|
1
|
Rimereit JE, Lindgren CGW, Nerup N, Madsen GI, Le DQS, Möller S, Qvist N, Ellebaek MB. Incorporating a poly-ε-caprolactone scaffold in a stapled small intestinal anastomosis with induced ischemia significantly increased anastomotic tensile strength. An experimental study in pigs. Scand J Gastroenterol 2025; 60:54-61. [PMID: 39636738 DOI: 10.1080/00365521.2024.2433541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 11/10/2024] [Accepted: 11/17/2024] [Indexed: 12/07/2024]
Abstract
OBJECTIVE Anastomotic leakage is a severe complication with multifactorial aetiology, including impaired tissue oxygenation, infection, inflammation, and anastomotic tension. Reinforcement with poly-ε-caprolactone (PCL) scaffold incorporated in a stapled intestinal anastomosis has demonstrated a significant increase in the anastomotic tensile strength. This study aimed to investigate whether incorporation of the scaffold would influence tensile strength with induced ischemia compared to normal blood perfusion. METHODS Eighteen pigs were randomly allocated into an intervention group with a induced relative reduction in blood perfusion to 30% at the anastomotic area and a control group with normal perfusion controlled by quantitative fluorescence angiography. Each pig recieved two stapled small intestinal anastomoses, one with a PCL scaffold incorporated and one without. On postoperative day five, the anastomoses were subjected to a maximal tensile strength test (MATS) and a histopathological analysis. Tensile strength was measured at three events: when a serosal tear became visible (MATS-1), at transmural rupture (MATS-2), and at maximum load before the load-strain curve dropped (MATS-3). RESULTS In the intervention group, MATS-1 was significantly higher in scaffold-reinforced anastomoses compared to controls (7.9 ± 4.2N and 4.4 ± 2.5N, p < 0.02). The same tendency was found for MATS-2 and MATS-3, with statistically significant differences after adjusting for adhesion grade (p < 0.05). Histological analysis revealed no significant differences in wound healing between groups. CONCLUSION Incorporating a PCL scaffold in a stapled small intestinal anastomosis with induced ischemia improved anastomotic tensile strength.
Collapse
Affiliation(s)
- Jon Erlend Rimereit
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Carl Gunnar William Lindgren
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Nikolaj Nerup
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gunvor Iben Madsen
- University of Southern Denmark, Odense, Denmark
- Research Unit for Pathology, Odense University Hospital, Odense, Denmark
| | | | - Sören Möller
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | | |
Collapse
|
|
2
|
Ben-David M, Makwana R, Yered T, Sanger GJ, Knowles CH, Wasserberg N, Shor E. Local Myoelectric Sensing During Human Colonic Tissue Perfusion. Diagnostics (Basel) 2024; 14:2870. [PMID: 39767231 PMCID: PMC11675604 DOI: 10.3390/diagnostics14242870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 12/07/2024] [Accepted: 12/17/2024] [Indexed: 01/11/2025] Open
Abstract
Objectives: Anastomotic leakage (AL) is one of the most devastating complications after colorectal surgery. The verification of the adequate perfusion of the anastomosis is essential to ensuring anastomosis integrity following colonic resections. This study aimed to evaluate the efficacy of measuring the electrical activity of the colonic muscularis externa at an anastomosis site for perfusion analysis following colorectal surgery. Methods: Strips of human isolated colon were maintained in a horizontal tissue bath to record spontaneous contractions and myoelectric activity and spike potentials (using a bipolar electrode array for the wireless transmission of myoelectric data-the xBar system) from the circular muscle. Intraoperative myoelectric signal assessment was performed by placing the electrode array on the colon prior to and following mesenteric artery ligation, just prior to colonic resection. Results: In human isolated colon, the amplitude, duration, and frequency of contractions were inhibited during hypoxia by >80% for each measurement, compared to control values and time-matched oxygenated muscle. Intraoperative (N = 5; mean age, 64.8 years; range, 54-74 years; 60% females) myoelectric signal assessment revealed a decline in spike rate following arterial ligation, with a mean reduction of 112.64 to 51.13 spikes/min (p < 0.0008). No adverse events were observed during the study, and the device did not substantially alter the surgical procedure. Conclusions: The electrical and contraction force of the human colon was reduced by ischemia, both in vitro and in vivo. These preliminary findings also suggest the potential of the xBar system to measure such changes during intraoperative and possibly postoperative periods to predict the risk of anastomotic viability as a surrogate of evolving dehiscence.
Collapse
Affiliation(s)
- Matan Ben-David
- Townsville Hospital and Health Service, Douglas, QLD 4814, Australia
- Exero Medical Ltd., Or Yehuda 6037606, Israel (E.S.)
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4814, Australia
| | - Raj Makwana
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (R.M.); (C.H.K.)
| | - Tal Yered
- Exero Medical Ltd., Or Yehuda 6037606, Israel (E.S.)
| | - Gareth J. Sanger
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (R.M.); (C.H.K.)
| | - Charles H. Knowles
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK; (R.M.); (C.H.K.)
| | - Nir Wasserberg
- Rabin Medical Center, Faculty of Health and Medical Sciences, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Erez Shor
- Exero Medical Ltd., Or Yehuda 6037606, Israel (E.S.)
| |
Collapse
|
|
3
|
Christofi A, Traska T, Dimitroulis D. Near-infrared indocyanine green angiography in recognizing bowel ischemia in emergency surgery: game changer or overrated? Innov Surg Sci 2024; 9:113-121. [PMID: 39309192 PMCID: PMC11415940 DOI: 10.1515/iss-2024-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/21/2024] [Indexed: 09/25/2024] Open
Abstract
Assessing bowel perfusion in emergency intestinal surgery can prove challenging even for experienced surgeons. The necessity of a technological tool assisting clinicians is undisputed. Near-infrared indocyanine green (NIR-ICG) angiography has been increasingly used in elective colorectal surgery to evaluate intestinal perfusion with promising results. This review aims to answer whether a similar outcome can be observed in acute cases of bowel ischemia. We conducted online research of the literature using keywords such as "indocyanine green", "bowel", "emergency" and "ischemia", to identify articles concerning the use of ICG-angiography in evaluating bowel perfusion during emergency operations. PubMed was the primary database. 11 articles were included in this systematic review with a total of 358 patients. Most papers showed a positive effect after using NIR-ICG-angiography, whereas one study indicated the limitations of the method by exhibiting increased reoperation and mortality rates. Moreover, a significant variation in indocyanine green (ICG) dose and fluorescence identification systems was observed. NIR-ICG-angiography has the potential to become a fundamental tool in emergency intestinal operations. Nevertheless, additional research, especially high-quality, randomized studies, as well as quantification techniques are still needed to support these preliminary observations.
Collapse
Affiliation(s)
- Anastasia Christofi
- Department of General, Visceral and Vascular Surgery, Agaplesion Bethesda Hospital Wuppertal, Wuppertal, Germany
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Thilo Traska
- Department of General, Visceral and Vascular Surgery, Agaplesion Bethesda Hospital Wuppertal, Wuppertal, Germany
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Second Department of Propedeutic Surgery, Laiko Hospital, Athens, Greece
| |
Collapse
|
|
4
|
Boland PA, Hardy NP, Moynihan A, McEntee PD, Loo C, Fenlon H, Cahill RA. Intraoperative near infrared functional imaging of rectal cancer using artificial intelligence methods - now and near future state of the art. Eur J Nucl Med Mol Imaging 2024; 51:3135-3148. [PMID: 38858280 PMCID: PMC11300525 DOI: 10.1007/s00259-024-06731-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/15/2024] [Indexed: 06/12/2024]
Abstract
Colorectal cancer remains a major cause of cancer death and morbidity worldwide. Surgery is a major treatment modality for primary and, increasingly, secondary curative therapy. However, with more patients being diagnosed with early stage and premalignant disease manifesting as large polyps, greater accuracy in diagnostic and therapeutic precision is needed right from the time of first endoscopic encounter. Rapid advancements in the field of artificial intelligence (AI), coupled with widespread availability of near infrared imaging (currently based around indocyanine green (ICG)) can enable colonoscopic tissue classification and prognostic stratification for significant polyps, in a similar manner to contemporary dynamic radiological perfusion imaging but with the advantage of being able to do so directly within interventional procedural time frames. It can provide an explainable method for immediate digital biopsies that could guide or even replace traditional forceps biopsies and provide guidance re margins (both areas where current practice is only approximately 80% accurate prior to definitive excision). Here, we discuss the concept and practice of AI enhanced ICG perfusion analysis for rectal cancer surgery while highlighting recent and essential near-future advancements. These include breakthrough developments in computer vision and time series analysis that allow for real-time quantification and classification of fluorescent perfusion signals of rectal cancer tissue intraoperatively that accurately distinguish between normal, benign, and malignant tissues in situ endoscopically, which are now undergoing international prospective validation (the Horizon Europe CLASSICA study). Next stage advancements may include detailed digital characterisation of small rectal malignancy based on intraoperative assessment of specific intratumoral fluorescent signal pattern. This could include T staging and intratumoral molecular process profiling (e.g. regarding angiogenesis, differentiation, inflammatory component, and tumour to stroma ratio) with the potential to accurately predict the microscopic local response to nonsurgical treatment enabling personalised therapy via decision support tools. Such advancements are also applicable to the next generation fluorophores and imaging agents currently emerging from clinical trials. In addition, by providing an understandable, applicable method for detailed tissue characterisation visually, such technology paves the way for acceptance of other AI methodology during surgery including, potentially, deep learning methods based on whole screen/video detailing.
Collapse
Affiliation(s)
- Patrick A Boland
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, 47 Eccles Street, Dublin 7, Dublin, Ireland
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - N P Hardy
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, 47 Eccles Street, Dublin 7, Dublin, Ireland
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Moynihan
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, 47 Eccles Street, Dublin 7, Dublin, Ireland
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - P D McEntee
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, 47 Eccles Street, Dublin 7, Dublin, Ireland
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Loo
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, 47 Eccles Street, Dublin 7, Dublin, Ireland
| | - H Fenlon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - R A Cahill
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, 47 Eccles Street, Dublin 7, Dublin, Ireland.
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
| |
Collapse
|
|
5
|
Heuvelings DJI, Scheepers MHMC, Al-Difaie Z, Okamoto N, Diana M, Stassen LPS, Bouvy ND, Al-Taher M. Quantitative analysis of intestinal perfusion with indocyanine green (ICG) and methylene blue (MB) using a single clinically approved fluorescence imaging system: a demonstration in a porcine model. Surg Endosc 2024; 38:3556-3563. [PMID: 38727831 PMCID: PMC11219451 DOI: 10.1007/s00464-024-10864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/14/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Near-infrared fluorescence (NIRF) angiography with intraoperative administration of indocyanine green (ICG) has rapidly disseminated in clinical practice. Another clinically approved, and widely available dye, methylene blue (MB), has up to now not been used for this purpose. Recently, we demonstrated promising results for the real-time evaluation of intestinal perfusion using this dye. The primary aim of this study was to perform a quantitative analysis of bowel perfusion assessment for both ICG and MB. METHODS Four mature female Landrace pigs underwent laparotomy under general anesthesia. An ischemic bowel loop with five regions of interest (ROIs) with varying levels of perfusion was created in each animal. An intravenous (IV) injection of 0.25 mg/kg-0.50 mg/kg MB was administered after 10 min, followed by NIRF imaging in MB mode and measurement of local lactate levels in all corresponding ROIs. This procedure was repeated in ICG mode (IV dose of 0.2 mg/kg) after 60 min. The quest spectrum fluorescence camera (Quest Medical Imaging, Middenmeer, The Netherlands) was used for NIRF imaging of both MB and ICG. RESULTS Intraoperative NIRF imaging of bowel perfusion assessment with MB and ICG was successful in all studied animals. Ingress (i/s) levels were calculated and correlated with local lactate levels. Both MB and ICG ingress values showed a significant negative correlation (r = - 0.7709; p = < 0.001; r = - 0.5367, p = 0.015, respectively) with local lactate levels. This correlation was stronger for MB compared to ICG, although ICG analysis showed higher absolute ingress values. CONCLUSION Our fluorescence quantification analysis validates the potential to use MB for bowel perfusion assessment besides the well-known and widely used ICG. Further human studies are necessary to translate our findings to clinical applications.
Collapse
Affiliation(s)
- Danique J I Heuvelings
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Max H M C Scheepers
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Zaid Al-Difaie
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nariaki Okamoto
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Mahdi Al-Taher
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| |
Collapse
|
|
6
|
Haruta Y, Nakashima Y, Ikeda T, Oki E, Yoshizumi T. Evaluation of gastric tube blood flow by multispectral camera and fluorescence angiography. Surg Open Sci 2024; 19:87-94. [PMID: 38601735 PMCID: PMC11004983 DOI: 10.1016/j.sopen.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
Background Evidence regarding the application of the multispectral camera for blood flow measurement is insufficient, and its performance has not been compared with the conventional indocyanine green (ICG) method. Therefore, we retrospectively compared the effectiveness of a new multispectral camera for non-invasive, real-time, quantitative imaging of tissue oxygen (O2) saturation and hemoglobin (Hb) levels and commercially available ICG fluorescence imaging in hemodynamic assessment of gastric tubes in esophagectomy. Methods Thirty patients who underwent thoracoscopic esophagectomy and gastric tube reconstruction for esophageal cancer were included in this study. The multispectral camera was used to measure tissue O2 saturation and Hb levels. The ICG fluorescence imaging, with the analysis software tool Lumi view, was employed to record ICG luminance changes, with values measured at the anastomotic site. Furthermore, the usefulness of each assessment device was examined using the arterial and venous blood flow indices as cutoff lines for cases with anastomotic failure. Results In the evaluation of arterial perfusion, anastomotic leak occurred in three of the five (60 %) patients with arterial insufficiency as assessed by the ICG imaging, while anastomotic leakage occurred in all three patients (100 %) who were assessed as having arterial insufficiency by the multispectral camera. In the evaluation of venous perfusion, anastomotic leakage occurred in three of the nine (33.3 %) patients diagnosed with venous stasis by the IC imaging and in three of the five (60 %) patients assessed by the multispectral camera. Conclusion The multispectral camera assessed gastric tube blood flow more accurately than the ICG fluorescence method.
