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. in a new tab)

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


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

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.

Update from the 2019 World Lymphology Congress, Argentina

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.

World Lymphology Congress 2019, Buenos Aires

Speak to member of the Diagnostic Green team at this years World Lymphology Congress 2019 taking place from 23rd – 26th September, at the Catholic University of Argentina, Buenos Aires.

This years event will host sessions on Surgery for Lymphedema, Physical Theray for lymphedema, Diagnostics and New Technologies for Lymphedema. A full line up of speakers is announced here and promises to deliver outstanding content.

Program details can be found by clicking on the link here

Full details of the event can be found here. If you wish to arrange a one to one with one of our experts at the event please email

27th International Congress of Lymphology, Buenos Aires

Diagnostic Green are delighted to announce the team will attend the 27th International Congress of Lymphology in Buenos Aires, 23 – 26 September 2019.

Topics which will be covered this year include: Basic Lymphology, Lymphedema, Surgical treatment, Vascularized lymph-node transfer, LVA techniques, Lymph-lymphatic transfer and The future of lymphedema surgery to name a few.

More details of our attendance will be announced closer to the date of the congress. For more information on eh International Congress of Lymphology click here