Fluorescence Guided Laparoscopic Sigmoid Resection for Complicated Diverticular Diseases

The use of Near Infrared Imaging (ICG) has become state of art for colon resection and it is proven that it can reduce the incidence of anastomotic leakages by 5%. In this Live Surgery, Prof. Boni and his team at the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico (Italy) will perform a laparoscopic sigmoid resection with fluorescent identification of the left ureter and fluorescent angiography for perfusion control of the anastomosis and highlight the importance of NIR in colorectal surgery and illustrate how and when to use it.

Clinical History:

Clinical Background

• 63 years old, male.

• BMI 25.

• No significant past medical history other than occasional abdominal pain.

• Known for the uncomplicated sigmoid diverticular disease at colonoscopy.

• No previous abdominal surgeries.

• No familiar history of colonic cancer.

• In November 2022 complained of diffuse abdominal pain in the lower abdomen and fever.

• Admission to A&E and diagnosis of acute diverticular diseases and pelvic abscess treated with I.V. antibiotic and percutaneous drainage of pelvic abscess.

• 1/23 - Colonoscopy: Distal sigmoid diverticula with inflammation and stiffness of colonic wall with edema. Histology: mucosal edema with lymphoplasmacytic infiltration.

• 1/23 - Virtual colonoscopy (CT scan):  Presence, at 20 cm from the anus, sigmoid stenosis of 7 cm length with occlusion of the intestinal lumen with diverticula suspicious for “inflammatory pseudotumor”.

• 1/23 - Oncology Markers: CA19.9 1.2, CEA 1.10, Alpha1fetoprotein 2.48.

Technique Description