Esophagogastroduodenoscopy did not reveal any pathologic findings. The patient was referred to the bariatric surgery clinic for evaluation in view of her elevated BMI and her comorbidity. After discussing surgical options, the patient elected to undergo a combined laparoscopic sleeve gastrectomy and cholecystectomy using NIFC.

Procedure: Under general anesthesia, the abdominal cavity was accessed through an optical trocar in the supraumbilical position. After insertion of accessory trocars, a sleeve gastrectomy was performed in standard fashion. Next, 3mL of Indocyanine green for Injection, USP (ICG) were injected
intravenously. The gallbladder was cranially retracted. The hepatoduodenal ligament was exposed. Using near-infrared imaging we identified the ICG perfusion times of the liver, common hepatic duct and gallbladder at 1, 12 and 22 minutes after the injection of the ICG, respectively (Figures 2-4).
The cystic duct and cystic artery entrance into the gallbladder were both clearly identified (Figure 5) and transected between clips. The very large and chronically inflamed gallbladder was excised from the liver bed in retrograde fashion and retrieved with the specimen through the umbilicus. All trocar sites were closed with sutures and injected with local anesthesia.

For images, references and conclusions please click here

HTA Approach on Surgical Endoscopy Procedures using ICG

Indocyanine Green ICG use in Fluorescence Guided Surgery

Economic Health Technology Assessment (HTA) Approach on Surgical Endoscopy Procedures using Indocyanine Green (ICG)

Authors: Vettoretto, N; Foglia, E; Ferrario, L; Gerardi, C; Molteni, B; Nocco, U; Lettieri, E; Molfino, S; Baiocchi, G.L; Elmore, U; Rosati, R; Currò, G; Cassinotti, E; Boni, L; Cirocchi, R; Marano, A, Petz, W.L; Arezzo, A; Bonino, M.A; Davini, F; Biondi, A; Anania A; Agresta, A; Silecchia, G.

This paper offers a summary of a number of key findings published in Surgical Endoscopy, April 2020.
Could fluorescence‑guided surgery be an efficient and sustainable option? A SICE (Italian Society of Endoscopic Surgery) health technology assessment summary.

A paper published in Surgical Endoscopy, April 2020, undertook a Health Technology Assessment (HTA) approach to investigate the economic, social, ethical and organizational implications related to the adoption of ICG based fluorescence guided surgery, summurizing the key findings.

With the support of a multidisciplinary team, qualitative and quantitative data were collected, by means of literature evidence, validated Questionnaires and self reported interviews. Research included a systematic search of literature. This present paper, under the patronage of Italian Society of Endoscopic Surgery, based on an Health Technology Assessment (HTA) approach, supports “the use of fluorescence guided vision in minimally invasive surgery, ….as an efficient and economically sustainable technology”.

The use of fluorescence guided vision in minimally invasive surgery, ….as an efficient and economically sustainable technology

Recently image-guided by indocyanine green (ICG) fluorescence has been introduced in minimally invasive clinical practice. The fluorescence approach is detected thanks to special cameras that are sensitive to the nearinfrared (NIR) spectrum. Indocyanine Green (ICG) absorbs Near-infrared light (NIR) at wavelengths of 800 to 810 nm. This fluorophore emits fluorescence at 830 nm when bound to tissue proteins if excited, with specific wavelength light in the Near-infrared light (NIR) spectrum (w820 nm).

85% of those interviewed believe Indocyanine Green (ICG) Fluorescence Guided Surgery will become standard in the near future

Fifty-six surgeons working in both teaching and community, public and private hospitals (covering 75% of the Italian regions), answered a questionnaire. 66.1% of the respondents already used fluorescence during their everyday practice. 63.3% of the surgeons consider Indocyanine Green (ICG) fluorescence guided surgery as an improvement of their practice, while 62.5% think that this technology can help in surgical education. When asked about the potential growth of Indocyanine Green (ICG), 85% of those interviewed believe that it has the potential to become a standard vision technology, in the near future.