Collapse
Affiliation(s)
- Yasuhiro Haruta
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Yuichiro Nakashima
- National Hospital Organization, Kyushu Medical Center, 810-8563, 1-8-1 Tigyouhama, Tyuou-ku, Fukuoka, Fukuoka, Japan
| | - Tetsuo Ikeda
- Center of Endoscopy and Endoscopic Surgery, Medical and Dental Hospital, Fukuoka Dental College, 814-0193, 2-15-1 Tamura, Sawara-ku, Fukuoka, Fukuoka, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| |
Collapse
|
|
7
|
Studier-Fischer A, Schwab FM, Rees M, Seidlitz S, Sellner J, Özdemir B, Ayala L, Odenthal J, Knoedler S, Kowalewski KF, Haney CM, Dietrich M, Salg GA, Kenngott HG, Müller-Stich BP, Maier-Hein L, Nickel F. ICG-augmented hyperspectral imaging for visualization of intestinal perfusion compared to conventional ICG fluorescence imaging: an experimental study. Int J Surg 2023; 109:3883-3895. [PMID: 38258996 PMCID: PMC10720797 DOI: 10.1097/js9.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/13/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Small bowel malperfusion (SBM) can cause high morbidity and severe surgical consequences. However, there is no standardized objective measuring tool for the quantification of SBM. Indocyanine green (ICG) imaging can be used for visualization, but lacks standardization and objectivity. Hyperspectral imaging (HSI) as a newly emerging technology in medicine might present advantages over conventional ICG fluorescence or in combination with it. METHODS HSI baseline data from physiological small bowel, avascular small bowel and small bowel after intravenous application of ICG was recorded in a total number of 54 in-vivo pig models. Visualizations of avascular small bowel after mesotomy were compared between HSI only (1), ICG-augmented HSI (IA-HSI) (2), clinical evaluation through the eyes of the surgeon (3) and conventional ICG imaging (4). The primary research focus was the localization of resection borders as suggested by each of the four methods. Distances between these borders were measured and histological samples were obtained from the regions in between in order to quantify necrotic changes 6 h after mesotomy for every region. RESULTS StO2 images (1) were capable of visualizing areas of physiological perfusion and areas of clearly impaired perfusion. However, exact borders where physiological perfusion started to decrease could not be clearly identified. Instead, IA-HSI (2) suggested a sharp-resection line where StO2 values started to decrease. Clinical evaluation (3) suggested a resection line 23 mm (±7 mm) and conventional ICG imaging (4) even suggested a resection line 53 mm (±13 mm) closer towards the malperfused region. Histopathological evaluation of the region that was sufficiently perfused only according to conventional ICG (R3) already revealed a significant increase in pre-necrotic changes in 27% (±9%) of surface area. Therefore, conventional ICG seems less sensitive than IA-HSI with regards to detection of insufficient tissue perfusion. CONCLUSIONS In this experimental animal study, IA-HSI (2) was superior for the visualization of segmental SBM compared to conventional HSI imaging (1), clinical evaluation (3) or conventional ICG imaging (4) regarding histopathological safety. ICG application caused visual artifacts in the StO2 values of the HSI camera as values significantly increase. This is caused by optical properties of systemic ICG and does not resemble a true increase in oxygenation levels. However, this empirical finding can be used to visualize segmental SBM utilizing ICG as contrast agent in an approach for IA-HSI. Clinical applicability and relevance will have to be explored in clinical trials. LEVEL OF EVIDENCE Not applicable. Translational animal science. Original article.
Collapse
Affiliation(s)
| | | | - Maike Rees
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ)
- Faculty of Mathematics and Computer Science
| | - Silvia Seidlitz
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ)
- Faculty of Mathematics and Computer Science
- HIDSS4Health—Helmholtz Information and Data Science School for Health, Karlsruhe
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg
| | - Jan Sellner
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ)
- Faculty of Mathematics and Computer Science
- HIDSS4Health—Helmholtz Information and Data Science School for Health, Karlsruhe
| | - Berkin Özdemir
- Departments ofGeneral, Visceral, and Transplantation Surgery
| | - Leonardo Ayala
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ)
- Medical Faculty, Heidelberg University
| | - Jan Odenthal
- Departments ofGeneral, Visceral, and Transplantation Surgery
| | - Samuel Knoedler
- Departments ofGeneral, Visceral, and Transplantation Surgery
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | - Lena Maier-Hein
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ)
- Faculty of Mathematics and Computer Science
- HIDSS4Health—Helmholtz Information and Data Science School for Health, Karlsruhe
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg
| | - Felix Nickel
- Departments ofGeneral, Visceral, and Transplantation Surgery
- HIDSS4Health—Helmholtz Information and Data Science School for Health, Karlsruhe
- Department of General, Visceral, and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
|
8
|
Heuvelings DJI, Al-Difaie Z, Scheepers MHMC, Okamoto N, Diana M, Stassen LPS, Bouvy ND, Al-Taher M. Simultaneous fluorescence imaging of bowel perfusion and ureter delineation using methylene blue: a demonstration in a porcine model. Surg Endosc 2023; 37:6779-6790. [PMID: 37253870 PMCID: PMC10462514 DOI: 10.1007/s00464-023-10142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Intraoperative near-infrared fluorescence imaging (NIRF) with preoperative optical dye administration is a promising technique for quick and easy intraoperative visualization of the ureter and for an improved, real-time assessment of intestinal perfusion. During colorectal surgery, there is a need for simultaneous non-invasive ureteral imaging and bowel perfusion assessment, using one single camera system. The purpose of this study is to investigate the feasibility of simultaneous intestinal perfusion and ureteral imaging using a single commercially available NIRF imaging system. METHODS Six Landrace pigs underwent laparotomy under general anesthesia in this experiment. An intravenous (IV) dose of 0.2 mg/kg indocyanine green (ICG) was given to assess bowel perfusion. Two pairs received a methylene blue (MB) iv injection of 0.75, 0.50 or 0.25 mg/kg respectively to investigate ureteral visualization. Quest Spectrum Fluorescence Camera (Quest Medical Imaging, Middenmeer, The Netherlands) was used for NIRF imaging. RESULTS Ureter visualization and bowel perfusion under NIRF imaging was achieved in all animals. All ureters were visible after five to ten minutes and remained clearly visible until the end of every experiment (120-420 min). A mixed model analysis did not show any significant differences neither between the three groups nor over time. Importantly, we demonstrated that bowel perfusion could be visualized with methylene blue (MB) as well. We observed no interference between ICG and MB and a faster washout of MB. CONCLUSION We successfully demonstrated simultaneous fluorescence angiography with ICG and ureteral imaging with MB in the same surgical procedure, with the same commercially available NIRF imaging equipment. More importantly, we showed that the use MB is adequate for bowel perfusion assessment and ureter visualization with this NIRF imaging system. Besides, MB showed an earlier washout time, which can be clinical beneficial as a repeated dye injection may be necessary during a surgical procedure.
Collapse
Affiliation(s)
- Danique J I Heuvelings
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Max H M C Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nariaki Okamoto
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Laurents P S Stassen
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nicole D Bouvy
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mahdi Al-Taher
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
|
9
|
Abdelrahman H, El-Menyar A, Peralta R, Al-Thani H. Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients. World J Gastrointest Surg 2023; 15:757-775. [PMID: 37342859 PMCID: PMC10277941 DOI: 10.4240/wjgs.v15.i5.757] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/18/2023] [Accepted: 03/27/2023] [Indexed: 05/26/2023] Open
Abstract
Background: Modern surgical medicine strives to manage trauma while improving outcomes using functional imaging. Identification of viable tissues is crucial for the surgical management of polytrauma and burn patients presenting with soft tissue and hollow viscus injuries. Bowel anastomosis after trauma-related resection is associated with a high rate of leakage. The ability of the surgeon’s bare eye to determine bowel viability remains limited, and the need for a more standardized objective assessment has not yet been fulfilled. Hence, there is a need for more precise diagnostic tools to enhance surgical evaluation and visualization to aid early diagnosis and timely management to minimize trauma-associated complications. Indocyanine green (ICG) coupled with fluorescence angiography is a potential solution for this problem. ICG is a fluorescent dye that responds to near-infrared irradiation. Methods: We conducted a narrative review to address the utility of ICG in the surgical management of patients with trauma as well as elective surgery. Discussion: ICG has many applications in different medical fields and has recently become an important clinical indicator for surgical guidance. However, there is a paucity of information regarding the use of this technology to treat traumas. Recently, angiography with ICG has been introduced in clinical practice to visualize and quantify organ perfusion under several conditions, leading to fewer cases of anastomotic insufficiency. This has great potential to bridge this gap and enhance the clinical outcomes of surgery and patient safety. However, there is no consensus on the ideal dose, time, and manner of administration nor the indications that ICG provides a genuine advantage through greater safety in trauma surgical settings. Conclusions: There is a scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy to facilitate intraoperative decisions and to limit the extent of surgical resection. This review will improve our understanding of the utility of intraoperative ICG fluorescence in guiding and assisting trauma surgeons to deal with the intraoperative challenges and thus improve the patients’ operative care and safety in the field of trauma surgery.
Collapse
Affiliation(s)
| | - Ayman El-Menyar
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Ruben Peralta
- Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Hassan Al-Thani
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| |
Collapse
|
|
10
|
Moncy AA, Kavalakat AJ, Vikraman B. Utility of Serum L-lactate in Identifying Ischemia in Acute Intestinal Obstruction: A Prospective Observational Study. Cureus 2023; 15:e38443. [PMID: 37143858 PMCID: PMC10153587 DOI: 10.7759/cureus.38443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/06/2023] Open
Abstract
Introduction In cases of intestinal obstruction, increasing luminal dilatation compromises bowel wall perfusion, eventually resulting in intestinal ischemia and bowel necrosis in advanced cases. Elevated L-lactate, as a biomarker of ischemia, may indicate the presence of bowel ischemia in cases of obstruction. The objective of this study was to evaluate the value of serum L-lactate measurement in predicting the presence of intraoperatively observed intestinal ischemia in patients with acute intestinal obstruction. Methods Patients diagnosed with acute intestinal obstruction were prospectively studied over an 18-month period. Serum L-lactate values were assayed twice: at the time of presentation and following appropriate fluid resuscitation. Receiver operating characteristic (ROC) curve analysis was applied to determine the predictive value of serum L-lactate in detecting intestinal ischemia. Results One hundred forty-four cases of intestinal obstruction were included in this study, of which 91 underwent operative intervention. Intestinal ischemia was identified in 52 cases and categorized intra-operatively as reversible (n = 33) and irreversible (n = 19). ROC analysis showed a good predictive value of serum L-lactate after fluid resuscitation for irreversible intestinal ischemia (area under the curve (AUC) = 0.884, 95% confidence interval (CI), 0.812-0.956). An L-lactate cut-off of 19.1 mg/dL following fluid resuscitation was determined to have a sensitivity of 89.5%, a specificity of 72.9%, a positive predictive value of 46.6%, and a negative predictive value of 96.3% for gangrenous bowel. Conclusion Serum L-lactate is a good predictive tool for identifying intestinal ischemia during the management of intestinal obstruction. Serum L-lactate after resuscitation showed better predictive value for ischemic bowel.
