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Background: Fluorescence angiography with indocyanine green (ICG-FA) is frequently used in colorectal surgery to assess the blood perfusion in the region of an anastomosis. Previous studies with ICG-FA in both open and laparoscopic surgery could show a low rate of anastomotic leakage, e.g. the PILLAR II study with a leakage rate of 1.4%. This article presents own results, the current status of ICG-FA and the fields of application., Objective: The aim of the study was to analyze whether the results obtained so far with ICG-FA are sufficient to recommend an extended use of this relatively new method in colorectal surgery., Material and Methods: From July 2009 to June 2019 a total of 378 colorectal resections (280 colon resections and 98 rectal resections) with intraoperative examination of the anastomosis using ICG-FA were performed. In 13 patients (3.4%) there was reduced intraoperative perfusion, which led to a change in the operative procedure (resection of the anastomosis and new anastomosis, colostomy)., Results: The total anastomotic leakage rate was 3.7% with 8 leaks in the colon (2.9%) and 6 in the rectum (6.1%). Without the intraoperative change in 13 patients the rate of leakages could have increased to 7.1% (27/378). The use of ICG-FA in the group of patients studied potentially led to a reduction of the leakage rate by 48%. Current publications show similar results with a potential decrease in the rate of anastomotic leaks in colorectal surgery., Conclusion: The results show a very low rate of anastomotic leakage when using ICG-FA. These results are promising in colorectal surgery but controlled randomized studies are lacking and should be carried out before final recommendations can be given.

Laparoscopic operations using only one trocar (single-port technique) have the aim to further minimize the trauma of access incisions similar to NOTES. To carry this out special trocars and instruments are needed which are presented in this article with respect to application and function. The range of indications corresponds to the conventional laparoscopic surgery. Recent publications have shown that operations using a single-port technique are safe and efficient. Greater technical difficulties and higher costs must be considered. For the identification of significant advantages, randomized studies are still lacking.

Background: During complex laparoscopic operations sometimes the situation of a "missing hand" will occur. Using a device for hand assistance, the surgeon can place one hand into the abdominal cavity to assist the laparoscopic procedures., Method: After a laparotomy of 7-8 cm length, the surgeon can bring one hand into the abdomen via a special device maintaining the pneumoperitoneum. This hand can be helpful, i.e. for exploration, for retraction of gut and organs or for extraction of the specimen. Indications are complex laparoscopic operations such as stomach or colonic resections or splenectomies. In obese patients or patients with extended adhesions, preparation can be facilitated., Results: The literature review and the author's own results with 10 patients since 2000 show remarkable advantages in operative situations when the laparoscopic procedure is complicated or even impossible. In our 10 patients, all operations could be managed laparoscopically by using the HandPort device., Conclusions: Complicated operations can be performed laparoscopically without conversion to conventional laparotomy by using the hand assistance. These patients do not have to forgo to the benefit of minimally invasive operations.