Dottorato in TECNOLOGIE AVANZATE IN CHIRURGIA

Titolo della tesi: Chirurgia mininvasiva guidata dalla fluorescenza al verde di indocianina nel trattamento d'urgenza dell’occlusione di piccolo intestino. Studio multicentrico internazionale con proposta di score laparoscopico di resecabilità

In the treatment of small bowel obstruction, the evaluation of the viability of the compromised intestinal tract is often clinical and entrusted mainly to the sensations and experience of the surgeon. By the minimally invasive approach, the lack of tactile feedback and reduced visibility in the case of bowel distension amplify the difficulty in assessing intestinal vitality. Therefore, the conversion to open surgery is due precisely to the difficulty and necessity of evaluating intestinal viability. Preliminary studies on the use of intraoperative indocyanine green fluorescence angiography in laparoscopy have shown promising results. At the moment there is no possibility of an objective and objectivable evaluation of the intraoperative finding. The aim of this study is the development of a laparoscopic resectability score, in order to provide a helpful tool in decision-making during emergency surgery by the minimally invasive approach to small bowel obstruction. Therefore, the creation of a large data registry is necessary. The research is a multicentric study, consisting of a prospective data collection phase and a retrospective analysis phase. Among the variables taken into consideration, there is also the verification of intraoperative angiographic patterns provided by indocyanine green fluorescence, therefore the participating centers must be those equipped with optical systems with near-infrared light dedicated to using. To standardize the angiographic technique, we provided indications that each participating center will have to follow. The study foresees a duration of 12 months, the data collection procedure was deliberately made fast and intuitive through the compilation of an online Data Form, reachable through a link. Sixteen centers accepeted to participate and 62 patients has been enrolled. A multivariate analysis has been performed and besd on the results a proposal of laparoscopic resectability score was developed.Selective use of intraoperative fluorescent angiography may overcome some of the intrinsic limitations of laparoscopy in assessing bowel viability during surgery for acute small bowel obstruction. The fluorescence angiograophy is a safe and reproducible procedure that may have a role in aiding the decision-making process of any emergency surgeon, regardless of the personal expertise. It may decrease the number of unnecessary bowel resections and widen the proportion of patients benefiting from a minimally invasive intervention. However, identifying more objective methods for the interpretation of fluorescence angiographic patterns remains an avenue for further research.