Collapse
Affiliation(s)
- Aneena A Moncy
- Department of General Surgery, Jubilee Mission Medical College and Research Institute, Thrissur, IND
| | - Alfie J Kavalakat
- Department of General Surgery, Jubilee Mission Medical College and Research Institute, Thrissur, IND
| | - B Vikraman
- Department of General Surgery, Jubilee Mission Medical College and Research Institute, Thrissur, IND
| |
Collapse
|
|
11
|
Garzelli L, Felli E, Al-Taher M, Barberio M, Agnus V, Plaforet V, Bonvalet F, Baiocchini A, Nuzzo A, Paulatto L, Vilgrain V, Gallix B, Diana M, Ronot M. MRI for the Detection of Small Bowel Ischemic Injury in Arterial Acute Mesenteric Ischemia: Preclinical Study in a Porcine Model. J Magn Reson Imaging 2023; 57:918-927. [PMID: 35852296 DOI: 10.1002/jmri.28344] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND MRI is the reference for the diagnosis of arterial cerebral ischemia, but its role in acute mesenteric ischemia (AMI) is poorly known. PURPOSE To assess MRI detection of early ischemic bowel lesions in a porcine model of arterial AMI. STUDY TYPE Prospective/cohort. ANIMAL MODEL Porcine model of arterial AMI obtained by embolization of the superior mesenteric artery (seven pigs). FIELD STRENGTH/SEQUENCE A 5-T. T1 gradient-echo-weighted-imaging (WI), half-Fourier-acquisition-single-shot-turbo-spin-echo, T2 turbo-spin-echo, true-fast-imaging-with-steady-precession (True-FISP), diffusion-weighted-echo-planar (DWI). ASSESSMENT T1-WI, T2-WI, and DWI were performed before and continuously after embolization for 6 hours. The signal intensity (SI) of the ischemic bowel was assessed visually and quantitatively on all sequences. The apparent diffusion coefficient (ADC) was assessed. STATISTICAL TESTS Paired Student's t-test or Mann-Whitney U-test, significance at P < 0.05. RESULTS One pig died from non-AMI-related causes. The remaining pigs underwent a median 5 h53 (range 1 h24-6 h01) of ischemia. Visually, the ischemic bowel showed signal hyperintensity on DWI-b800 after a median 85 (57-276) minutes compared to the nonischemic bowel. DWI-b800 SI significantly increased after 2 hours (+19%) and the ADC significant decrease within the first hour (-31%). The ischemic bowel was hyperintense on precontrast T1-WI after a median 87 (70-171) minutes with no significant quantitative changes over time (P = 0.46-0.93). The ischemic bowel was hyperintense on T2-WI in three pigs with a significant SI increase on True-FISP after 1 and 2 hours. DATA CONCLUSION Changes in SI and ADC can be seen early after the onset of arterial AMI with DWI. The value of T2-WI appears to be limited. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Lorenzo Garzelli
- Université Paris Cité, Paris, France & Department of Radiology, Beaujon Hospital, APHP.Nord, Clichy, France.,IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France
| | - Eric Felli
- IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France.,Hepatology, Department of Biomedical Research, Inselspital, University of Bern, Bern, Switzerland
| | - Mahdi Al-Taher
- IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France
| | - Manuel Barberio
- IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France
| | - Vincent Agnus
- IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France
| | - Vincent Plaforet
- Université Paris Cité, Paris, France & Department of Radiology, Beaujon Hospital, APHP.Nord, Clichy, France
| | - Fanny Bonvalet
- Université Paris Cité, Paris, France & Department of Radiology, Beaujon Hospital, APHP.Nord, Clichy, France
| | - Andrea Baiocchini
- Department of Pathology, San Camillo Forlanini Hospital, Rome, Italy
| | - Alexandre Nuzzo
- Université Paris Cité, Paris, France & Structure d'Urgence Vasculaire Intestinales (SURVI), Nutritional support, Gastroenterology, Beaujon Hospital, APHP.Nord, Clichy, France
| | - Luisa Paulatto
- Université Paris Cité, Paris, France & Department of Radiology, Beaujon Hospital, APHP.Nord, Clichy, France
| | - Valérie Vilgrain
- Université Paris Cité, Paris, France & Department of Radiology, Beaujon Hospital, APHP.Nord, Clichy, France
| | - Benoit Gallix
- IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France
| | - Michele Diana
- IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France.,IRCAD, Research Institute against Digestive Cancer, Strasbourg, France.,Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, France.,ICube Lab, Photonics for Health, Strasbourg, France
| | - Maxime Ronot
- Université Paris Cité, Paris, France & Department of Radiology, Beaujon Hospital, APHP.Nord, Clichy, France
| |
Collapse
|
|
12
|
Yang CH, Chen LH, Lin YS, Hsu CY, Tung MC, Huang SW, Wu CH, Ou YC. Incorporating VR-RENDER Fusion Software in Robot-Assisted Partial Prostatectomy: The First Case Report. Curr Oncol 2023; 30:1699-1707. [PMID: 36826092 PMCID: PMC9955092 DOI: 10.3390/curroncol30020131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/21/2023] [Accepted: 01/28/2023] [Indexed: 02/03/2023] Open
Abstract
Currently, the active surveillance of men with favorable intermediate-risk localized prostate cancer (PCa) is a longstanding controversy, in terms of their oncological outcomes, and radical prostatectomy would constitute a similar concern of overtreatment, regarding its functional outcomes. Thus, focal therapy could be considered in men belonging to favorable intermediate-risk group. Among all focal therapies, high-intensity focused ultrasound (HIFU) was the most studied methodology in clinical trials. Although HIFU provided better functional outcomes than radical prostatecomy, the oncological outcomes were inferior in men with intermediate-risk localized PCa. Two articles have been published discussing the feasibility and clinical outcomes of robot-assisted partial prostatectomy (RAPP), and both the functional and oncological outcomes were superior than those with HIFU. However, the rate of positive surgical margins (PSMs) was reported as high in the literature. Here, we present a case of favorable intermediate-risk localized PCa with an isolated tumor at the anterior apex. After reconstructing a personal three-dimensional (3D) image, we utilized it in a 3D image-guided precise excise, followed by intraoperative frozen specimen review. We found that this method may present a resolution to the high PSM rate documented in the current literature regarding RAPP. This method merits further study with a well-designed prospective study.
Collapse
Affiliation(s)
- Che-Hsueh Yang
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Li-Hsun Chen
- Asian Institute of Telesurgery, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Taiwan
- Correspondence: (L.-H.C.); (Y.-C.O.)
| | - Yi-Sheng Lin
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Chao-Yu Hsu
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Min-Che Tung
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
| | - Shih-Wei Huang
- Asian Institute of Telesurgery, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Taiwan
- Division of General Surgery, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Taiwan
| | - Chi-Hsiang Wu
- Asian Institute of Telesurgery, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Taiwan
- Department of Urology, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Taiwan
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung 435, Taiwan
- Correspondence: (L.-H.C.); (Y.-C.O.)
| |
Collapse
|
|
13
|
Experimental evaluation of laparoscopic laser speckle contrast imaging to visualize perfusion deficits during intestinal surgery. Surg Endosc 2023; 37:950-957. [PMID: 36068388 PMCID: PMC9944003 DOI: 10.1007/s00464-022-09536-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Ischemia at the site of an intestinal anastomosis is one of the most important risk factors for anastomotic leakage (AL). Consequently, adequate intestinal microperfusion is essential for optimal tissue oxygenation and anastomotic healing. As visual inspection of tissue viability does not guarantee an adequate objective evaluation of intestinal microperfusion, surgeons are in dire need of supportive tools to decrease anastomotic leakage after colorectal surgery. METHODS In this feasibility study, laparoscopic laser speckle contrast imaging (LSCI) was used to evaluate intestinal microperfusion in an experimental ischemic bowel loop model. Both large and small ischemic loops were created from the small intestine of a pig; each loop was divided into 5 regions of interest (ROI) with varying levels of ischemia. Speckle contrast and local capillary lactate (LCL) was measured in all ROIs. RESULTS Both real-time visualization of intestinal microperfusion and induced perfusion deficits was achieved in all bowel loops. As a result, the emergence of regions of intestinal ischemia could be predicted directly after iatrogenic perfusion limitation, whereas without LSCI signs of decreased intestinal viability could only be seen after 30 minutes. Additionally, a significant relation was found between LCL and LSCI. CONCLUSION In conclusion, LSCI can achieve real-time intraoperative visualization of intestinal microperfusion deficits, allowing for accurate prediction of long-term postoperative ischemic complications. With this revealing capacity, LSCI could potentially facilitate surgical decision-making when constructing intestinal anastomoses in order to mitigate ischemia-related complications such as AL.
Collapse
|
|
14
|
Hardy NP, Joosten JJ, Dalli J, Hompes R, Cahill RA, van Berge Henegouwen MI. Evaluation of inter-user variability in indocyanine green fluorescence angiography to assess gastric conduit perfusion in esophageal cancer surgery. Dis Esophagus 2022; 35:6568917. [PMID: 35428892 DOI: 10.1093/dote/doac016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/21/2022] [Accepted: 02/14/2022] [Indexed: 02/07/2023]
Abstract
Indocyanine Green Fluorescence Angiography (ICGFA) has been deployed to tackle malperfusion-related anastomotic complications. This study assesses variations in operator interpretation of pre-anastomotic ICGFA inflow in the gastric conduit. Utilizing an innovative online interactive multimedia platform (Mindstamp), esophageal surgeons completed a baseline opinion-practice questionnaire and proceeded to interpret, and then digitally assign, a distal transection point on 8 ICGFA videos of esophageal resections (6 Ivor Lewis, 2 McKeown). Annotations regarding gastric conduit transection by ICGFA were compared between expert users versus non-expert participants using ImageJ to delineate longitudinal distances with Shapiro Wilk and t-tests to ascertain significance. Expert versus non-expert correlation was assessed via Intraclass Correlation Coefficients (ICC). Thirty participants (13 consultants, 6 ICGFA experts) completed the study in all aspects. Of these, a high majority (29 participants) stated ICGFA should be used routinely with most (21, including 5/6 experts) stating that 11-50 cases were needed for competency in interpretation. Among users, there were wide variations in dosing (0.05-3 mg/kg) and practice impact. Agreement regarding ICGFA video interpretation concerning transection level among experts was 'moderate' (ICC = 0.717) overall but 'good' (ICC = 0.871) among seven videos with Leave One Out (LOO) exclusion of the video with highest disagreement. Agreement among non-experts was moderate (ICC = 0.641) overall and in every subgroup including among consultants (ICC = 0.626). Experts choose levels that preserved more gastric conduit length versus non-experts in all but one video (P = 0.02). Considerable variability exists with ICGFA interpretation and indeed impact. Even adept users may be challenged in specific cases. Standardized training and/or computerized quantitative fluorescence may help better usage.
Collapse
Affiliation(s)
- Niall P Hardy
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Johanna J Joosten
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jeffrey Dalli
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland.,Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
|
15
|
Wagner M, Brandenburg JM, Bodenstedt S, Schulze A, Jenke AC, Stern A, Daum MTJ, Mündermann L, Kolbinger FR, Bhasker N, Schneider G, Krause-Jüttler G, Alwanni H, Fritz-Kebede F, Burgert O, Wilhelm D, Fallert J, Nickel F, Maier-Hein L, Dugas M, Distler M, Weitz J, Müller-Stich BP, Speidel S. Surgomics: personalized prediction of morbidity, mortality and long-term outcome in surgery using machine learning on multimodal data. Surg Endosc 2022; 36:8568-8591. [PMID: 36171451 PMCID: PMC9613751 DOI: 10.1007/s00464-022-09611-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/03/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Personalized medicine requires the integration and analysis of vast amounts of patient data to realize individualized care. With Surgomics, we aim to facilitate personalized therapy recommendations in surgery by integration of intraoperative surgical data and their analysis with machine learning methods to leverage the potential of this data in analogy to Radiomics and Genomics. METHODS We defined Surgomics as the entirety of surgomic features that are process characteristics of a surgical procedure automatically derived from multimodal intraoperative data to quantify processes in the operating room. In a multidisciplinary team we discussed potential data sources like endoscopic videos, vital sign monitoring, medical devices and instruments and respective surgomic features. Subsequently, an online questionnaire was sent to experts from surgery and (computer) science at multiple centers for rating the features' clinical relevance and technical feasibility. RESULTS In total, 52 surgomic features were identified and assigned to eight feature categories. Based on the expert survey (n = 66 participants) the feature category with the highest clinical relevance as rated by surgeons was "surgical skill and quality of performance" for morbidity and mortality (9.0 ± 1.3 on a numerical rating scale from 1 to 10) as well as for long-term (oncological) outcome (8.2 ± 1.8). The feature category with the highest feasibility to be automatically extracted as rated by (computer) scientists was "Instrument" (8.5 ± 1.7). Among the surgomic features ranked as most relevant in their respective category were "intraoperative adverse events", "action performed with instruments", "vital sign monitoring", and "difficulty of surgery". CONCLUSION Surgomics is a promising concept for the analysis of intraoperative data. Surgomics may be used together with preoperative features from clinical data and Radiomics to predict postoperative morbidity, mortality and long-term outcome, as well as to provide tailored feedback for surgeons.
Collapse
Affiliation(s)
- Martin Wagner
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
- National Center for Tumor Diseases (NCT), Heidelberg, Germany.
| | - Johanna M Brandenburg
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Sebastian Bodenstedt
- Department of Translational Surgical Oncology, National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- Cluster of Excellence "Centre for Tactile Internet with Human-in-the-Loop" (CeTI), Technische Universität Dresden, 01062, Dresden, Germany
| | - André Schulze
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Alexander C Jenke
- Department of Translational Surgical Oncology, National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Antonia Stern
- Corporate Research and Technology, Karl Storz SE & Co KG, Tuttlingen, Germany
| | - Marie T J Daum
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Lars Mündermann
- Corporate Research and Technology, Karl Storz SE & Co KG, Tuttlingen, Germany
| | - Fiona R Kolbinger
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden, Dresden, Germany
| | - Nithya Bhasker
- Department of Translational Surgical Oncology, National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Gerd Schneider
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Grit Krause-Jüttler
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Hisham Alwanni
- Corporate Research and Technology, Karl Storz SE & Co KG, Tuttlingen, Germany
| | - Fleur Fritz-Kebede
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Burgert
- Research Group Computer Assisted Medicine (CaMed), Reutlingen University, Reutlingen, Germany
| | - Dirk Wilhelm
- Department of Surgery, Faculty of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johannes Fallert
- Corporate Research and Technology, Karl Storz SE & Co KG, Tuttlingen, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Lena Maier-Hein
- Department of Intelligent Medical Systems (IMSY), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Dugas
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Marius Distler
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Beat-Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Stefanie Speidel
- Department of Translational Surgical Oncology, National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- Cluster of Excellence "Centre for Tactile Internet with Human-in-the-Loop" (CeTI), Technische Universität Dresden, 01062, Dresden, Germany
| |
Collapse
|
|
16
|
Nohara K, Takemura N, Ito K, Oikawa R, Yagi S, Wake H, Enomoto N, Yamada K, Kokudo N. Bowel perfusion demonstrated using indocyanine green fluorescence imaging in two cases of strangulated ileus. Clin J Gastroenterol 2022; 15:886-889. [PMID: 35763151 DOI: 10.1007/s12328-022-01656-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
We report the use of indocyanine green (ICG) fluorescence for intraoperative diagnosis in two cases of strangulated ileus. We successfully preserved the bowel and avoided postoperative complications by detecting adequate perfusion and no necrosis in the intestine's strangulated regions. In the first case, enhanced computed tomography (CT) revealed a closed loop intestine, which showed poor contrast, and we performed laparotomy with ICG fluorescence. In the second case, the CT scan revealed bowel obstruction without ascites. We conservatively treated the patient with the insertion of a long tube. The patient's condition did not improve, and we performed laparotomy using ICG fluorescence. In both of these cases, the visual observation during laparotomy showed that the ileum had dark-red discoloration. We demonstrated perfusion and preserved the ileum by injecting 2.5 mg of ICG intravenously; fluorescence was observed in the dark-red ileum using the PINPOINT system (Novadaq, Kalamazoo, MI, US). Both patients recovered successfully after the surgery with no adverse events. Our data suggest that ICG fluorescence imaging can be one of the decision-making modalities in patients with strangulated ileus.
