***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Decreasing anastomotic leak rates remain a major goal in colorectal surgery . Assessing intraoperative perfusion by indocyanine green ( ICG ) with near‐infrared ( NIR ) visualization may assist in selection of intestinal transection level and subsequent anastomotic vascular sufficiency . This study examined the use of NIR‐ICG imaging in colorectal surgery Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies BACKGROUND There have been few studies describing the use of indocyanine green ( ICG ) fluorescent imaging during robot-assisted ( RA ) sphincter-saving operations ( SSOs ) and assessing its potential role in reducing anastomotic leak ( AL ) . METHODS A consecutive cohort of 436 rectal cancer patients who underwent curative RA SSOs were prospect ively enrolled during 2010 - 2014 , including 123 patients with ICG imaging ( ICG+ group ) and 313 patients without ICG imaging ( ICG- group ) . RESULTS ICG imaging appeared to be helpful in identifying competent perfusion of the bowel adjacent to the anastomosis in 13 patients ( 10.6 % ) who might be susceptible to bowel ischaemia , including restrictive mesocolon . AL was remarkably greater in the ICG- group compared with the ICG+ group ( 5.4 % vs 0.8 % ; p = 0.031 ) . CONCLUSIONS ICG imaging during RA SSO provides accurate real-time knowledge of the perfusion status at or near the anastomosis , specifically reducing AL in patients who may incur bowel ischaemia . Copyright © 2015 John Wiley & Sons , Background Anastomotic complications such as leakage and bleeding remain among the most serious complications of laparoscopic colorectal surgery . No perfect method exists for accurate and reliable avoidance of these catastrophes . This study aim ed to study the usefulness of routine intraoperative endoscopy ( RIOE ) by comparing the surgical outcomes for  RIOE patients with those for selective intraoperative endoscopy ( SIOE ) patients . Methods A retrospective chart review was performed for consecutive patients who underwent elective laparoscopic colorectal resections with distal anastomosis between January 2004 and May 2007 . One surgeon performed RIOE , whereas the other three surgeons performed SIOE as necessary . All the abnormalities of IOE patients were managed with a subsequent salvage procedure , and the postoperative outcomes were compared between the RIOE and SIOE groups . Results The study included 107 patients in the RIOE group and 137 patients in the SIOE group .  Abnormalities were detected in 11 RIOE patients ( 10.3 % ) ( six with staple line bleeding , three with positive air leak test results , and two with additional pathology identified ) . All but one abnormality was laparoscopically managed without conversion to laparotomy . Whereas one patient experienced postoperative staple line bleeding that required a second operation , the remaining 10 patients recovered uneventfully . The mean hospital stay was 6 days ( range , 4–9 ) days . The RIOE group had overall rates of 0 % for anastomotic leakage and 0.9 % for staple line bleeding . Intraoperative endoscopies were performed for 30 ( 21.9 % ) of the 137 patients in the SIOE group . The postoperative outcomes comparison between the RIOE and SIOE groups showed a tendency toward more overall anastomotic complications ( 0.9 % vs. 5.1 % ) in the SIOE group , which due to the small sample size did not translate into significant differences in terms of staple line bleeding and anastomotic leakage . There also were no significant differences in other outcomes such as ileus , abdominal or pelvic sepsis , reoperation , positive distal margin , distance from distal margins , length of hospital stay , or mortality . Conclusions Routine IOE for patients undergoing elective laparoscopic colorectal surgery with distal anastomosis can detect abnormalities at or around the anastomosis . Although the RIOE group had fewer postoperative anastomotic complications , due to the small sample size , the 5.7-fold increase in anastomotic failure did not translate into significantly better postoperative outcomes than the SIOE group experienced . A larger-scale single or multicenter prospect i ve r and omized study or a meta analysis including similar studies is necessary for further investigation of this issue Background Decreased blood perfusion at an intestinal anastomosis may contribute to  postoperative anastomotic leak ( AL ) result ing in substantial morbidity and mortality . Near-infrared ( NIR ) laparoscopy in conjunction with indocyanine green ( ICG ) allows for visualization of the microcirculation before formation of the anastomosis , thereby allowing the surgeon to choose the point of transection at an optimally perfused area . Methods This is a retrospective case-control analysis examining the effectiveness of NIR + ICG in reducing the rate of AL  after low anterior resection ( LAR ) for rectal cancer . Records of patients undergoing robot-assisted LAR for rectal cancer with and without ICG were analyzed for the years 2011 and 2012 . Results Among the 40 patients who underwent robotic LAR , NIR + ICG was used in 16 cases ( 41 % ) . Male patients accounted for the majority of cases in both groups ( 74 % ) . The median level of the anastomosis was 3.5 cm in the NIR + ICG group and 5.5 cm in the control group . There was no difference in the use of diverting ileostomy . In 3 patients ( 19 % ) , the use of NIR + ICG result ed in revision of the proximal bowel ( colonic ) transection point before formation of the anastomosis . The distal transection point was never revised . The rate of AL in the NIR + ICG group was 6 % versus 18 % in control group . Conclusions ICG fluorescence may play a role in anastomotic tissue perfusion assessment and affect the AL rate . Larger prospect i ve studies are needed to further vali date this novel technology Introduction : Anastomotic bleeding after a