Indocyanin Green (ICG) for Colonic Viability Assessment in Left Pancreatic Minimal Invasive Surgery (MIS)

Background: Large distal pancreatic tumors may involve the transverse or splenic flexure mesocolon. R0 resection of such lesions may be extended to the mesocolon. Interruption of the arc of Riolan may be difficult to assess especially in MIS. Case report: We report a case of a 17 years old male presenting epigastric pain. The CT scan showed two lesions of the distal pancreas of 7x8cm and 4x3.5cm with aspects compatible with a solid pseudopapillary tumor. The octreo PET showed no fixation of the two lesions. A laparoscopic distal pancreatectomy with splenic preservation was attempted. Transverse and splenic flexure mesocolon were involved by the lesions. The dissection of the mesocolon to release the tumors lead to probable interruption of arc of Riolan and to a doubt on colonic optimal vascularisation after the surgery. We therefore used ICG to assess the viability of the colonic splenic flexure. Discussion and Conclusion: This short video illustrates how ICG can be simply used in left pancreatic surgery when R0 resection requires removal of splenic flexure mesocolon and partial interruption of arc of Riolan. In this case, ICG confirms the adequate perfusion of the splenic flexure and its safe preservation without any need of colonic resection.