Collapse
Affiliation(s)
- Kyoko Nohara
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Nobuyuki Takemura
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kyoji Ito
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Ryo Oikawa
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Syusuke Yagi
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Hitomi Wake
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Naoki Enomoto
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kazuhiko Yamada
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Norihiro Kokudo
- Department of Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| |
Collapse
|
|
17
|
Wada T, Kawada K, Hanada K, Obama K. Quantitative Analysis of Colonic Perfusion Using ICG Fluorescence Angiography and Its Consequences for Anastomotic Healing in a Rat Model. Cancers (Basel) 2022; 14:cancers14164024. [PMID: 36011017 PMCID: PMC9406386 DOI: 10.3390/cancers14164024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
Forty-three rats were randomly assigned to the following four groups: non-ischemic group (Control Group), 1 cm-long ischemic group (Group 1), 2 cm-long ischemic group (Group 2), and 3 cm-long ischemic group (Group 3). The rates of AL were 0% (0/10) in the Control Group, 22.2% (2/9) in Group 1, 25% (2/8) in Group 2, and 50% (4/8) in Group 3. The bursting pressure of the Control Group was significantly higher than that of the other groups (p < 0.01). Regarding the pathological findings, the granulation thickness and the number of blood vessels at the anastomosed site were significantly higher in the Control Group than in Group 3 (p < 0.05). Receiver operating characteristics analysis revealed that Slope was the most significant predictor of AL, with an area under the curve of 0.861. When the cutoff value of Slope was 0.4, the sensitivity and specificity for the prediction of AL were 75% and 81.4%, respectively. Quantitative analysis of ICG fluorescence angiography could predict AL in a rat model.
Collapse
Affiliation(s)
- Toshiaki Wada
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
- Department of Surgery, Faculty of Medicine, Kindai University, Osaka 589-8511, Japan
| | - Kenji Kawada
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
- Correspondence: ; Tel.: +81-75-366-7595
| | - Keita Hanada
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
- Department of Surgery, Rakuwakai Otowa Hospital, Kyoto 607-8062, Japan
| | - Kazutaka Obama
- Department of Gastrointestinal Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| |
Collapse
|
|
18
|
Wildeboer A, Heeman W, van der Bilt A, Hoff C, Calon J, Boerma EC, Al-Taher M, Bouvy N. Laparoscopic Laser Speckle Contrast Imaging Can Visualize Anastomotic Perfusion: A Demonstration in a Porcine Model. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081251. [PMID: 36013430 PMCID: PMC9409722 DOI: 10.3390/life12081251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022]
Abstract
Background: Intestinal resection causes inevitable vascular damage, which cannot always be seen during an intraoperative clinical assessment of local intestinal perfusion. If left unaltered, impaired perfusion can lead to complications, such as anastomotic leakage (AL). Therefore, we demonstrate the use of a novel laparoscopic laser speckle contrast imaging (LSCI)-based approach in order to assess local intestinal perfusion during the construction of intestinal anastomoses. Methods: Three segments were isolated from the small intestine of a pig, while the perfusion of each was compromised by coagulating 7–8 mesenteric arteries. Both clinical assessments and LSCI were used to detect the induced perfusion deficits and to subsequently guide a transection in either a well perfused, marginally perfused, or poorly perfused tissue area within the segment. Bowel ends were then utilized for the creation of three differently perfused anastomoses: well perfused/well perfused (anastomosis segment 1), well perfused/poorly perfused (anastomosis segment 2), and poorly perfused/poorly perfused (anastomosis segment 3). After construction of the anastomoses, a final perfusion assessment using both clinical assessment and LSCI was executed in order to evaluate the vascular viability of the anastomosis. Results: Laparoscopic LSCI enabled continuous assessment of local intestinal perfusion and allowed for detection of perfusion deficits in real time. The imaging feedback precisely guided the surgical procedure, and, when evaluating the final anastomotic perfusion, LSCI was able to visualize the varying degrees of perfusion, whereas standard clinical assessment yielded only minor differences in visual appearance of the tissue. Conclusions: In this technical note, we demonstrate a novel LSCI-based approach for intraoperative perfusion assessment. With its ability to continuously visualize perfusion in real time, laparoscopic LSCI has significant potential for the optimization of anastomotic surgery in the near future.
Collapse
Affiliation(s)
- Aurelia Wildeboer
- Department of Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
- Correspondence:
| | - Wido Heeman
- University Campus Fryslân, University of Groningen, 8911 CE Leeuwarden, The Netherlands
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
- LIMIS Development BV, 8934 AD Leeuwarden, The Netherlands
| | - Arne van der Bilt
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
| | - Christiaan Hoff
- Department of Surgery, Medical Centre Leeuwarden, 8934 AD Leeuwarden, The Netherlands
| | - Joost Calon
- ZiuZ Visual Intelligence BV, 8401 DK Gorredijk, The Netherlands
| | - E. Christiaan Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, 8934 AD Leeuwarden, The Netherlands
| | - Mahdi Al-Taher
- Department of Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| | - Nicole Bouvy
- Department of Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| |
Collapse
|
|
19
|
Ekman M, Girnyi S, Marano L, Roviello F, Chand M, Diana M, Polom K. Near-Infrared Fluorescence Image-Guided Surgery in Esophageal and Gastric Cancer Operations. Surg Innov 2022; 29:540-549. [PMID: 35285305 DOI: 10.1177/15533506211073417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2025]
Abstract
BACKGROUND Near-infrared fluorescence image-guided surgery helps surgeons to see beyond the classical eye vision. Over the last few years, we have witnessed a revolution which has begun in the field of image-guided surgery. PURPOSE, AND RESEARCH DESIGN Fluorescence technology using indocyanine green (ICG) has shown promising results in many organs, and in this review article, we wanted to discuss the 6 main domains where fluorescence image-guided surgery is currently used for esophageal and gastric cancer surgery. STUDY SAMPLE AND DATA COLLECTION Visualization of lymphatic vessels, tumor localization, fluorescence angiography for anastomotic evaluation, thoracic duct visualization, tracheal blood flow analysis, and sentinel node biopsy are discussed. CONCLUSIONS It seems that this technology has already found its place in surgery. However, new possibilities and research avenues in this area will probably make it even more important in the near future.
Collapse
Affiliation(s)
- Marcin Ekman
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Sergii Girnyi
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, 243257University of Siena, Siena, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, 243257University of Siena, Siena, Italy
| | - Manish Chand
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), 4919University College London, London
| | - Michele Diana
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, 243257University of Siena, Siena, Italy
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), 4919University College London, London
| | - Karol Polom
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
|
20
|
Serra-Aracil X, García-Nalda A, Serra-Gómez B, Serra-Gómez A, Mora-López L, Pallisera-Lloveras A, Lucas-Guerrero V, Navarro-Soto S. Experimental study of the quantification of indocyanine green fluorescence in ischemic and non-ischemic anastomoses, using the SERGREEN software program. Sci Rep 2022; 12:13120. [PMID: 35908045 PMCID: PMC9338976 DOI: 10.1038/s41598-022-17395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Tissue ischemia is a key risk factor in anastomotic leak (AL). Indocyanine green (ICG) is widely used in colorectal surgery to define the segments with the best vascularization. In an experimental model, we present a new system for quantifying ICG fluorescence intensity, the SERGREEN software. Controlled experimental study with eight pigs. In the initial control stage, ICG fluorescence intensity was analyzed at the level of two anastomoses, in the right and in the left colon. Control images of the two segments were taken after ICG administration. The images were processed with the SERGREEN program. Then, in the experimental ischemia stage, the inferior mesenteric artery was sectioned at the level of the anastomosis of the left colon. Fifteen minutes after the section, sequential images of the two anastomoses were taken every 30 min for the following 2 h. At the control stage, the mean scores were 134.2 (95% CI 116.3–152.2) for the right colon and 147 (95% CI 134.7–159.3) for the left colon (p = 0.174) (Scale RGB—Red, Green, Blue). The right colon remained stable throughout the experiment. In the left colon, intensity fell by 47.9 points with respect to the pre-ischemia value (p < 0.01). After the first post-ischemia determination, the values of the ischemic left colon remained stable throughout the experiment. The relative decrease in ICG fluorescence intensity of the ischemic left colon was 32.6%. The SERGREEN program quantifies ICG fluorescence intensity in normal and ischemic situations and detects differences between them. A reduction in ICG fluorescence intensity of 32.6% or more was correlated with complete tissue ischemia.
Collapse
Affiliation(s)
- X Serra-Aracil
- Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain. .,Taulí Research and Innovation Institute I3PT, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain.
| | - A García-Nalda
- Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain.,Taulí Research and Innovation Institute I3PT, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain
| | - B Serra-Gómez
- Taulí Research and Innovation Institute I3PT, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain
| | - A Serra-Gómez
- Taulí Research and Innovation Institute I3PT, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain
| | - L Mora-López
- Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain.,Taulí Research and Innovation Institute I3PT, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain
| | - A Pallisera-Lloveras
- Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain.,Taulí Research and Innovation Institute I3PT, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain
| | - V Lucas-Guerrero
- Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain.,Taulí Research and Innovation Institute I3PT, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain
| | - S Navarro-Soto
- Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain.,Taulí Research and Innovation Institute I3PT, Parc Taulí University Hospital, Departament de Cirurgia, Universitat Autònoma de Barcelona, Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain
| |
Collapse
|
|
21
|
Emile SH, Khan SM, Wexner SD. Impact of change in the surgical plan based on indocyanine green fluorescence angiography on the rates of colorectal anastomotic leak: a systematic review and meta-analysis. Surg Endosc 2022; 36:2245-2257. [PMID: 35024926 DOI: 10.1007/s00464-021-08973-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the present study, patients with colorectal anastomoses that were assessed with indocyanine green (ICG) fluorescence angiography (FA) were compared to patients who had only white light visual inspection of their anastomosis. The impact of change in surgical plan guided by ICG-FA on anastomotic leak (AL) rates was assessed. METHODS PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were queried for eligible studies. Studies included were comparative cohort studies and randomized trials that compared perfusion assessment of colorectal anastomosis with ICG-FA and inspection under white light. Main outcome measures were change in surgical plan guided by ICG-FA and rates of AL. Risk of bias was assessed using RoB-2 and ROBINS-1 tools. Differences between the two groups in categorical and continuous variables were expressed as odds ratio (OR) with 95% confidence interval (CI) and weighted mean difference. RESULTS This systematic review included 27 studies comprising 8786 patients (48.5% males). Using ICG-FA was associated with significantly lower odds of AL (OR 0.452; 95% CI 0.366-0.558) and complications (OR 0.747; 95% CI 0.592-0.943) than the control group. The weighted mean rate of change in surgical plan based on ICG-FA was 9.6% (95% CI 7.3-11.8) and varied from 0.64% to 28.75%. A change in surgical plan was associated with significantly higher odds of AL (OR 2.73; 95% CI 1.54-4.82). LIMITATIONS Technical heterogeneity due to using different dosage of ICG and statistical heterogeneity in operative time and complication rates. CONCLUSION Assessment of colorectal anastomoses with ICG-FA is likely to be associated with lower odds of anastomotic leak than is traditional white light assessment. Change in plan based on ICG-FA may be associated with higher odds of AL. PROSPERO registration number: CRD42021235644.
Collapse
Affiliation(s)
- Sameh Hany Emile
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, 35516, Egypt.
