Author: joannerenew

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

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.

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

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 ISL XXVII world congress took place in Buenos Aires last week with a great mix of lymphology and related specialists gathering from around the world.  Buenos Aires was a most welcoming city, with beautiful spring-like weather for us all to enjoy.  As an exhibitor, Diagnostic Green met with  many colleagues including members of the executive committee such as Dr Amore (Argentina), Dr Campisi (Italy) as well as Scientific Program presenters including Dr Dip and Prof Masia. 

One of the key topics of interest for Diagnostic Green was the Near Infrared Guided Procedures in Lymphology session run by the International Society for Fluorescence Guided Surgery (ISFGS)  and chaired by Drs Dip and Amore.  Run on the Tuesday morning, it covered such topics as Principles of NIR techniques by Dr Dip; Evaluation of Peripheral lymphedema using ICG lymphology by Dr Takumi (Japan) and Barcelona Lymphedema Algorithm for Surgical Treatment – the importance of the ICG assessment by Prof Masia (Spain).

We are already looking forward to the ISL XXVIII congress, which we hope will be equally as successful as the event in Argentina this year.