Quantitative Perfusion Assessment with Indocyanine Green in Gastrointestinal Surgery (2019)


The outcome after surgical treatment for gastrointestinal cancer, highly depends on the viability of the anastomosis. Leakage of an anastomosis is associated with reduced survival, and increased recurrence of cancer. Since perfusion is crucial to ensure optimal healing of the anastomosis, a tool to assess the perfusion is warranted, and fluorescence angiography with indocyanine green (ICG-FA) seems promising.

In previous studies, ICG-FA was assessed visually, leaving room for observer bias and lack of reproducibility. This thesis aimed to develop and gain validity evidence of a method to perform quantitative indocyanine green fluorescent angiography (q-ICG). Through four different animal experimental studies, we presented and validated the q-ICG method.

A method for q-ICG was developed using readily available equipment and software. The preferred value of q-ICG based on the findings of this thesis was the normalized slope as it showed; high correlation to regional flow measured by radioactive microspheres, high reproducibility and reliability, ability to detect augmented and attenuated perfusion, and showed only slight variance when changing angle and distance between the camera and the tissue. Nevertheless, other studies propose different parameters for q-ICG, and large-scale studies should evaluate the clinical relevance of the method.

Additional project information

CESVI - Center for Enhanced Surgical Vision

Place of employment

PhD author

Date and place of defense

4th October 2019


Michael Patrick Achiam (main)
Lars Bo Svendsen


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