changes in tissue and vascular patterns that may indicate otherwise
undetected pre-cancerous polyps or other mucosal malignancies.
"Flat but clearly atypical cells are not easily distinguishable, but now
they stand out," says Dr. Shah, adding that the availability of image
enhancement applications has changed the effectiveness of endoscopy.
"The simple fact is, we missed a lot. As good as we were, we weren't as
good as we are now. We're better, as the technology allows us to be bet-
ter."
Surgical results might be better as well. Fluorescence imaging does-
n't just help you see where not to cut, it also suggests the sites that
will heal the best. Once injected, indocyanine green — the contrast
dye that fluorescent light excites into visibility — binds to plasma pro-
teins for a few minutes before being removed by the liver. While it's
actively glowing green, it demonstrates where the blood flows and,
consequently, the quality of its tissue perfusion.
This is extremely beneficial information when performing colorec-
tal, esophageal and bariatric resections, says David Renton, MD,
FACS, MPH, an assistant professor of surgery at the Ohio State
University's Center for Minimally Invasive Surgery in Columbus, Ohio.
"You don't know how good the blood supply is to the ends," he says.
"But if you switch on the filter, the fluorescence will tell you how well
you'll be able to create an anastomosis. If it glows, it has good blood
flow. If it doesn't glow, there is no blood supply. You can avoid any
kind of leaks."
Improved visualization could even improve your physicians' efficiency,
says Alexander Rosemurgy, MD, director of the Southeastern Center for
Digestive Disorders at Florida Hospital Tampa. "Before, the best you
could do might have been less accurate. But this changes how long it
takes you to do the incision, and ultimately the length of surgery."
8 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 6