“The use of ICG is perceived as improving the precision of the surgical technique, the identification of the blood vessels, allowing for a better image quality compared with standard white light”

To read the full summary of the paper click here

Full reference Source: Could fluorescence‑guided surgery be an efficient and sustainable option? A SICE (Italian Society of Endoscopic Surgery) health technology assessment (HTA) summary

Case Study: Colorectal Surgery

Evaluation of Anastomotic Perfusion following Laparoscopic Anterior Resection with Coloanal Anastomosis
A case study by Dr. Cyrus Jahansouz, Dr. Hayim Gilshtein and Dr. Steven D. Wexner, Cleveland Clinic Florida, USA

Summary: A cornerstone of colorectal surgery is the bowel anastomosis. Anastomotic leak is a devastating complication to the patient that can result in infection, sepsis, and even death.1 Healing of the anastomosis depends on both the patient’s general health condition as well as technical factors related to surgery, namely the creation of a well perfused and tension free anastomosis. The evaluation of anastomotic perfusion at the time of surgery remains a significant challenge, even to the most experienced of colorectal surgeons. Ensuring adequate blood flow at the anastomosis has the potential to reduce anastomotic leaks and improve patient outcomes following colorectal
surgery. Real-time visualization of tissue perfusion using the Indocyanine Green (ICG) pharmaceutical enables real-time assessment of anastomotic tissue perfusion allowing for a rapid determination of adequacy of the bowel anastomosis.

Case Details: The following case study Evaluation of Anastomotic Perfusion following Laparoscopic Anterior Resection with Coloanal Anastomosis discusses a patient who underwent laparoscopic anterior resection with coloanal anastomosis for rectal cancer. The patient is a 77 year old female who presented after a rectal mass was discovered during a colonoscopy. Further imaging and biopsy results were consistent with the diagnosis of a Stage 2 (T3, N0, M0) rectal cancer, the distal edge of which was situated approximately 7 cm from the anal verge. After discussion at National Accreditation for Rectal Cancer multidisciplinary tumor board, a laparoscopic anterior resection with coloanal anastomosis was offered to the patient.

Procedure: The procedure began laparoscopically with mobilization of the descending and sigmoid colon and splenic flexure, followed by high ligations of the inferior mesenteric artery and vein. The mesentery was intracorporeally divided to the distal descending colon and a total mesorectal excision was undertaken. A Lone Star retractor® (Cooper Surgical, Trumbull, CT) was placed and a circumferential full thickness incision was made 1 cm above the dentate line. Once dissection was completed, the specimen containing the tumor was carefully delivered though a wound protector placed through the enlarged umbilical port site. After resection of the rectosigmoid, a 5 cm x 5 cm colonic J-pouch was fashioned and delivered to the perineum; 3.5 mL of Indocyanine Green for Injection, USP (ICG) followed by 10 mL of saline solution was administered. Fluorescence angiography
confirmed excellent serosal perfusion of the colonic J pouch (Figure A). A hand-sewn coloanal anastomosis was then fashioned, and an additional 3.5 mL of ICG was administered confirming excellent mucosal perfusion of the anastomosis (Figure B). In addition, a reverse leak test was undertaken.

For the conclusion and full list of references please download the case study here.

SAGES Annual Meeting goes Virtual for 2020

It has been announced by the SAGES Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2020 Annual Meeting will now be held as a Virtual Meeting in 2020 and not take place at the at Huntington Convention Center of Cleveland, Cleveland, Ohio.

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) informed the industry of their decision yesterday, 10th June that due to Covid-19 and the unknowns surrounding the pandemic that they will now hold a virtual event. 

sages.org/meetings/(opens in a new tab)

Further details to follow over the next week, so watch out for updates @sages_updates twitter account.

#sages2020

Virtual AORN Global Surgical Conference and Expo

The Association of periOperative Registered Nurses (AORN) have created an online training and education expo for 2020, in light of COVID-19.

The Virtual AORN Expo 2020 is available free of charge for members of the AORN and will run from now until the end of July. You can download the App at the Apple App Store or Google Play, just search for “AORN Expo”. And if you are not a member, you can join the AORN for access.