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.
| | - Sualeh Muslim Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| |
Collapse
|
|
22
|
Koyanagi K, Ozawa S, Ninomiya Y, Yatabe K, Higuchi T, Yamamoto M, Kanamori K, Tajima K. Indocyanine green fluorescence imaging for evaluating blood flow in the reconstructed conduit after esophageal cancer surgery. Surg Today 2022; 52:369-376. [PMID: 33977382 DOI: 10.1007/s00595-021-02296-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/27/2021] [Indexed: 11/26/2022]
Abstract
We investigated the effectiveness of indocyanine green (ICG) fluorescence blood flow imaging of the gastric conduit to evaluate anastomotic leakage after esophagectomy. We identified 19 articles using the PRISMA standard for systematic reviews. The more recent studies reported attempts at objective quantification of ICG fluorescence imaging, rather than qualitative assessment. Anastomotic leakage after esophagectomy occurred in 0-33% of the patients who underwent ICG fluorescence imaging. According to the six studies that compared the incidence of anastomotic leakage in the ICG group and the control group, it ranged from 0 to 18.3% in the ICG group and from 0 to 25.2% in the control group, respectively. Overall, the incidence of anastomotic leakage in the ICG group (8.4%) was lower than that in the control group (18.5%). Although the incidence of anastomotic leakage was as high as 43.1% in patients who did not undergo any intraoperative intervention for poor blood flow, it was only 24% in patients who underwent intraoperative intervention. This systematic review revealed that ICG fluorescence imaging may be a crucial adjunctive tool for reducing anastomotic leakage after esophagectomy, suggesting that it should be performed during esophageal reconstruction.
Collapse
Affiliation(s)
- Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Soji Ozawa
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yamato Ninomiya
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Kentaro Yatabe
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Tadashi Higuchi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Miho Yamamoto
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Kohei Kanamori
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Kohei Tajima
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| |
Collapse
|
|
23
|
Border Line Definition Using Hyperspectral Imaging in Colorectal Resections. Cancers (Basel) 2022; 14:cancers14051188. [PMID: 35267496 PMCID: PMC8909141 DOI: 10.3390/cancers14051188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Good oxygenation of both bowel ends is an important prerequisite to promote anastomotic healing after colorectal resections. Bowel oxygenation is usually assessed clinically. Hyperspectral imaging is a contactless and contrast-free tool that allows quantifying tissue oxygen intraoperatively. In this study, the results of 105 colorectal resections with hyperspectral imaging are reported. Abstract Background: A perfusion deficit is a well-defined and intraoperatively influenceable cause of anastomotic leak (AL). Current intraoperative perfusion assessment methods do not provide objective and quantitative results. In this study, the ability of hyperspectral imaging (HSI) to quantify tissue oxygenation intraoperatively was assessed. Methods: 115 patients undergoing colorectal resections were included in the final analysis. Before anastomotic formation, the bowel was extracted and the resection line was outlined and imaged using a compact HSI camera, in order to provide instantaneously quantitative perfusion assessment. Results: In 105 patients, a clear demarcation line was visible with HSI one minute after marginal artery transection, reaching a plateau after 3 min. In 58 (55.2%) patients, the clinically determined transection line matched with HSI. In 23 (21.9%) patients, the clinically established resection margin was entirely within the less perfused area. In 24 patients (22.8%), the HSI transection line had an irregular course and crossed the clinically established resection line. In four cases, HSI disclosed a clinically undetected lesion of the marginal artery. Conclusions: Intraoperative HSI is safe, well reproducible, and does not disrupt the surgical workflow. It also quantifies bowel surface perfusion. HSI might become an intraoperative guidance tool, potentially preventing postoperative complications.
Collapse
|
|
24
|
Multisensor perfusion assessment cohort study: Preliminary evidence toward a standardized assessment of indocyanine green fluorescence in colorectal surgery. Surgery 2022; 172:69-73. [DOI: 10.1016/j.surg.2021.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 12/22/2022]
|
|
25
|
|
|
26
|
Guerra F, Coletta D. Laparoscopic surgery for acute small bowel obstruction: How best to determine bowel viability. Colorectal Dis 2022; 24:135-136. [PMID: 34653308 DOI: 10.1111/codi.15953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Francesco Guerra
- Ospedali Riuniti Marche Nord, Pesaro, Italy
- USL Toscana Sud-Est, Grosseto, Italy
| | - Diego Coletta
- Ospedali Riuniti Marche Nord, Pesaro, Italy
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
|
27
|
Spota A, Al-Taher M, Felli E, Morales Conde S, Dal Dosso I, Moretto G, Spinoglio G, Baiocchi G, Vilallonga R, Impellizzeri H, Martin-Martin GP, Casali L, Franzini C, Silvestri M, de Manzini N, Castagnola M, Filauro M, Cosola D, Copaescu C, Garbarino GM, Pesce A, Calabrò M, de Nardi P, Anania G, Carus T, Boni L, Patané A, Santi C, Saadi A, Rollo A, Chautems R, Noguera J, Grosek J, D'Ambrosio G, Ferreira CM, Norcic G, Navarra G, Riva P, Quaresima S, Paganini A, Rosso N, De Paolis P, Balla A, Sauvain MO, Gialamas E, Bianchi G, La Greca G, Castoro C, Picchetto A, Franchello A, Tartamella L, Juvan R, Ioannidis O, Kosir JA, Bertani E, Stassen L, Marescaux J, Diana M. Fluorescence-based bowel anastomosis perfusion evaluation: results from the IHU-IRCAD-EAES EURO-FIGS registry. Surg Endosc 2021; 35:7142-7153. [PMID: 33492508 DOI: 10.1007/s00464-020-08234-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Near-infrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry. METHODS Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications. RESULTS A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013-0.89 mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not. CONCLUSION The EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery.
Collapse
Affiliation(s)
- Andrea Spota
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France
- Scuola di Specializzazione in Chirurgia Generale, Università Degli Studi di Milano, Milano, Italy
| | - Mahdi Al-Taher
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Eric Felli
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Salvador Morales Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Sevilla, Spain
- General and Digestive Unit, Hospital Quironsalud Sagrado Corazon, Sevilla, Spain
| | | | | | | | - Gianluca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | | | | | | | | | | | | | | | - Davide Cosola
- Clinica Chirurgica, University of Trieste, Trieste, Italy
| | | | - Giovanni Maria Garbarino
- San Pietro Fatebenefratelli Hospital, Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Roma, Italy
| | | | | | | | | | | | - Luigi Boni
- Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico di Milano, University of Milan, Milano, Italy
| | | | | | - Alend Saadi
- Réseau Hospitalier Neuchâtelois, Neuchatel, Switzerland
| | | | | | | | - Jan Grosek
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Giancarlo D'Ambrosio
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | | | - Gregor Norcic
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Pietro Riva
- Unit of Foregut Surgery, IRCCS Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Alessandro Paganini
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | | | | | - Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | | | | | | | | | - Carlo Castoro
- Unit of Foregut Surgery, IRCCS Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | - Andrea Picchetto
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | | | | | - Robert Juvan
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | | | | | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jacques Marescaux
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France
| | - Michele Diana
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France.
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.
- Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.
- ICube Lab, Photonics for Health, University of Strasbourg, Strasbourg, France.
| |
Collapse
|
|
28
|
Barberio M, Benedicenti S, Pizzicannella M, Felli E, Collins T, Jansen-Winkeln B, Marescaux J, Viola MG, Diana M. Intraoperative Guidance Using Hyperspectral Imaging: A Review for Surgeons. Diagnostics (Basel) 2021; 11:2066. [PMID: 34829413 PMCID: PMC8624094 DOI: 10.3390/diagnostics11112066] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 12/12/2022] Open
Abstract
Hyperspectral imaging (HSI) is a novel optical imaging modality, which has recently found diverse applications in the medical field. HSI is a hybrid imaging modality, combining a digital photographic camera with a spectrographic unit, and it allows for a contactless and non-destructive biochemical analysis of living tissue. HSI provides quantitative and qualitative information of the tissue composition at molecular level in a contrast-free manner, hence making it possible to objectively discriminate between different tissue types and between healthy and pathological tissue. Over the last two decades, HSI has been increasingly used in the medical field, and only recently it has found an application in the operating room. In the last few years, several research groups have used this imaging modality as an intraoperative guidance tool within different surgical disciplines. Despite its great potential, HSI still remains far from being routinely used in the daily surgical practice, since it is still largely unknown to most of the surgical community. The aim of this study is to provide clinical surgeons with an overview of the capabilities, current limitations, and future directions of HSI for intraoperative guidance.
Collapse
Affiliation(s)
- Manuel Barberio
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (T.C.); (J.M.); (M.D.)
- General Surgery Department, Ospedale Card. G. Panico, 73039 Tricase, Italy; (S.B.); (M.P.); (M.G.V.)
| | - Sara Benedicenti
- General Surgery Department, Ospedale Card. G. Panico, 73039 Tricase, Italy; (S.B.); (M.P.); (M.G.V.)
| | - Margherita Pizzicannella
- General Surgery Department, Ospedale Card. G. Panico, 73039 Tricase, Italy; (S.B.); (M.P.); (M.G.V.)
| | - Eric Felli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, 3008 Bern, Switzerland;
- Department for BioMedical Research, Visceral Surgery and Medicine, University of Bern, 3008 Bern, Switzerland
| | - Toby Collins
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (T.C.); (J.M.); (M.D.)
| | | | - Jacques Marescaux
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (T.C.); (J.M.); (M.D.)
| | - Massimo Giuseppe Viola
- General Surgery Department, Ospedale Card. G. Panico, 73039 Tricase, Italy; (S.B.); (M.P.); (M.G.V.)
| | - Michele Diana
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (T.C.); (J.M.); (M.D.)
- ICube Laboratory, Photonics Instrumentation for Health, University of Strasbourg, 67400 Strasbourg, France
| |
Collapse
|
|
29
|
Barberio M, Felli E, Pizzicannella M, Agnus V, Al-Taher M, Seyller E, Moulla Y, Jansen-Winkeln B, Gockel I, Marescaux J, Diana M. Quantitative serosal and mucosal optical imaging perfusion assessment in gastric conduits for esophageal surgery: an experimental study in enhanced reality. Surg Endosc 2021; 35:5827-5835. [PMID: 33026514 PMCID: PMC8437861 DOI: 10.1007/s00464-020-08077-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/01/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION/OBJECTIVE Gastric conduit (GC) is used for reconstruction after esophagectomy. Anastomotic leakage (AL) incidence remains high, given the extensive disruption of the gastric circulation. Currently, there is no reliable method to intraoperatively quantify gastric perfusion. Hyperspectral imaging (HSI) has shown its potential to quantify serosal StO2. Confocal laser endomicroscopy (CLE) allows for automatic mucosal microcirculation quantification as functional capillary density area (FCD-A). The aim of this study was to quantify serosal and mucosal GC's microperfusion using HSI and CLE. Local capillary lactate (LCL) served as biomarker. METHODS GC was formed in 5 pigs and serosal StO2% was quantified at 3 regions of interest (ROI) using HSI: fundus (ROI-F), greater curvature (ROI-C), and pylorus (ROI-P). After intravenous injection of sodium-fluorescein (0.5 g), CLE-based mucosal microperfusion was assessed at the corresponding ROIs, and LCLs were quantified via a lactate analyzer. RESULTS StO2 and FCD-A at ROI-F (41 ± 10.6%, 3.3 ± 3.8, respectively) were significantly lower than ROI-C (68.2 ± 6.7%, p value: 0.005; 18.4 ± 7, p value: 0.01, respectively) and ROI-P (72 ± 10.4%, p value: 0.005; 15.7 ± 3.2 p value: 0.001). LCL value at ROI-F (9.6 ± 4.7 mmol/L) was significantly higher than at ROI-C (2.6 ± 1.2 mmol/L, p value: 0.04) and ROI-P (2.6 ± 1.3 mmol/L, p value: 0.04). No statistically significant difference was found in all metrics between ROI-C and ROI-P. StO2 correlated with FCD-A (Pearson's r = 0.67). The LCL correlated negatively with both FCD-A (Spearman's r = - 0.74) and StO2 (Spearman's r = - 0.54). CONCLUSIONS GC formation causes a drop in serosal and mucosal fundic perfusion. HSI and CLE correlate well and might become useful intraoperative tools.
Collapse
Affiliation(s)
- Manuel Barberio
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France.
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany.
| | - Eric Felli
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France
| | - Margherita Pizzicannella
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France
| | - Vincent Agnus
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France
| | - Mahdi Al-Taher
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France
| | - Emilie Seyller
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Jacques Marescaux
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Michele Diana
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- ICube Lab, Photonics Instrumentation for Health, Strasbourg, France
- Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| |
Collapse
|
|
30
|
Nakashima K, Ryu S, Okamoto A, Hara K, Ishida K, Ito R, Nakabayashi Y. Usefulness of blood flow evaluation with indocyanine green fluorescence imaging during laparoscopic surgery for strangulated bowel obstruction: A cohort study. Asian J Surg 2021; 45:867-873. [PMID: 34518078 DOI: 10.1016/j.asjsur.2021.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/06/2021] [Accepted: 08/04/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Intestinal blood flow evaluation during strangulated bowel obstruction is often based on the subjective assessment of the operator. Therefore, we aimed to comprehensively determine the presence or absence of intestinal blood flow based on normal light and indocyanine green (ICG) fluorescence imaging. Moreover, we ascertained whether the chosen surgical plan was appropriate, based on the patients' postoperative course and pathological findings. METHODS All 14 patients diagnosed with strangulated bowel obstruction at our hospital who underwent laparoscopic surgery between July 2019 and January 2021 were enrolled. Surgical plans were chosen based on normal light imaging combined with near-infrared imaging after intravenous ICG injection. Intestinal resection was performed via a small laparotomy if resection was considered necessary. In the intestinal resection group, the presence of intestinal necrosis was examined based on the pathological findings of the resected specimens. In the intestinal preservation group, postoperative complications, such as delayed intestinal perforation and intestinal stricture, were examined. RESULTS Intestinal resection was performed in 4 cases. The pathological findings of the resected specimens showed necrosis of the small intestine in all cases. No intra-abdominal complication occurred any of the cases, and the median postoperative hospital stay was 9.9 days. CONCLUSIONS The selection of a surgical plan in conjunction with ICG fluorescence findings was valid in all 14 cases. ICG fluorescence imaging is useful in laparoscopic surgery for strangulated bowel obstruction and may be a novel method for evaluating intestinal blood flow during surgery.
