LAUSR

Amongst the multiple factors associated with a successful colorectal anastomosis, two are potentially determined by the surgeon—structural integrity of the anastomosis and adequate tissue perfusion. While structural integrity can be assessed using objective methods such as an air-leak test, perfusion has thus far been evaluated by subjective measures, with the inherent risk of interpretation bias. There has been a growing interest in assessing anastomotic perfusion intra-operatively using intravenous (IV) indocyanine green paired with near-infrared fluorescence imaging (NIR-ICG). While the PILLAR II study established the safety and feasibility of using ICG to evaluate the perfusion of colorectal anastomoses, subsequent publications have questioned its clinical benefit. Most of the reviews on the topic have included studies of low-grade evidence with marked heterogeneity and variability, highlighting the need for large multicentre randomized controlled trials. While the role of NIR-ICG for perfusion assessment appears promising, there remain certain pitfalls in its use. This article aims