Meta-analysis shows ICGFA lowers anastomotic leak rates, confirming surgeon judgment and guiding intraoperative decisions.

MUV Taskforce defines multimodal imaging criteria to diagnose and monitor MEWDS, aiding in accurate uveitis classification and care.

Background Indocyanine green fluorescence angiography (ICGFA) during colorectal surgery either reassures surgeons regarding intestinal perfusion sufficiency or prompts changed surgical strategy by indicating unsuspected insufficiency. This study describes existing evidence supporting ICGFA use in colorectal surgery, particularly regarding impact on intraoperative decisions. Methods Searches were performed on PubMed, ScienceDirect, Scopus, Web of Science, Cochrane Collaboration databases on 5th December 2023, updated to 19th August 2024. Full English language publications of clinical studies in human patients undergoing colorectal resection with primary anastomosis with the use of ICGFA to assess bowel perfusion intraoperatively, with a control group, were included. Pooling of anastomotic leak (AL) rates was performed for primary outcome analysis with odds ratio (OR) and number-needed-to-treat (NNT) calculated regarding leak reduction. Results 45 studies comprising 14,333 patients were included, with 7 randomised controlled trials (2911 patients). Overall, AL rate was 6.8%, 4.5% with ICGFA and 8.5% without (OR:0.47, p < 0.001, NNT 23), increasing to 9.5%, 7.5% and 11.6%, respectively, in randomised controlled trials (OR:0.62, p < 0.01, NNT 25). In rectal resections, AL rate was 4.7% with ICGFA vs 11.5% without (OR: 0.38, p < 0.0001). 26 studies performed ICGFA before and after anastomosis formation and 19 used ICGFA only prior to bowel transection, with no significant difference of AL rate reduction on subgroup testing. ICGFA prompted a change in surgical plan in 8.4% of thirty-four studies reporting this. Interestingly, in these studies, leak rates overall were 3.7% when ICGFA matched surgeon judgement versus 5.7% when it prompted change (OR 0.51, p < 0.0025), versus 7.7% without (OR 0.45, p < 0.0001). In rectal resections, these figures were 5%, 8.8% (OR 0.42, p = 0.01) and 12.0% (OR0.39, p < 0.0001), respectively. Conclusions ICGFA colorectal perfusion assessment is associated with lower anastomotic leak rates, especially when confirming surgeons’ judgement, and may so stratify patients post-operatively regarding subsequent anastomotic leak rate.

Systematic review shows ICG-FA reduces anastomotic leaks by 55%, improving perfusion assessment without raising complications.

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ICG-FA shows promise in trauma surgery for assessing perfusion, guiding debridement, and reducing complications. More studies are needed.

AUGUR-AIM validates AI-driven ICGFA interpretation in colorectal surgery, aiming to match expert decisions and improve surgical outcomes.