Diagnostic Green are delighted to team up with Pfiedler, Continuing Nursing and Allied Health Education Provider, to contribute to the educational sessions with their learning guide Fluorescence Guided Surgery: A Nurse’s Guide to ICG. And you can find us at the Virtual Booth 8254 once logged into the portal.

The International Colorectal Disease Symposium, Jerusalem, Israel 2020

The International Colorectal Disease Symposium will take place at the David Citadel Hotel, Jerusalem from 25th – 28th February 2020 and Diagnostic Green are proud to be one of the main sponsors of this prestigious event and to participate as an exhibitor.

This meeting is a Joint Annual Meeting of the Israel Society of Colon and Rectal Surgery and is attended by experts in the world of Colorectal Surgery.

Day 1 of the event takes place on February 25th and features The Fluorescence Imaging Day , which the 2020 program feature a full day of presentations from various stakeholders in Florescence Guided Surgery. This program is endorsed by the ISFGS.

From Wednesday 26th key sessions will take place, hosted and presented by key experts in Colorectal Surgery, read the details of the Scientific Program for the International Colorectal Disease Symposium

Our Sales Team are available to meet with you at the Diagnostic Green booth in the exhibition hall or if you would like to set up an appointment, you can contact Stephen Henderson, Mike Broome or Ron Clarke on our website at Diagnostic Green Executive Team where you will find all their details or contact info@diagnosticgreen.com.

We look forward to meeting you at this year’s International Colorectal Disease Symposium Jerusalem, Israel.

Written by Diagnostic Green, February 2020

Diagnostic Green at 19th Surgery of the Foregut Symposium, Miami, 2020

The 19th Surgery of the Foregut Symposium will take place at the Biltmore Hotel, Coral Gables, Florida from 15th – 19th February 2020 and Diagnostic Green are proud to participate as an exhibitor at this prestigious event.

The event features world-renowned gastrointestinal surgeons, gastroenterologists and oncologists who will present their expertise and update audiences on the most recent technological and therapeutic advances in their field.

The 2020 scientific sessions will feature a full day and a half for the 7th International Conference on Fluorescent Guided Imaging Surgery, under the leadership of Dr. Fernando Dip, ISFGS President.

During the International Conference on Fluorescent Guided Imaging Surgery event, attendees will discover the fascinating and promising developments in the field of Fluorescent Guided Surgery, FGS and discover how to the use near infrared light combined with Indocyanine Green, ICG and alternative probes will enhance better visualization of critical anatomical structures. 

The program outlines that the third day will be devoted to Foregut Surgical Management followed by further scientific sessions on the fourth day. For full details go to Surgery of Foregut Symposium to find out more.

Our Sales Team are available to meet with you at the Diagnostic Green booth in the exhibition hall or if you would like to set up an appointment, you can contact Mike Broome or Ron Clarke on our website at Diagnostic Green Executive Team where you will find all their details.

We look forward to meeting you at this year’s Surgery of the Foregut Symposium.

Written by Diagnostic Green, February 2020

Diagnostic Green attending American College of Surgeons, Annual Scientific Meeting

The 2020 Annual Scientific Meeting of the Southern California Chapter, American College of Surgeons will be held from January 10-12, 2020 at the Four Seasons Resort Biltmore Santa Barbara in Santa Barbara, CA and Diagnostic Green are delighted to announce they will be exhibition at this event.

For more details about the Annual Scientific Meeting click here

Diagnostic Green will attend American College of Surgeons, Clinical Congress 2019, Booth 213

Diagnostic Green are delighted to announce that our team will attend the American College of Surgeons, Clinical Congress 2019 from 27th – 31st October, San Francisco. Find us at booth 213.

The Ehibit Hall is located in Moscone South Halls ABC and has more than 170 companies who will display products and services for advanced surgical patient care.

More than 8,000 domestic and international surgeons will arrive in San Francisco, CA, for the Clinical Congress, which is one the largest surgical meetings. This year the Clinical Congress 2019 will be held at the Moscone Center on 27th–31st October, with the exhibition taking place 28th–30th October 2019.

More details about this American College of Surgeons, Clinical Congress 2019 click here.

If you are attending and wish to make an appointment with one of our team contact Ron Clark or Mike Broom here.