Background

Evaluation of laparoscopic staple lines can be challenging as they are difficult to see once embeded in tissue. Malformed staples or poorly formed staples can affect staple line integrity and are difficult to identify using white light laparoscopy. ICG can visualize staples that are embedded in tissue. Broken and misshapen staples, missing staples and integrity of the 'B' formation can be visualized well with ICG immunofluorescent imaging.

Methods

10 patients undergoing LRYGB had staple lines on the biliopancreatic and alimentary limbs assessed for using ICG. 7.5 mg of ICG was administered intravenously and the staple lines on the the biliopancreatic and alimentary limb were examined for the presence of missing staples, misshapen staples and quality of 'B' formation. A single 45 mm white cartridge (Lexington Medical) was used to divide the jejunum. There were no crossing staple lines. White light laparoscopy was subjectively compared to the images seen using ICG for all staple lines

Results

20 staple lines were assessed for quality of staple line formation using ICG imaging. The position of the staple head and the deployment of the legs were visible and assessed in all cases. 'B' formation was well formed in all outer row staples. There were no misshapen or malformed staples seen. Middle and inner row staples were more difficult to assess than outer row staples

Conclusions

ICG has potential as an intraoperative imaging modality to assess proper staple line formation and identify misshapen or poorly formed staples.