Collapse
Affiliation(s)
- Keigo Nakashima
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180 Nishiaraijyuku Kawaguchi, Saitama, 333-0833, Japan.
| | - Shunjin Ryu
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180 Nishiaraijyuku Kawaguchi, Saitama, 333-0833, Japan.
| | - Atsuko Okamoto
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180 Nishiaraijyuku Kawaguchi, Saitama, 333-0833, Japan.
| | - Keigo Hara
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180 Nishiaraijyuku Kawaguchi, Saitama, 333-0833, Japan.
| | - Kota Ishida
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180 Nishiaraijyuku Kawaguchi, Saitama, 333-0833, Japan.
| | - Ryusuke Ito
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180 Nishiaraijyuku Kawaguchi, Saitama, 333-0833, Japan.
| | - Yukio Nakabayashi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180 Nishiaraijyuku Kawaguchi, Saitama, 333-0833, Japan.
| |
Collapse
|
|
31
|
Zhang W, Che X. Effect of indocyanine green fluorescence angiography on preventing anastomotic leakage after colorectal surgery: a meta-analysis. Surg Today 2021; 51:1415-1428. [PMID: 33428000 DOI: 10.1007/s00595-020-02195-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022]
Abstract
Anastomotic leakage (AL) is a serious but not uncommon complication after colorectal surgery. We conducted this study to evaluate the effect of routine indocyanine green fluorescence angiography (ICG-FA) on reducing the AL rate after colorectal surgery. We identified all research articles about colorectal surgery using ICG-FA, published in the PubMed, EMBASE, and Cochrane Library databases from the date of database establishment to May 2020. Revman 5.3 was used for statistical analysis. We analyzed 22 controlled studies and 7 non-controlled studies on ICG-FA, including 6312 patients. The controlled studies included 2354 patients in the ICG group and 3522 patients in the non-ICG group. Meta-analysis showed that ICG-FA reduced the AL rate after colorectal surgery significantly (RR = 0.39; 95% CI 0.30-0.50; P < 0.00001). However, patients whose resection line was changed based on the fluorescence angiography had a higher AL rate than those whose resection line was not changed (OR = 5.37; 95% CI 2.67-10.81; P < 0.00001). The overall complication rate, severe complication rate, and reoperation rate in the ICG group were significantly lower than those in the non-ICG group (RR = 0.79, 95% CI 0.67-0.92, P = 0.002; RR = 0.67, 95% CI 0.47-0.96, P = 0.03; RR = 0.53, 95% CI 0.29-0.96, P = 0.04, respectively), whereas the postoperative ileus rate was significantly higher in the ICG group than in the non-ICG group (RR = 1.65; 95% CI 1.09-2.50; P = 0.02), especially in Western countries (RR = 1.6; 95% CI 1.04-2.47; P = 0.03).ICG-FA may reduce the AL rate after colorectal surgery, but ICG-FA group patients with transection line change for insufficient blood perfusion to the anastomotic stoma after evaluation had a higher AL rate than those without transection line change. Therefore, ICG-FA can help to identify patients at high risk of AL and intercept its occurrence. Moreover, ICG-FA may reduce the overall complication rate, severe complication rate, and reoperation rate, but induce postoperative ileus. High-quality randomized-controlled trials with a placebo control are needed to further evaluate the effectiveness and safety of ICG-FA.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Xu Che
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
| |
Collapse
|
|
32
|
Gosvig K, Jensen SS, Qvist N, Nerup N, Agnus V, Diana M, Ellebæk MB. Quantification of ICG fluorescence for the evaluation of intestinal perfusion: comparison between two software-based algorithms for quantification. Surg Endosc 2021; 35:5043-5050. [PMID: 32968913 DOI: 10.1007/s00464-020-07986-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Indocyanine green fluorescence imaging (ICG-FI) can be used to evaluate intestinal perfusion prior to anastomosis. Several software for the quantification of fluorescence have emerged, but these have not previously been compared. The aim of this study was to compare the results from quantitative ICG-FI analysis of relative perfusion in an experimental setting using two different software-based quantification algorithms (FLER and Q-ICG). METHODS Twenty pigs received a laparotomy, and ischemic areas were created in three segments of the small intestine of each pig. For each ischemic area, fluorescence imaging was performed and the fluorescence recordings were quantitatively analyzed using FLER and Q-ICG. The quantitative analysis resulted in a set of perfusion lines for each software for either 30%, 60% or 100% relative perfusion. The perfusion lines were compared by registering the normalized slope for each set of perfusion lines, calculating the relative perfusion percentage in the FLER perfusion line according to Q-ICG, and measuring the length of the ischemic area for each analysis. RESULTS Fifty-four fluorescence recordings from 18 pigs were included. The ischemic segment for FLER was significantly longer in the 30% perfusion group and significantly shorter in the 100% perfusion group as compared to Q-ICG. The normalized slope for the FLER perfusion lines was significantly higher in the 30% perfusion group and significantly lower in the 100% perfusion group as compared to the Q-ICG perfusion lines. For the perfusion lines defined by FLER as 30%, 60%, and 100%, Q-ICG found 35.2% (p = 0.07), 63.7% (p = 0.31), and 84.1% perfusion (p = 0.003) respectively. CONCLUSION The two software demonstrated significant differences in quantitative fluorescence analysis when perfusion was either very high or very low. The clinical relevance of these differences is unclear.
Collapse
Affiliation(s)
- Kristina Gosvig
- Research Unit for Surgery, Odense University Hospital, J. B. Winsløws Vej 4, Indgang 20, Penthouse, 5000, Odense C, Denmark.
- University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Signe Steenstrup Jensen
- Research Unit for Surgery, Odense University Hospital, J. B. Winsløws Vej 4, Indgang 20, Penthouse, 5000, Odense C, Denmark
- University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, J. B. Winsløws Vej 4, Indgang 20, Penthouse, 5000, Odense C, Denmark
- University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Nikolaj Nerup
- Department of Surgical Gastroenterology, Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, Afsnit 2212, 2100, Copenhagen, Denmark
| | - Vincent Agnus
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1 Place de l'Hôpital, 67091, Strasbourg, France
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1 Place de l'Hôpital, 67091, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, 1 Place de l'Hôpital, 67091, Strasbourg, France
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, 1 Rue David Richard, 67000, Strasbourg, France
- ICube Lab, Photonics Instrumentation for Health, 300 Bd Sébastien Brant, 67400, Illkirch-Graffenstaden, France
| | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Odense University Hospital, J. B. Winsløws Vej 4, Indgang 20, Penthouse, 5000, Odense C, Denmark
- University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| |
Collapse
|
|
33
|
McInerney N, Khan MF, McLoughlin J, Shields C, Eaton D, Cahill RA. Emergency perioperative near-infrared assessment of small bowel viability in a case of incarcerated diaphragmatic hernia - a video vignette. Colorectal Dis 2021; 23:2204-2205. [PMID: 33974341 DOI: 10.1111/codi.15726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Niall McInerney
- UCD Centre for Precision Surgery, University College Dublin, Dublin 7, Ireland
| | - Mohammad Faraz Khan
- UCD Centre for Precision Surgery, University College Dublin, Dublin 7, Ireland
| | - Joseph McLoughlin
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Conor Shields
- UCD Centre for Precision Surgery, University College Dublin, Dublin 7, Ireland.,Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Donna Eaton
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, University College Dublin, Dublin 7, Ireland
| |
Collapse
|
|
34
|
Al-Taher M, Barberio M, Felli E, Agnus V, Ashoka AH, Gioux S, Klymchenko A, Bouvy N, Stassen L, Marescaux J, Diana M. Simultaneous multipurpose fluorescence imaging with IRDye® 800BK during laparoscopic surgery. Surg Endosc 2021; 35:4840-4848. [PMID: 32860134 DOI: 10.1007/s00464-020-07931-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
|
|
35
|
Guerra F, Coletta D, Greco PA, Eugeni E, Patriti A. The use of indocyanine green fluorescence to define bowel microcirculation during laparoscopic surgery for acute small bowel obstruction. Colorectal Dis 2021; 23:2189-2194. [PMID: 33876537 DOI: 10.1111/codi.15680] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/27/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
AIM Although there is growing evidence to support the feasibility of a minimally invasive approach for acute small bowel obstruction, the inability to adequately evaluate compromised bowel segments has been cited as a major limitation. The aim of this work is to report a novel application of extemporaneous indocyanine green (ICG) fluorescence to assess bowel viability where there is a concern for ischaemic damage. METHOD After the cause of obstruction has been identified and resolved, and where there are dubious signs of bowel ischaemia present, fluorescent selective angiography is undertaken. The segment of bowel in question is observed under both normal and fluorescent light to assess local microcirculation. The adequacy of both the arterial supply and the venous drainage is thus appraised to define bowel viability. RESULTS Among 71 patients who have undergone surgery for acute small bowel obstruction with a laparoscopic approach, seven received extemporaneous ICG fluorescence assessment of bowel viability. Different presentations with their relevant management are described. CONCLUSIONS Selective use of intraoperative fluorescent angiography may overcome some of the intrinsic limitations of laparoscopy in assessing bowel viability during surgery for acute small bowel obstruction.
Collapse
|
|
36
|
D'Urso A, Agnus V, Barberio M, Seeliger B, Marchegiani F, Charles AL, Geny B, Marescaux J, Mutter D, Diana M. Computer-assisted quantification and visualization of bowel perfusion using fluorescence-based enhanced reality in left-sided colonic resections. Surg Endosc 2021; 35:4321-4331. [PMID: 32856153 DOI: 10.1007/s00464-020-07922-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fluorescence-based enhanced reality (FLER) is a computer-based quantification method of fluorescence angiographies to evaluate bowel perfusion. The aim of this prospective trial was to assess the clinical feasibility and to correlate FLER with metabolic markers of perfusion, during colorectal resections. METHODS FLER analysis and visualization was performed in 22 patients (diverticulitis n = 17; colorectal cancer n = 5) intra- and extra-abdominally during distal and proximal resection, respectively. The fluorescence signal of indocyanine green (0.2 mg/kg) was captured using a near-infrared camera and computed to create a virtual color-coded cartography. This was overlaid onto the bowel (enhanced reality). It helped to identify regions of interest (ROIs) where samples were subsequently obtained. Resections were performed strictly guided according to clinical decision. On the surgical specimen, samplings were made at different ROIs to measure intestinal lactates (mmol/L) and mitochondria efficiency as acceptor control ratio (ACR). RESULTS The native (unquantified) fluorescent signal diffused to obvious ischemic areas during the distal appreciation. Proximally, a lower diffusion of ICG was observed. Five anastomotic complications occurred. The expected values of local capillary lactates were correlated with the measured values both proximally (3.62 ± 2.48 expected vs. 3.17 ± 2.8 actual; rho 0.89; p = 0.0006) and distally (4.5 ± 3 expected vs. 4 ± 2.5 actual; rho 0.73; p = 0.0021). FLER values correlated with ACR at the proximal site (rho 0.76; p = 0.04) and at the ischemic zone (rho 0.71; p = 0.01). In complicated cases, lactates at the proximal resection site were higher (5.8 ± 4.5) as opposed to uncomplicated cases (2.45 ± 1.5; p = 0.008). ACR was reduced proximally in complicated (1.3 ± 0.18) vs. uncomplicated cases (1.68 ± 0.3; p = 0.023). CONCLUSIONS FLER allows to image the quantified fluorescence signal in augmented reality and provides a reproducible estimation of bowel perfusion (NCT02626091).
Collapse
Affiliation(s)
- Antonio D'Urso
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Vincent Agnus
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Manuel Barberio
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Barbara Seeliger
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | | | - Anne-Laure Charles
- Institute of Physiology, EA3072, Mitochondria and Oxidative Stress, University of Strasbourg, Strasbourg, France
| | - Bernard Geny
- Institute of Physiology, EA3072, Mitochondria and Oxidative Stress, University of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Didier Mutter
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg, France
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Institute of Physiology, EA3072, Mitochondria and Oxidative Stress, University of Strasbourg, Strasbourg, France
| | - Michele Diana
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg, France.
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.
- Institute of Physiology, EA3072, Mitochondria and Oxidative Stress, University of Strasbourg, Strasbourg, France.
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France.
