Although total operative time was recorded, the total imaging time was not recorded. Importantly, there was no standardization of the “standard of care” assessment of proximal

bowel viability based on normal visual assessment or assessment of bleeding at the transection line. The patients were a heterogeneous group undergoing low pelvic and 3-MA relatively high-risk anastomoses. This heterogeneous population and our sample size did not allow us to draw any specific conclusions with regard to the consequence that patient characteristics may have on interpretation of data. However, we report a 98.6% successful imaging rate and did not encounter any difficulty in interpreting fluorescence angiography in patients with peripheral vascular disease (n = 3), and/or diabetes (n = 11). The low conversion rates may imply a more experienced

and skilled set of surgeons as compared with those reported in the literature, which may translate into a lower morbidity.7 and 35 Despite the modest variability in practice, surgical preference, and technique, we have demonstrated that this technology for assessing anastomotic perfusion is reliable, safe, easy to use, and may lower the rate of anastomotic leaks in patients undergoing colorectal surgery. Although many factors that contribute to failure of an anastomosis are out of a surgeon’s control, this technology offers a new and seemingly reliable technique to lend credence to the surgical dogma that blood Sorafenib in vitro Y-27632 mw supply and viability have a large impact on the creation of a healthy anastomosis. In conclusion, this study demonstrates the feasibility and safety of fluorescence angiography using PINPOINT during left segmental colectomy and anterior resection. The study further demonstrates that the use of this technology may result in revisions of the proximal planned bowel transection point, and provide florescence angiography perfusion

assessment of a completed anastomosis. Intraoperative assessment of perfusion of the bowel planned for primary anastomosis with florescence angiography may decrease the rates of anastomotic leak and thereby improve patient outcomes. A randomized controlled clinical trial is planned to further evaluate the true clinical significance of this new technology compared with the more standard assessment of the proximal transection line. Study conception and design: Stamos Acquisition of data: Jafari, Wexner, Martz, McLemore, Margolin, Sherwinter, Lee, Senagore, Phelan, Stamos Analysis and interpretation of data: Jafari, Wexner, Martz, McLemore, Margolin, Sherwinter, Lee, Senagore, Phelan, Stamos Drafting of manuscript: Jafari, Wexner, Stamos Critical revision: Jafari, Wexner, Martz, McLemore, Margolin, Sherwinter, Lee, Senagore, Phelan, Stamos We would like to acknowledge all participating sites and staff, especially Drs Conor P Delaney, David W Larson, and Madhulika G Varma, for their invaluable contribution to the study as well as to the preparation of the manuscript.