ArticleSurgical endoscopy2023
Anastomotic perfusion assessment with indocyanine green in robot-assisted low-anterior resection, a multicenter study of interobserver variation.
Article in Surgical endoscopy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04766060 (Indocyanine Green Enhanced Fluorescent Angiography), which is not on this map. Cited by 18 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Indocyanine Green Enhanced Fluorescent Angiography: Can it Predict Anastomotic Leakage (AL) After Recto-sigmoid Resection for Malignancy, and Are we Able to Evaluate the Findings? -A Small Multi-centre Trial Study
Who cites it
18 citing papers in PubMed, 3 syntheses or guidelines pooled it, 17 citations in OpenAlex.
- Indocyanine green fluorescence-guided perfusion vs. standard assessment to prevent clinical anastomotic leak after colorectal resection: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials with site-specific subgroup analysis.World journal of surgical oncology · 2025Pooled it
- Indocyanine green and height of anastomosis in colorectal surgery- a network meta-analysis.Langenbeck's archives of surgery · 2025Pooled it
- Quantification of indocyanine green fluorescence angiography in colorectal surgery: a systematic review of the literature.Surgical endoscopy · 2025Pooled it
- Real-time intraoperative perfusion assessment using indocyanine green fluorescence angiography as a predictor of anastomotic integrity in colorectal surgery: A systematic review and meta-analysis.Surgery open science · 2026Article
- Decreased fluorescence latency and plateau intensity ratio as predictive markers of intraoperative hypoperfusion: quantitative indocyanine green perfusion analysis in colorectal cancer surgery.Annals of coloproctology · 2026Article
- Assessment of intra-operative bowel perfusion in children using indocyanine green: an exploratory study investigating its effect on surgical management.Pediatric surgery international · 2026Article
- Fluorescence-Guided Surgery in Colorectal Cancer: State-of-the-Art and Translational Perspectives.Current oncology (Toronto, Ont.) · 2026Review
- Improved Quantification of ICG Perfusion Through Motion Compensation in Fluorescence-Guided Surgery.Diagnostics (Basel, Switzerland) · 2026Article
- Beyond fluorescence intensity: a Minimum acquisition and reporting standard and emerging technologies for colorectal indocyanine green fluorescence angiography studies.Frontiers in surgery · 2026Article
- Current Practices and Perceptions of Indocyanine Green Fluorescence Guided Liver Surgery: Insights from a Survey of Hepato-Pancreato-Biliary Surgeons in the United Kingdom.Journal of fluorescence · 2025Article
- Prospective analysis of factors influencing the change of the section line based on fluorescence angiography with ICG for colorectal anastomosis.Techniques in coloproctology · 2025Article
- AUGUR-AIM: Clinical validation of an artificial intelligence indocyanine green fluorescence angiography expert representer.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2025Observational
- Optimal Indocyanine Green Dosage for Repetitive Angiography for Laparoscopic Colorectal Surgery.Medicina (Kaunas, Lithuania) · 2024Article
- Robotic Rectosigmoid Resection with Totally Intracorporeal Colorectal Anastomosis (TICA) for Recurrent Ovarian Cancer: A Case Series and Description of the Technique.Journal of personalized medicine · 2024Article
- Dye-less quantification of tissue perfusion by laser speckle contrast imaging is equivalent to quantified indocyanine green in a porcine model.Surgical endoscopy · 2024Article
- Clinical and computational development of a patient-calibrated ICGFA bowel transection recommender.Surgical endoscopy · 2024Article
- Impact of standardising indocyanine green fluorescence angiography technique for visual and quantitative interpretation on interuser variability in colorectal surgery.Surgical endoscopy · 2024Article
- Quantification of Indocyanine Green Fluorescence Imaging in General, Visceral and Transplant Surgery.Journal of clinical medicine · 2023Review
Corrections and comments
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Authors and funding
15 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSecuring sufficient blood perfusion to the anastomotic area after low-anterior resection is a crucial factor in preventing anastomotic leakage (AL). Intra-operative indocyanine green fluorescent imaging (ICG-FI) has been suggested as a tool to assess perfusion. However, knowledge of inter-observer variation among surgeons in the interpretation of ICG-FI is sparse. Our primary objective was to evaluate inter-observer variation among surgeons in the interpretation of bowel blood-perfusion assessed visually by ICG-FI. Our secondary objective was to compare the results both from the visual assessment of ICG and from computer-based quantitative analyses of ICG-FI between patients with and without the development of AL.
methodA multicenter study, including patients undergoing robot-assisted low anterior resection with stapled anastomosis. ICG-FI was evaluated visually by the surgeon intra-operatively. Postoperatively, recorded videos were anonymized and exchanged between centers for inter-observer evaluation. Time to visibility (TTV), time to maximum visibility (TMV), and time to wash-out (TWO) were visually assessed. In addition, the ICG-FI video-recordings were analyzed using validated pixel analysis software to quantify blood perfusion.
resultsFifty-five patients were included, and five developed clinical AL. Bland-Altman plots (BA plots) demonstrated wide inter-observer variation for visually assessed fluorescence on all parameters (TTV, TMV, and TWO). Comparing leak-group with no-leak group, we found no significant differences for TTV: Hazard Ratio; HR = 0.82 (CI 0.32; 2.08), TMV: HR = 0.62 (CI 0.24; 1.59), or TWO: HR = 1.11 (CI 0.40; 3.11). In the quantitative pixel analysis, a lower slope of the fluorescence time-curve was found in patients with a subsequent leak: median 0.08 (0.07;0.10) compared with non-leak patients: median 0.13 (0.10;0.17) (p = 0.04).
conclusionThe surgeon's visual assessment of the ICG-FI demonstrated wide inter-observer variation, there were no differences between patients with and without AL. However, quantitative pixel analysis showed a significant difference between groups.
trial registrationClinicalTrials.gov Identifier: NCT04766060.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.