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This video demonstrates Fluorescence Angiography During Laparoscopic Sleeve Gastrectomy performed by Dr. R. K. Mishra at World Laparoscopy Hospital. A new technology involving indocyanine green (ICG) fluorescence angiography has been introduced to assess tissue perfusion and perform vascular mapping during laparoscopic surgery. The purpose of this video was to describe the use of this technology to identify the variable blood supply patterns to the stomach and gastroesophageal (GE) junction during laparoscopic sleeve gastrectomy (LSG), which may help in preserving the blood supply and preventing ischemia-related leaks. Fluorescence imaging is currently being used for multiple applications across multiple subspecialties of surgery. Regarding gastrointestinal surgery, this technology can be used to assess proper tissue perfusion and vascular mapping of the patient's arterial/venous anatomy, as described in this article. Our group is currently exploring this technology in LSG cases to perform “perfusion-preserving” dissection and checking for adequate perfusion of the sleeve product afterward.
Fluorescence angiography is an advanced imaging technology that is transforming the safety and precision of modern minimally invasive surgery. During laparoscopic sleeve gastrectomy (LSG), this technique—commonly performed using indocyanine green (ICG) dye and near-infrared imaging—helps surgeons evaluate tissue perfusion in real time. At institutions such as World Laparoscopy Hospital, the adoption of advanced visualization tools like fluorescence angiography reflects the commitment to safer bariatric surgery and high-quality surgical training.
Laparoscopic sleeve gastrectomy is one of the most widely performed bariatric procedures for the treatment of morbid obesity. However, complications such as staple line leak and bleeding remain important concerns. One of the major causes of leak after LSG is ischemia or poor blood supply to the gastric tube. Fluorescence angiography allows surgeons to visualize vascular perfusion intraoperatively, helping them identify areas with compromised blood flow and modify surgical decisions accordingly. Studies have shown that ICG fluorescence imaging offers excellent tissue penetration and has become increasingly used across multiple laparoscopic procedures due to its effectiveness in assessing tissue vascularity.
Clinical evidence suggests several potential advantages of using fluorescence angiography during LSG. In a retrospective study of 291 patients, the group where ICG fluorescence angiography was used showed significantly reduced staple-line blood loss compared with conventional surgery. The same study also demonstrated shorter operative time and reduced average hospital stay in the fluorescence group. Importantly, no adverse reactions related to ICG injection were observed, highlighting the safety of this technique.
Despite these benefits, current evidence also indicates that fluorescence angiography is not a standalone solution for preventing complications. Some studies suggest that although perfusion can be assessed accurately, gastric leak development is multifactorial and may depend on factors such as intragastric pressure, surgical technique, and patient physiology. Therefore, while fluorescence imaging provides valuable additional information, it must be integrated with sound surgical judgment and standardized operative techniques.
From a training and academic perspective, World Laparoscopy Hospital plays a crucial role in introducing surgeons to such cutting-edge technologies. Surgeons trained in advanced laparoscopic and bariatric procedures at specialized centers gain exposure to fluorescence-guided surgery, improving their understanding of tissue perfusion assessment, intraoperative decision making, and complication prevention strategies. The incorporation of technologies like fluorescence angiography also reflects the broader evolution of minimally invasive surgery toward image-guided precision surgery.
In conclusion, fluorescence angiography during laparoscopic sleeve gastrectomy represents an important advancement in bariatric surgery. It enhances intraoperative visualization of tissue perfusion, may reduce bleeding and operative time, and supports safer surgical outcomes when combined with proper surgical expertise. As technology and research continue to evolve, fluorescence-guided surgery is expected to play an increasingly significant role in bariatric procedures, especially in advanced training institutions such as World Laparoscopy Hospital, where innovation and surgical excellence remain a priority.