The role of indocyanine green performing a minimally invasive right colectomy

Despite nowadays minimally invasive surgery is the standard approach for treatment of right colorectal cancer, surgical technique is not yet standardized and severe complications, such as anastomotic leakage, are still reported. Furthermore, some aspects of the technique, as the extension of the lymphadenectomy, are still debated. In recent years, indocyanine green (ICG) fluorescence imaging was introduced in laparoscopic surgery to provide more detailed anatomical information. Based on our experience in the use of ICG fluorescence technology and through a review of literature, this paper defines the possible different applications and potential advantages of ICG fluorescence imaging during laparoscopic right colectomy. A literature search was performed using PubMed, Embase and Cochrane Library database to identify relevant articles on ICG fluorescence guided surgery and laparoscopic right colectomy. In more detail, the paper describes the application of ICG fluorescence angiography to check bowel perfusion intra-operatively and its association with a lower rate of anastomotic leakage, when compared with standard approach. Then, it defines the sentinel lymph node mapping technique, with its possible application in early colon cancer and the importance of lymphatic mapping in detecting aberrant metastases. Finally, experimental applications, such as ureters and tumor tissue identification through fluorescence guided surgery and their potential developments in the future, are reported.