ICG fluorescence triple check during TaTME

The use of fluorescence angiography has been widespread for almost 50 years, and the use of Indocyanine Green angiography is one of the latest technical evolutions in colorectal surgery. Its application to evaluate the vascular supply of the colon is analyzed in many studies to assess its possible effectiveness to minimize the risk of anastomotic leak. This article describes the ICG fluorescence triple check technique, standardized in a high-volume colorectal center and applied during transanal total mesorectal excision (TaTME) to assess the vascularization of both the colonic stump and the rectal stump before the anastomosis. A last transanal check is performed after the construction of the anastomosis. This technique is now standardized in this center and it could represent a possible application of ICG fluorescence to minimize the risk of anastomotic leak following TaTME.