circular-stapled anastomosis in laparoscopic colon resections is a rare but extremely aggravating complication . An intraoperative endoscopic assessment of the anastomosis allows immediate evaluation regarding bleeding and possible leakage . The aim of the study was to evaluate the impact of routine intraoperative endoscopy on postoperative complications . Methods : Since May 1999 , data of all laparoscopic colon resections were collected in a prospect i ve data base . Since July 2007 , we assessed every circular-stapled anastomosis with a flexible endoscope for bleeding , integrity of mucosa , and leakage . The patients with ( + ) and without ( − ) routine endoscopic assessment were compared regarding postoperative complications . Results : Group(− ) consisted of 253 patients [ 133 male , 120 female ; mean age , 60 years ( 25 to 86 y ) ] and group(+ ) consisted of 85 patients [ 44 male , 41 female ; mean age , 62 years ( 22 to 87 y ) , P = not significant ] In group(− ) , postoperative anastomotic bleeding was diagnosed in 11 patients ( 4.3 % ) and 7 ( 2.8 % ) of these patients required endoscopic assessment and clipping . In group(+ ) , endoscopy  showed anastomotic bleeding in 5 patients ( 5.9 % ) at the time of surgery , which required clipping . Anastomotic leak was observed in 2 patients ( 2.4 % ) : in one patient the circular staple line was oversewn and in the other patient anastomosis was redone . Two ( 2.4 % ) patients in group(+ ) had postoperative anastomotic bleeding requiring reendoscopy and clipping . The postoperative leakage rate was not significantly different in both the groups [ (−)1.6 % , (+)1.2 % , P= not significant ] . Conclusions : Intraoperative endoscopic assessment of circular-stapled anastomosis can detect early anastomotic bleeding and leakage . Although the postoperative rate of bleeding and leakage was not significantly reduced in our study , we still recommend endoscopic assessment of the circular-stapled anastomosis as a routine procedure in colorectal surgery , as the benefits outweigh the risks Background The evidence supporting the use of the air leak test ( ALT ) after  laparoscopic left-sided colon resection ( LLCR ) to test the colorectal anastomosis ( CA ) integrity aim ing at reducing the rate of postoperative CA leakage ( CAL ) is not conclusive . The aim of this study was to challenge the use of ALT after elective LLCR . Methods It is a retrospective analysis of a prospect ively collected data base including all patients undergoing elective LLCR with primary CA and no proximal bowel diversion between January 1996 and June 2017 . The decision to perform the ALT was based on the individual surgeon routine practice . A multivariate analysis was performed to identify independent risk factors for CAL . Results A total of 777 LLCR without proximal diversion were included in the analysis : the CA was tested in 398 patients ( ALT group ) , while intraoperative ALT was not performed in 379 patients ( No-ALT group ) . The two groups were similar in demographic characteristics , indication , and type of procedure . Intraoperative ALT  was positive in 20 ( 5 % ) patients : a stoma was created in 14 ( 70 % ) patients , while 6 ( 30 % ) patients had a suture repair alone . Overall , postoperative CAL occurred in 32 patients ( 4.1 % ) : the postoperative CAL rate was lower in ALT patients ( 2.5 % vs. 5.8 % , p = 0.025 ) . A reoperation was needed in 87.5 % of cases . No CAL occurred in the 20 patients with intraoperative positive ALT . Multivariate analysis showed that ASA score 3–4 ( OR 5.39 , 95 % CI 2.53–11.51 , p < 0.001 ) and male sex ( OR 3.96 , 95 % CI 1.66–9.43 , p = 0.002 ) were independent risk factors for postoperative CAL , while intraoperative ALT independently reduced the postoperative CAL rate ( OR 0.40 , 95 % CI 0.18–0.88 , p = 0.022 ) . Conclusion Intraoperative ALT allows to detect AL defects after LLCR that can be effectively managed intraoperatively , leading to a significant lower risk of postoperative CAL OBJECTIVE To determine the value of anastomotic leak testing of  left-sided colorectal anastomoses . DESIGN Cohort analysis . SETTING Subspecialty practice at a tertiary care facility . PATIENTS Consecutive subjects were selected from a prospect i ve colorectal data base of 2627 patients treated between January l , 2001 , and December 31 , 2007 . INTERVENTION Creation of left-sided colorectal anastomoses and air leak testing per surgeon preference . MAIN OUTCOMES MEASURES Anastomosis type , method ( h and sewn vs stapled ) , performance of air leak testing , repair method of anastomoses after air leak tests yielding positive results , and development of postoperative clinical leak . RESULTS A total of 998 left-sided colorectal anastomoses  were performed without proximal diversion ; 90.1 % were stapled and 9.9 % were h and sewn . Intraoperative air leaks were noted in 65 of 825 tested anastomoses ( 7.9 % ) , that is , 7.8 % of stapled anastomoses and 9.5 % of h and sewn anastomoses . A clinical leak developed in 48 patients ( 4.8 % ) . Clinical leaks were noted in 7.7 % of anastomoses with positive air leak test results compared with 3.8 % of anastomoses with negative air leak test results and 8.1 % of all untested anastomoses ( P < .03 ) . If air leak testing yielded positive results , suture repair alone was associated with the highest rate of postoperative clinical leak compared with diversion or reanastomosis , 12.2 % vs 0 % vs 0 % , respectively ( P = .19 ) . CONCLUSIONS Our data indicate a high rate of air leaks at air leak testing of left-sided colorectal anastomoses . In addition , the high rate of clinical leaks in untested anastomoses leads us to recommend air leak testing of all left-sided anastomoses , whether stapled or h and sewn 
    Output:
    
This study suggests that intraoperative testing for a good blood supply using ICG may reduce the AL rate following colorectal surgery