Intraoperative ICG fluorescence contrast imaging of the main artery watershed area in colorectal cancer surgery: Report of a case

INTRODUCTION: Visualization of the main artery watershed area may be useful for determining the area that should be resected in colorectal cancer surgery. Resection of the main artery watershed area may result in complete resection of lymph nodes along the main artery and area of potential ischemia. PRESENTATION OF CASE: A man in his 60 s with a chief complaint of hematochezia visited our hospital, was diagnosed with colorectal cancer and underwent surgery. A case that underwent colorectal resection with intraoperative indocyanine green (ICG) fluorescence angiography from the resection-side of the superior rectal artery (SRA) in order to confirm the watershed area is reported. Observation was performed using a PINPOINT(®) bright-field, color, near-infrared fluorescence camera, and the watershed area of the SRA fluoresced 33 s after the intra-arterial injection of ICG. After observation resection and anastomosis was performed. The patient’s postoperative course was good. DISCUSSION: The method is simple and can be performed within a short time, and it enables visual evaluation of the blood flow in the intestinal tract before anastomosis. CONCLUSION: This method can be expected to provide useful information for complete resection of lymph nodes along the main artery and area of potential ischemia.