Variability of Splanchnic Blood Flow During Colorectal Surgery Assessed by ICG Technologies

Overview

This study prospectively evaluated splanchnic perfusion variability in colorectal surgery patients using indocyanine green peripheral pulse spectrophotometry (ICG-PPS) and fluorescence angiography (ICGFA). Findings demonstrated significant perioperative fluctuations in splanchnic blood flow and highlighted the complementary roles of quantitative PPS and qualitative ICGFA in assessing intestinal perfusion.

Background

Adequate splanchnic and intestinal perfusion is critical for healing and reducing anastomotic leakage after colorectal surgery. Despite normal systemic blood pressure, splanchnic blood flow can vary due to physiological adaptations such as splanchnic shunting triggered by anesthesia, sepsis, or pneumoperitoneum during minimally invasive surgery. Traditional intraoperative assessment relies on surgeon judgment of intestinal appearance, but validated technologies using indocyanine green (ICG) allow objective measurement of splanchnic perfusion. ICG-PPS provides quantitative data on hepatosplanchnic blood flow, while ICGFA offers real-time visual assessment of local intestinal perfusion.

Data Highlights

Key Findings

• Splanchnic blood flow exhibits significant variability perioperatively in colorectal surgery patients despite stable systemic hemodynamics.
• ICG-PPS provides quantitative, reproducible measurements of hepatosplanchnic perfusion correlating with clinical status.
• ICGFA offers qualitative, real-time visualization of intestinal tissue perfusion, aiding intraoperative decision-making.
• Combined use of ICG-PPS and ICGFA may help identify patients at increased risk of postoperative complications such as anastomotic leakage.
• Standardized anesthetic protocol and timing of measurements enhance reliability of perfusion assessment.

Clinical Implications

Incorporating ICG-PPS and ICGFA into colorectal surgery practice can improve detection of splanchnic hypoperfusion that is not apparent from systemic parameters alone. This may guide intraoperative strategies to optimize intestinal perfusion and potentially reduce complications like anastomotic leakage. Routine perioperative monitoring with these technologies could enhance patient risk stratification and postoperative management.

Conclusion

This exploratory study demonstrates that perioperative splanchnic perfusion is dynamic and can be effectively assessed using complementary ICG-based technologies. These findings support further research into their role for improving outcomes in colorectal surgery.

References

1. ClinicalTrials.gov NCT04220242 -- Study Protocol
2. Clavien-Dindo Classification -- Surgical Complications
3. Pulsion Medical Systems -- LiMON ICG-PPS Technology
4. Stryker Corp -- Pinpoint Fluorescence Imaging System