The Role of Indocyanine Green (ICG) Fluorescence Imaging on Anastomotic Leak in Robotic Colorectal Surgery

NCT ID: NCT02598414

Last Updated: 2015-11-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE2/PHASE3

Total Enrollment

102 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-11-30

Study Completion Date

2017-12-31

Brief Summary

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In colorectal surgery, anastomotic leak and its septic consequences still remain as the most concerning complications resulting in substantial morbidity and mortality. A common determining factor for assessing the viability of a bowel anastomosis is adequate arterial perfusion to ensure sufficient local tissue oxygenation. Intraoperative near-infrared fluorescence (INIF) imaging using indocyanine green (ICG) dye is a novel technique which allows the surgeon to choose the point of transection at an optimally perfused area before creating a bowel anastomosis. Recently, the INIF imaging system has been installed on the robotic systems and this helps identify intravascular NIF signals in real time.

Although reports from several case series and retrospective cohorts have described the feasibility and safety of this imaging system during robotic colorectal surgery, to date, no studies have addressed more systematically the outcomes of this technique in robotic surgery. Considering the limitations of these reports, investigators aim to conduct a prospective randomized trial to compare robotic procedures with or without INIF imaging in patients undergoing colorectal surgery.

Detailed Description

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Conditions

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Colon Neoplasms Rectal Neoplasms Inflammatory Bowel Disease Diverticular Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Bowel Anastomosis Under ICG Guidance

Patients undergo robotic colon/rectal resection and anastomosis with near-infrared ICG fluorescence imaging.

Group Type EXPERIMENTAL

Near-infrared ICG fluorescence imaging

Intervention Type PROCEDURE

Patient will have their bowel anastomosis assessed intraoperatively by near-infrared technology after indocyanine green has been injected intravenously at a concentration of 2.5 mg/ml. This procedure will be repeated twice during surgery, the first time before and the second time after the anastomosis has been done. The microvascularization at the anastomosis site will be assessed using a robotic fluorescence imaging device (FireFly™).

FireFly™

Intervention Type DEVICE

The microvascularization at the anastomosis site will be assessed using a robotic fluorescence imaging device (FireFly™).

Standard Bowel Anastomosis

Patients undergo robotic colon/rectal resection and anastomosis without near-infrared ICG fluorescence imaging.

Group Type ACTIVE_COMPARATOR

Traditional bowel anastomosis

Intervention Type PROCEDURE

Traditional bowel anastomosis will be performed without ICG fluorescence imaging.

Interventions

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Near-infrared ICG fluorescence imaging

Patient will have their bowel anastomosis assessed intraoperatively by near-infrared technology after indocyanine green has been injected intravenously at a concentration of 2.5 mg/ml. This procedure will be repeated twice during surgery, the first time before and the second time after the anastomosis has been done. The microvascularization at the anastomosis site will be assessed using a robotic fluorescence imaging device (FireFly™).

Intervention Type PROCEDURE

Traditional bowel anastomosis

Traditional bowel anastomosis will be performed without ICG fluorescence imaging.

Intervention Type PROCEDURE

FireFly™

The microvascularization at the anastomosis site will be assessed using a robotic fluorescence imaging device (FireFly™).

Intervention Type DEVICE

Other Intervention Names

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Near-infrared fluorescence imaging Indocyanine green

Eligibility Criteria

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Inclusion Criteria

* Subject is able to give informed consent for participation in the study
* Subject is willing and able to comply with the study procedures
* Subject is diagnosed with colon/rectal neoplasia, inflammatory bowel disease, diverticular disease requiring surgical excision
* Subject is scheduled for robotic colon or rectal resection
* A negative pregnancy test for women of childbearing potential prior to surgery

Exclusion Criteria

* Subjects present with bowel obstruction or perforation
* Subject undergo emergency surgery
* Subject with ASA IV, V
* History of allergy or hypersensitivity against indocyanine green
* Pregnant or breast-feeding women
* Subject has uremia (serum creatinine \>2.5 mg/dl)
* Subject is undergoing palliative surgery or who is terminally ill
* Subject who is unable to discontinue warfarin anticoagulation 5 days before surgery
* Subject taking phenobarbital, phenylbutazone, primidone, phenytoin, haloperidol, nitrofurantoin, probenecid
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Acibadem Atakent University Hospital

OTHER

Sponsor Role collaborator

Acibadem University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Bilgi Baca, MD,Prof.Dr.

Role: PRINCIPAL_INVESTIGATOR

Department of General Surgery, Acibadem University, Atakent Hospital

Locations

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Acibadem University

Istanbul, , Turkey (Türkiye)

Site Status RECRUITING

Countries

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Turkey (Türkiye)

Central Contacts

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Volkan Ozben, MD

Role: CONTACT

+905346484678

Facility Contacts

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norgaz, MD

Role: primary

References

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Ris F, Hompes R, Cunningham C, Lindsey I, Guy R, Jones O, George B, Cahill RA, Mortensen NJ. Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery. Surg Endosc. 2014 Jul;28(7):2221-6. doi: 10.1007/s00464-014-3432-y. Epub 2014 Feb 25.

Reference Type RESULT
PMID: 24566744 (View on PubMed)

Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, Lee SW, Senagore AJ, Phelan MJ, Stamos MJ. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg. 2015 Jan;220(1):82-92.e1. doi: 10.1016/j.jamcollsurg.2014.09.015. Epub 2014 Sep 28.

Reference Type RESULT
PMID: 25451666 (View on PubMed)

Other Identifiers

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ICG-COLORECTAL

Identifier Type: -

Identifier Source: org_study_id