Live surgeryJune 6, 20234:40:0013 speakersAvailable in: EN / IT
Live Surgery: ICG-guided Sigmoidectomy/Left Hemicolectomy for Sigmoid Cancer
Live surgery of laparoscopic ICG-guided left hemicolectomy for proximal sigmoid cancer, with multidisciplinary discussion and faculty lectures.
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Clinical case
Adenocarcinoma del sigma prossimale, substenosante, a manicotto
Patient framing as discussed at case introduction
SexM
Age57
StagecT3-T4 N+ (adenopatie sospette nel meso del sigma)
DiagnosisAdenocarcinoma del sigma prossimale, substenosante, a manicotto
Prior treatmentMarcatura endoscopica con ICG/glicerolo eseguita la mattina dell'intervento
Clinical historyIpertensione arteriosa, obesità addominale e viscerale, ipertrofia prostatica; protorragia recente che ha portato a colonoscopia diagnostica
NotesDiscussione multidisciplinare: nessuna indicazione a neoadiuvante. Candidato a emicolectomia sinistra laparoscopica ICG-guidata.
Overview
First event of the third edition of the Permanent School of ICG Fluorescence-Guided Surgery, led by Gian Luca Baiocchi in Cremona with moderators Nereo Vettoretto and Marco Confalonieri. The day features a live laparoscopic ICG-guided left hemicolectomy in a 57-year-old man with sub-stenosing adenocarcinoma of the proximal sigmoid and suspicious adenopathies in the sigmoid mesentery.
The episode alternates live surgery with structured educational segments: multidisciplinary case presentation (oncology with Romanini and Grizzi, radiology, endoscopy with Roberto Grazia, who illustrates endoscopic tattooing of the lesion using ICG carried in glycerol), discussion on bowel preparation (lecture by Alberto Arezzo with data from the Coloral and Oralev trials), patient positioning and blended anesthesia with epidural, choice of laparoscopic access, energy devices (lecture by Gabriele Anania on radiofrequency vs ultrasound), the Knight-Griffen technique (lecture by Nicola De Angelis from Paris), and mechanical staplers.
During the procedure, Baiocchi performs a targeted ICG-guided lymphadenectomy preserving the inferior mesenteric artery and superior rectal artery, selectively ligating the main sigmoid artery identified as the true lymphatic pedicle. High vs low ligation strategies are extensively discussed with Michele Masetti, along with intracorporeal side-to-side anastomosis (with intra- vs extracorporeal comparison with Scabini), specimen quality, and finally postoperative management with the issue of protective loop colostomy vs ileostomy. The episode highlights the philosophy of fluorescence-guided 'colon sparing surgery' as a possible evolution of colorectal oncologic surgery.
Topics
Preoperative endoscopic tattooing with ICG
CT staging and the role of MRI
Neoadjuvant therapy in colon cancer and MSI
Sentinel lymph node in rectal cancer
Bowel preparation and oral antibiotics (Coloral, Oralev)
Antithrombotic prophylaxis and immunonutrition
Patient positioning and prevention of brachial plexus injury
Blended anesthesia and TAP block
Laparoscopic access (open vs Veress)
Energy devices: radiofrequency vs ultrasound
High vs low ligation of the inferior mesenteric artery
LAR syndrome and genitourinary function
Intracorporeal vs extracorporeal anastomosis
Knight-Griffen technique and dog ears vs tennis racket
Mechanical staplers and tree staple line
Intraoperative checks of the anastomosis
Protective colostomy vs ileostomy
Specimen quality and lymphadenectomy
Fluorescence-guided colon sparing surgery
Tools used
Verde di indocianina (ICG)Glicerolo come veicolo per marcatura endoscopicaPentax i-Scan (cromoendoscopia virtuale)Ligasure (radiofrequenza bipolare avanzata)Ultrasuoni (Harmonic)Suturatrice lineare meccanicaSuturatrice circolare (Tree Staple)Hem-o-lok / clip in titanioSistema di imaging in fluorescenza StrykerMaterassino a depressioneCatetere periduraleMost CareDrenaggio Jackson-Pratt / tubulare
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