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France.
| |
Collapse
|
|
37
|
Intraoperative quality assessment of tissue perfusion with indocyanine green (ICG) in a porcine model of mesenteric ischemia. PLoS One 2021; 16:e0254144. [PMID: 34283875 PMCID: PMC8291700 DOI: 10.1371/journal.pone.0254144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background Mesenteric ischemia is a severe and potentially lethal event. Assessment of intestine perfusion is eminently depending on the skills, and the experience of the surgeon. Thus, the therapy is biased by the right evaluation. Aim of this study is to determine the applicability, and the usefulness of fluorescent-imaging (FI) with indocyanine green (ICG) in a porcine model of mesenteric ischemia. Second end-point is the verification of a visual and quantitative assessment tool of the intestinal perfusion. Methods In 18 pigs (54,2 ±2,9kg) an occlusion of a side-branch of the mesenteric artery was performed for 3 (group I, n = 7), 6 (group II, n = 7), and 10 hours (group III, n = 4). After reperfusion a 60 minutes observation period was carried out. 3 regions of interest were defined: ischemic bowel (D1), transitional zone (D2), and non-ischemic bowel (D3). ICG-FI was performed during baseline (T0), occlusion (T1), reperfusion (T2) and after an observation period of 60 minutes (T4). Results All experiments could be finished successfully. ICG-FI was assessed using assessment of background-subtracted peak fluorescence intensity (BSFI), slope of fluorescence intensity (SFI), and a baseline adjusted ratio of both parameters. ICG-FI confirmed loss of perfusion in D1, decreased perfusion in D2, and increased perfusion in D3. After reperfusion ICG-FI increased in group 2 due to a severe tissue damage resulting in a capillary leakage. In group I ICG-FI was equal to baseline values indicating the totally reversible loss of perfusion. Conclusion Using ICG-FI to estimate intestine perfusion after different durations of ischemia is viable using a porcine model of mesenteric ischemia. Even small differences in perfusion can be reliably determined by ICG-FI. Thus, ICG-FI is an encouraging method to evaluate intestine perfusion intraoperatively.
Collapse
|
|
38
|
Gockel I, Barberio M, Diana M, Thieme R, Pfahl A, Sucher R, Köhler H, Chalopin C, Maktabi M, Jansen-Winkeln B. [New intraoperative fluorescence-based and spectroscopic imaging techniques in visceral medicine - precision surgery in the "high tech"-operating room]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:683-690. [PMID: 34157756 DOI: 10.1055/a-1481-1993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Fluorescence angiography (FA) with indocyanine green (ICG) and hyperspectral imaging (HSI) are novel intraoperative visualization techniques in abdominal, vascular and transplant surgery. With the purpose of precision surgery, and in order to increase patient's safety, these new tools aim at reducing postoperative morbidity and mortality. This review discusses and highlights recent developments and the future potential of real-time imaging modalities. METHODS The underlying mechanisms of the novel imaging methods and their clinical impact are displayed in the context of avoiding anastomotic leaks, the most momentous complications in gastrointestinal surgery after oncologic resections. RESULTS While FA is associated with the admission of a fluorescence agent, HSI is contact-free and non-invasive. Both methods are able to record physiological tissue properties in real-time. Additionally, FA also measures dynamic phenomena. The techniques take a few seconds only and do not hamper the operative workflow considerably. With regard to a potential change of the surgical strategy, FA and HSI have an equal significance. Our own advancements reflect, in particular, the topics of data visualization and automated data analyses together with the implementation of artificial intelligence (AI) and minimalization of the current devices to install them into endoscopes, minimal-invasive and robot-guided surgery. CONCLUSION There are a limited number of studies in the field of intraoperative imaging techniques. Whether precision surgery in the "high-tech" OR together with FA, HSI and robotics will result in more secure operative procedures to minimize the postoperative morbidity and mortality will have to be evaluated in future multicenter trials.
Collapse
Affiliation(s)
- Ines Gockel
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Leipzig
| | - Manuel Barberio
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Leipzig.,IRCAD, Research Institute against Digestive Cancer, Straßburg, Frankreich.,IHU-Strasbourg, Institute of Image-Guided Surgery, Frankreich
| | - Michele Diana
- IRCAD, Research Institute against Digestive Cancer, Straßburg, Frankreich.,IHU-Strasbourg, Institute of Image-Guided Surgery, Frankreich
| | - René Thieme
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Leipzig
| | - Annekatrin Pfahl
- ICCAS, Innovation Center Computer Assisted Surgery, Universität Leipzig, Leipzig, Deutschland
| | - Robert Sucher
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Leipzig
| | - Hannes Köhler
- ICCAS, Innovation Center Computer Assisted Surgery, Universität Leipzig, Leipzig, Deutschland
| | - Claire Chalopin
- ICCAS, Innovation Center Computer Assisted Surgery, Universität Leipzig, Leipzig, Deutschland
| | - Marianne Maktabi
- ICCAS, Innovation Center Computer Assisted Surgery, Universität Leipzig, Leipzig, Deutschland
| | - Boris Jansen-Winkeln
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Leipzig
| |
Collapse
|
|
39
|
Kanammit P, Sirisreetreerux P, Boongird S, Worawichawong S, Kijvikai K. Intraoperative assessment of ureter perfusion after revascularization of transplanted kidneys using intravenous indocyanine green fluorescence imaging. Transl Androl Urol 2021; 10:2297-2306. [PMID: 34295717 PMCID: PMC8261407 DOI: 10.21037/tau-21-160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background Kidney transplantation is the most valuable renal replacement therapy. One of the most common urologic complications following kidney transplantation is ureter anastomosis leakage, which leads to high morbidity along with kidney graft loss. We hypothesized that indocyanine green (ICG) fluorescence videography can assess ureter perfusion after revascularization of transplanted kidneys. Methods We conducted a prospective cross-sectional study in end-stage renal disease patients who underwent deceased donor kidney transplantation at Ramathibodi Hospital from September 2019 to January 2020. The segments of transplanted ureters were categorized as having good or poor perfusion based on the percentage from ICG fluorescence videography images. Then the results from ICG fluorescence videography were compared with histopathology which is considered the gold standard. Results Thirty-one sections of dissected ureters were evaluated from 10 patients. Compared with pathological diagnosis of ureteral ischemia, ICG videography had sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive likelihood ratio of 100%, 92.6%, 66.7%, 100%, and 14, respectively. Accuracy was 93.6%. The area under the curve of ICG fluorescence videography was 0.96. The average ureter length that maintained good perfusion was 14 cm from the ureteropelvic junction. Adverse events from ICG were not observed in this study. Conclusions We conclude that ICG fluorescence videography is beneficial for detection of early ureteral ischemia in kidney transplantation patients, with negligible adverse events. However, further studies with larger numbers of patients are necessary to confirm our results and clinical outcomes regarding complication rates.
Collapse
Affiliation(s)
- Potchara Kanammit
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pokket Sirisreetreerux
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sarinya Boongird
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchin Worawichawong
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kittinut Kijvikai
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
|
40
|
Al-Taher M, Pruimboom T, Schols RM, Okamoto N, Bouvy ND, Stassen LPS, van der Hulst RRWJ, Kugler M, Hostettler A, Noll E, Marescaux J, Diemunsch S, Diana M. Influence of intraoperative vasopressor use on indocyanine green fluorescence angiography: first evaluation in an experimental model. Sci Rep 2021; 11:9650. [PMID: 33958693 PMCID: PMC8102475 DOI: 10.1038/s41598-021-89223-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/22/2021] [Indexed: 12/13/2022] Open
Abstract
Intraoperative indocyanine green (ICG) fluorescence angiography has gained popularity and acceptance in many surgical fields for the real-time assessment of tissue perfusion. Although vasopressors have the potential to preclude an accurate assessment of tissue perfusion, there is a lack of literature with regards to its effect on ICG fluorescence angiography. An experimental porcine model was used to expose the small bowel for quantitative tissue perfusion assessment. Three increasing doses of norepinephrine infusion (0.1, 0.5, and 1.0 µg/kg/min) were administered intravenously over a 25-min interval. Time-to-peak fluorescence intensity (TTP) was the primary outcome. Secondary outcomes included absolute fluorescence intensity and local capillary lactate (LCL) levels. Five large pigs (mean weight: 40.3 ± 4.24 kg) were included. There was no significant difference in mean TTP (in seconds) at baseline (4.23) as compared to the second (3.90), third (4.41), fourth (4.60), and fifth ICG assessment (5.99). As a result of ICG accumulation, the mean and the maximum absolute fluorescence intensity were significantly different as compared to the baseline assessment. There was no significant difference in LCL levels (in mmol/L) at baseline (0.74) as compared to the second (0.82), third (0.64), fourth (0.60), and fifth assessment (0.62). Increasing doses of norepinephrine infusion have no significant influence on bowel perfusion using ICG fluorescence angiography.
Collapse
Affiliation(s)
- Mahdi Al-Taher
- IRCAD, Research Institute Against Digestive Cancer, 1, Place de l'Hôpital, 67000, Strasbourg, France.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Tim Pruimboom
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Rutger M Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Nariaki Okamoto
- IRCAD, Research Institute Against Digestive Cancer, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - René R W J van der Hulst
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Michael Kugler
- IRCAD, Research Institute Against Digestive Cancer, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - Alexandre Hostettler
- IRCAD, Research Institute Against Digestive Cancer, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - Eric Noll
- Department of Anesthesiology, Critical Care and Prehospital Emergency Medicine, University Hospital of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- IRCAD, Research Institute Against Digestive Cancer, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - Sophie Diemunsch
- Department of Anesthesiology, Critical Care and Prehospital Emergency Medicine, University Hospital of Strasbourg, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, 1, Place de l'Hôpital, 67000, Strasbourg, France
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| |
Collapse
|
|
41
|
Nerup N, Svendsen MBS, Rønn JH, Konge L, Svendsen LB, Achiam MP. Quantitative fluorescence angiography aids novice and experienced surgeons in performing intestinal resection in well-perfused tissue. Surg Endosc 2021; 36:2373-2381. [PMID: 33942183 PMCID: PMC8921116 DOI: 10.1007/s00464-021-08518-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/17/2021] [Indexed: 02/07/2023]
Abstract
Background Anastomotic leakage (AL) after gastrointestinal resection is a devastating complication with huge consequences for the patient. As AL is associated with poor blood supply, tools for objective assessment of perfusion are in high demand. Indocyanine green angiography (ICG-FA) and quantitative analysis of ICG-FA (q-ICG) seem promising. This study aimed to investigate whether ICG-FA and q-ICG could improve perfusion assessment performed by surgeons of different experience levels. Methods Thirteen small bowel segments with a varying degree of devascularization, including two healthy sham segments, were constructed in a porcine model. We recruited students, residents, and surgeons to perform perfusion assessment of the segments in white light (WL), with ICG-FA, and after q-ICG, all blinded to the degree of devascularization. Results Forty-five participants fulfilled the study (18 novices, 12 intermediates, and 15 experienced). ICG and q-ICG helped the novices correctly detect the healthy bowel segments to experienced surgeons’ level. ICG and q-ICG also helped novice surgeons to perform safer resections in healthy tissue compared with normal WL. The relative risk (RR) of leaving ischemic tissue in WL and ICG compared with q-ICG, even for experienced surgeons was substantial, intermediates (RR = 8.9, CI95% [4.0;20] and RR = 6.2, CI95% [2.7;14.1]), and experienced (RR = 4.7, CI95% [2.6;8.7] and RR = 4.0, CI95% [2.1;7.5]). Conclusion Q-ICG seems to guide surgeons, regardless of experience level, to safely perform resection in healthy tissue, compared with standard WL. Future research should focus on this novel tool’s clinical impact.
Collapse
Affiliation(s)
- Nikolaj Nerup
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9 DK-2100, Copenhagen Ø, Denmark.
| | - Morten Bo Søndergaard Svendsen
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Copenhagen, Capital Region of Denmark, Denmark
| | - Jonas Hedelund Rønn
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9 DK-2100, Copenhagen Ø, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Copenhagen, Capital Region of Denmark, Denmark
| | - Lars Bo Svendsen
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9 DK-2100, Copenhagen Ø, Denmark
| | - Michael Patrick Achiam
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9 DK-2100, Copenhagen Ø, Denmark
| |
Collapse
|
|
42
|
Slooter MD, Mansvelders MSE, Bloemen PR, Gisbertz SS, Bemelman WA, Tanis PJ, Hompes R, van Berge Henegouwen MI, de Bruin DM. Defining indocyanine green fluorescence to assess anastomotic perfusion during gastrointestinal surgery: systematic review. BJS Open 2021; 5:6249560. [PMID: 33893811 PMCID: PMC8271268 DOI: 10.1093/bjsopen/zraa074] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/09/2020] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this systematic review was to identify all methods to quantify intraoperative fluorescence angiography (FA) of the gastrointestinal anastomosis, and to find potential thresholds to predict patient outcomes, including anastomotic leakage and necrosis. Methods This systematic review adhered to the PRISMA guidelines. A PubMed and Embase literature search was performed. Articles were included when FA with indocyanine green was performed to assess gastrointestinal perfusion in human or animals, and the fluorescence signal was analysed using quantitative parameters. A parameter was defined as quantitative when a diagnostic numeral threshold for patient outcomes could potentially be produced. Results Some 1317 articles were identified, of which 23 were included. Fourteen studies were done in patients and nine in animals. Eight studies applied FA during upper and 15 during lower gastrointestinal surgery. The quantitative parameters were divided into four categories: time to fluorescence (20 studies); contrast‐to‐background ratio (3); pixel intensity (2); and numeric classification score (2). The first category was subdivided into manually assessed time (7 studies) and software‐derived fluorescence–time curves (13). Cut‐off values were derived for manually assessed time (speed in gastric conduit wall) and derivatives of the fluorescence–time curves (Fmax, T1/2, TR and slope) to predict patient outcomes. Conclusion Time to fluorescence seems the most promising category for quantitation of FA. Future research might focus on fluorescence–time curves, as many different parameters can be derived and the fluorescence intensity can be bypassed. However, consensus on study set‐up, calibration of fluorescence imaging systems, and validation of software programs is mandatory to allow future data comparison.
