PMC8084531_01
A computed tomography colonography after colonoscopy, showing the locations of the three lesions. Two early colon cancers were located at the splenic flexure ( ) and sigmoid colon ( ). The submucosal tumor was located at the lower rectum ( ).
2432-3853-5-0202-g002.jpg
PMC8084531_01_2432-3853-5-0202-g002.jpg
g002
The lesion of the transverse colon was located at the splenic flexure (Figure 2).
(A) Rectal retroflexion of colonoscopy showing that a 25-mm submucosal tumor was located at 4 cm from the anal verge ( ). It was diagnosed as a neuroendocrine tumor (G1) by a core needle biopsy.. (B) A computed tomography scan showing the 25-mm submucosal tumor located at the right wall of the lower rectum ( ).
2432-3853-5-0202-g003.jpg
PMC8084531_01_2432-3853-5-0202-g003.jpg
g003
The rectal submucosal tumor was 2.5 cm in diameter, and its distal edge was located at 4 cm from the anal verge (Figure 3).
ICG fluorescence imaging of the remaining colon, taken 30 seconds after an intravenous injection of ICG (12.5 mg). Blood flow of the colon was evaluated with a NIR camera fixed 10 cm apart from the bowels in a completely dark operative room. The left side of the line between two arrows ( ) was the proximal colon, and dyed green by ICG, which means that it was well-perfused. The colonic segment distal to this line was not dyed owing to the poor blood flow.
2432-3853-5-0202-g004.jpg
PMC8084531_01_2432-3853-5-0202-g004.jpg
g004
Tokyo, Japan), and the demarcation line between the green and non-green areas was identified clearly (Figure 4).
The right colon was extracorporeally rotated counterclockwise to the anus. The left side of the picture shows the cranial view and the right side shows the caudal view. The right side of the line between two arrows ( ) was the distal colon, which was additionally resected owing to the poor blood flow after evaluation using ICG imaging. The remaining colon reached the line 2 fingerbreadth below the pubis ( ), which meant that it had enough length for tension-free coloanal anastomosis.
2432-3853-5-0202-g005.jpg
PMC8084531_01_2432-3853-5-0202-g005.jpg
g005
The section of the transverse colon with reduced blood flow, measuring 20 cm in length, was additionally resected (Figure 5).