Objective:

To provide an overview of current practice patterns and variability in the use of indocyanine green (ICG) fluorescence and intraoperative flexible endoscopy (FE) for assessing bowel perfusion and anastomotic integrity.

Approach:

• Survey Methodology: An international, cross-sectional snapshot survey was conducted among surgeons, focusing on the use of ICG and FE in colorectal surgery.

Key Findings:

• 1,367 surgeons from 83 countries participated, with a mean age of 64.4 years.
• Majority of respondents were affiliated with university hospitals (49%) and had completed general surgery training (86%).
• Surgeons reported low anastomotic leakage rates for right colectomies (77% reported rates < 5%), left colectomies (60% reported rates < 5%), but higher rates for rectal surgery (34% reported rates < 5%).
• ICG fluorescence was used by 23% of surgeons for perfusion assessment before anastomosis, while visual inspection was most common (30.6%).

Interpretation:

The survey results indicate variability in the application of ICG and FE in clinical practice, including differences in protocols and techniques.

Limitations:

• Lack of standardization in the use of ICG and FE across different institutions.
• Survey responses may not represent all surgeons globally due to potential selection bias.

Conclusion:

The study identifies variability in the use of ICG and FE in colorectal surgery, suggesting a need for further investigation into standardized protocols.