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Page 4 of 7 Chouhan et al. Mini-invasive Surg 2018;2:18 I http://dx.doi.org/10.20517/2574-1225.2018.40

Figure 2. The Arc of Riolan (arrow) is highlighted by indocyanine green fluorescence during a high ligation of the inferior mesenteric vein
(IMV) close to the pancreas (P). The transverse colon (TC) is cephalad retracted

Figure 3. The rectum is transected with guidance of indocyanine green fluorescence to confirm good perfusion on the distal rectal stump

ICG is also gaining popularity in identifying bilateral ureters and positive lateral pelvic lymph nodes during
robotic rectal surgery [Figures 2 and 3].

The Arc of Riolan can be highlighted by indocyanine green fluorescence during a high ligation of the inferior
mesenteric vein close to the pancreas. The transverse colon is cephalad retracted. When the Arc of Riolan
exists, it should be preserved for better perfusion to the proximal segment of the anastomosis after rectal
resection [Figures 2 and 3].
[35]

Ability to perform an advanced MIS procedure robotically
The optimal surgical approach for a positive lateral pelvic node has yet to be established in rectal surgery.
Lateral node dissection is associated with increased blood loss and risk of damage to pelvic nerves, however
the safety and feasibility of the robotic approach in pelvic lateral node dissection has been demonstrated [36,37] .
The ability to perform precise dissection with the stable robotic platform and the use of ICG to identify
positive lateral nodes may potentially reduce the morbidity associated with this procedure.