Collapse
Affiliation(s)
- M D Slooter
- Departments of Surgery, Amsterdam the Netherlands
| | | | - P R Bloemen
- Biomedical Engineering and Physics, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - S S Gisbertz
- Departments of Surgery, Amsterdam the Netherlands
| | - W A Bemelman
- Departments of Surgery, Amsterdam the Netherlands
| | - P J Tanis
- Departments of Surgery, Amsterdam the Netherlands
| | - R Hompes
- Departments of Surgery, Amsterdam the Netherlands
| | | | - D M de Bruin
- Departments of Surgery, Amsterdam the Netherlands
| |
Collapse
|
|
43
|
Urade T, Felli E, Barberio M, Al-Taher M, Felli E, Goffin L, Agnus V, Ettorre GM, Marescaux J, Mutter D, Diana M. Hyperspectral enhanced reality (HYPER) for anatomical liver resection. Surg Endosc 2021; 35:1844-1850. [PMID: 32342212 DOI: 10.1007/s00464-020-07586-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Clinical evaluation of the demarcation line separating ischemic from non-ischemic liver parenchyma may be challenging. Hyperspectral imaging (HSI) is a noninvasive imaging modality, which combines a camera with a spectroscope and allows quantitative imaging of tissue oxygenation. Our group developed a software to overlay HSI images onto the operative field, obtaining HSI-based enhanced reality (HYPER). The aim of the present study was to evaluate the accuracy of HYPER to identify the demarcation line after a left vascular inflow occlusion during an anatomical left hepatectomy. MATERIALS AND METHODS In the porcine model (n = 3), the left branches of the hepatic pedicle were ligated. Before and after vascular occlusion, HSI images based on tissue oxygenation (StO2), obtained through the Near-Infrared index (NIR index), were regularly acquired and superimposed onto RGB video. The demarcation line was marked on the liver surface with electrocautery according to HYPER. Local lactates were measured on blood samples from the liver surface in both ischemic and perfused segments using a strip-based device. At the same areas, confocal endomicroscopy was performed. RESULTS After ligation, HSI demonstrated a significantly lower oxygenation (NIR index) in the left medial lobe (LML) (0.27% ± 0.21) when compared to the right medial lobe (RML) (58.60% ± 12.08; p = 0.0015). Capillary lactates were significantly higher (3.07 mmol/L ± 0.84 vs. 1.33 ± 0.71 mmol/L; p = 0.0356) in the LML versus RML, respectively. Concordantly, confocal videos demonstrated the absence of blood flow in the LML and normal perfusion in the RML. CONCLUSIONS HYPER has made it possible to correctly identify the demarcation line and quantify surface liver oxygenation. HYPER could be an intraoperative tool to guide perfusion-based demarcation line assessment and segmentation.
Collapse
Affiliation(s)
- Takeshi Urade
- Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France
| | - Eric Felli
- Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France
- Institute of Physiology, EA3072 Mitochondria Respiration and Oxidative Stress, University of Strasbourg, Strasbourg, France
| | - Manuel Barberio
- Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France
- Institute of Physiology, EA3072 Mitochondria Respiration and Oxidative Stress, University of Strasbourg, Strasbourg, France
| | - Mahdi Al-Taher
- Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France
| | - Emanuele Felli
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Laurent Goffin
- ICube/CNRS, University of Strasbourg, Strasbourg, France
| | - Vincent Agnus
- Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France
| | | | - Jacques Marescaux
- Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France
- Research Institute against Digestive Cancer, IRCAD, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Didier Mutter
- Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
- Research Institute against Digestive Cancer, IRCAD, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Michele Diana
- Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France.
- Institute of Physiology, EA3072 Mitochondria Respiration and Oxidative Stress, University of Strasbourg, Strasbourg, France.
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.
- ICube/CNRS, University of Strasbourg, Strasbourg, France.
- Research Institute against Digestive Cancer, IRCAD, 1, place de l'Hôpital, 67091, Strasbourg, France.
| |
Collapse
|
|
44
|
Vaassen HGM, Wermelink B, Geelkerken RH, Lips DJ. Fluorescence-Based Quantification of Gastrointestinal Perfusion: A Step Towards an Automated Approach. J Laparoendosc Adv Surg Tech A 2021; 32:293-298. [PMID: 33739876 DOI: 10.1089/lap.2021.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Qualitative fluorescence angiography (FA) provides insights into intestinal tissue perfusion, but today it is not yet accurate in predicting anastomotic leakage. To improve peroperative detection of impaired perfusion, quantified parameters should be investigated using a standardized method. The aim of this study was to develop a (semi)automated algorithm for comprehensive and convenient analysis of FA parameters. Materials and Methods: An analysis tool was developed for the extraction of quantified FA parameters. The start- and endpoint of intensity increase (T0 and Tmax) were automatically detected in the intensity-time curves. Algorithm performance was measured against manual assignment of T0 and Tmax by 9 independent observers in 18 in vivo generated test signals, using the intraclass correlation coefficient (ICC). Characteristics of parameter T1∕2 (time to 50% of maximal intensity) were analyzed in normally perfused small intestine of 32 subjects who underwent robotic laparoscopic surgery. Since ethical approval was not required under the Dutch law, the need for informed consent was waived. Results: Automated detection of T0 and Tmax was successful in all subjects. Output of the algorithm had an excellent agreement with the median of the human observations: ICC = 0.95 (95% confidence interval: 0.86-0.96). Overall, T1∕2 had a median value of 5.1 (interquartile range = 2.4) seconds and a minimal and maximal value of 1.3 and 9.9 seconds, respectively. Conclusions: The presented method provided convenient data analysis in the search for effective FA quantification. Future research should expand the data to find adequate threshold values for peroperatively identifying insufficient perfusion and investigate the influence of physiological conditions.
Collapse
Affiliation(s)
- Harry G M Vaassen
- Multi-Modality Medical Imaging (M3i) Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Bryan Wermelink
- Multi-Modality Medical Imaging (M3i) Group, TechMed Centre, University of Twente, Enschede, The Netherlands.,Section of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Robert H Geelkerken
- Multi-Modality Medical Imaging (M3i) Group, TechMed Centre, University of Twente, Enschede, The Netherlands.,Section of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Daan J Lips
- Section of Gastrointestinal and Oncology Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| |
Collapse
|
|
45
|
Barberio M, Al-Taher M, Felli E, Ashoka AH, Marescaux J, Klymchenko A, Diana M. Intraoperative ureter identification with a novel fluorescent catheter. Sci Rep 2021; 11:4501. [PMID: 33627768 PMCID: PMC7904916 DOI: 10.1038/s41598-021-84121-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/12/2021] [Indexed: 12/16/2022] Open
Abstract
Iatrogenic ureteral injuries (IUI) occur in 0.5-1.3% of cases during abdominal surgery. If not recognized intraoperatively, IUI increase morbidity/mortality. A universally accepted method to prevent IUI is lacking. Near-infrared fluorescent imaging (NIRF), penetrating deeper than normal light within the tissue, might be useful, therefore ureter visualization combining NIRF with special dyes (i.e. IRDye 800BK) is promising. Aim of this work is to evaluate the detection of ureters using stents coated with a novel biocompatible fluorescent material (NICE: near-infrared coating of equipment), during laparoscopy. female pigs underwent placement of NICE-coated stents (NS). NIRF was performed, and fluorescence intensity (FI) was computed. Successively, 0.15 mg/kg of IRDye 800BK was administered intravenously, and FI was computed at different timepoints. Ureter visualization using NS only was further assessed in a human cadaver. Both methods allowed in vivo ureter visualization, with equal FI. However, NS were constantly visible whereas IRDye 800BK allowed visualization exclusively during the ureteral peristaltic phases. In the human cadaver, NS provided excellent ureter visualization in its natural anatomical position. NS provided continuous ureteral visualization with similar FI as the IRDye 800BK, which exclusively allowed intermittent visualization, dependent on ureteral peristalsis. NS might prove useful to visualize ureters intraoperatively, potentially preventing IUI.
Collapse
Affiliation(s)
- Manuel Barberio
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg, France.
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France.
- Ospedale Cardinale G. Panico, Tricase (LE), Italy.
| | - Mahdi Al-Taher
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Eric Felli
- Institute of Image-Guided Surgery, IHU-Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Anila Hoskere Ashoka
- Laboratoire de Bio-Imagerie et Pathologies, UMR 7021, CNRS, Université de Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
| | - Andrey Klymchenko
- Laboratoire de Bio-Imagerie et Pathologies, UMR 7021, CNRS, Université de Strasbourg, Strasbourg, France
| | - Michele Diana
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
- iCube Laboratory, Photonics for Health, Strasbourg, France
| |
Collapse
|
|
46
|
Marchegiani F, Noll E, Riva P, Kong SH, Saccomandi P, Vita G, Lindner V, Namer IJ, Marescaux J, Diemunsch P, Diana M. Effects of Warmed and Humidified CO 2 Surgical Site Insufflation in a Novel Experimental Model of Magnetic Compression Colonic Anastomosis. Surg Innov 2021; 28:7-17. [PMID: 33095686 DOI: 10.1177/1553350620967225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background. Pneumoperitoneum insufflation with warmed and humidified carbon dioxide (WH-CO2) can prevent heat loss and increase tissue oxygenation. We evaluated the impact of localized WH-CO2 insufflation on the anastomotic healing process. Methods. Sixty male Wistar rats were randomized: Group 1 (control, n = 12), Group 2 (cold and dry CO2, CD-CO2, n = 24), and Group 3 (WH-CO2, n = 24). A magnetic compression side-to-side colonic anastomosis was performed under 60-minute local abdominal CO2 flow insufflation. Animal temperature was recorded. IL-1, IL-6, and CRP levels were assessed before and after insufflation and on postoperative day (POD) 7 and POD 10. Endoscopic follow-up was performed on POD 7 and POD 10. A burst pressure (BP) test of the specimen was performed on POD 10, and histopathological analysis was then performed. Metabolomics of the anastomotic site was determined. Results. Seven rats (5 CD-CO2 group, 1 WH-CO2 group, and 1 control group) died during the survival period. Necropsies revealed intestinal occlusions (n = 2). One additional rat from the CD-CO2 group was sacrificed on POD 7 due to intestinal perforation. The postoperative course was uneventful in the remaining cases. There was no difference in BP among the groups. Thermal monitoring confirmed that WH-CO2 insufflation was effective to reduce heat loss. IL-1 levels were statistically and significantly lower on POD 10 in the WH-CO2 group than the CD-CO2 group but not lower than the control group. CRP levels, histopathology, and metabolomics did not show any difference between the 3 groups. Conclusions. WH-CO2 was effective to preserve core temperature. However, it did not improve anastomotic healing.
Collapse
Affiliation(s)
- Francesco Marchegiani
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Eric Noll
- Anesthesiology and Intensive Care Department, 36604University Hospital of Strasbourg, Strasbourg, France
| | - Pietro Riva
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Seong-Ho Kong
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Department of Surgery, 58927Seoul National University Hospital, Seoul, South Korea
| | - Paola Saccomandi
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Giorgia Vita
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Véronique Lindner
- Pathology Department, 36604University Hospital of Strasbourg, Strasbourg, France
| | - Izzie Jacques Namer
- Membrane Biophysics Laboratory and Nuclear Medicine Chemistry Institute, 27083University of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Pierre Diemunsch
- Anesthesiology and Intensive Care Department, 36604University Hospital of Strasbourg, Strasbourg, France
| | - Michele Diana
- IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| |
Collapse
|
|
47
|
Wakabayashi T, Barberio M, Urade T, Pop R, Seyller E, Pizzicannella M, Mascagni P, Charles AL, Abe Y, Geny B, Baiocchini A, Kitagawa Y, Marescaux J, Felli E, Diana M. Intraoperative Perfusion Assessment in Enhanced Reality Using Quantitative Optical Imaging: An Experimental Study in a Pancreatic Partial Ischemia Model. Diagnostics (Basel) 2021; 11:93. [PMID: 33430038 PMCID: PMC7826658 DOI: 10.3390/diagnostics11010093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 02/06/2023] Open
Abstract
To reduce the risk of pancreatic fistula after pancreatectomy, a satisfactory blood flow at the pancreatic stump is considered crucial. Our group has developed and validated a real-time computational imaging analysis of tissue perfusion, using fluorescence imaging, the fluorescence-based enhanced reality (FLER). Hyperspectral imaging (HSI) is another emerging technology, which provides tissue-specific spectral signatures, allowing for perfusion quantification. Both imaging modalities were employed to estimate perfusion in a porcine model of partial pancreatic ischemia. Perfusion quantification was assessed using the metrics of both imaging modalities (slope of the time to reach maximum fluorescence intensity and tissue oxygen saturation (StO2), for FLER and HSI, respectively). We found that the HSI-StO2 and the FLER slope were statistically correlated using the Spearman analysis (R = 0.697; p = 0.013). Local capillary lactate values were statistically correlated to the HSI-StO2 and to the FLER slope (R = -0.88; p < 0.001 and R = -0.608; p = 0.0074). HSI-based and FLER-based lactate prediction models had statistically similar predictive abilities (p = 0.112). Both modalities are promising to assess real-time pancreatic perfusion. Clinical translation in human pancreatic surgery is currently underway.
Collapse
Affiliation(s)
- Taiga Wakabayashi
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (T.W.); (E.S.); (M.P.); (J.M.)
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan; (Y.A.); (Y.K.)
| | - Manuel Barberio
- Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, University of Strasbourg, 67091 Strasbourg, France; (M.B.); (T.U.); (R.P.); (P.M.); (E.F.)
- Institute of Physiology, UR3072 ‘Mitochondria, Oxidative Stress and Muscle Protection’, Translational Medicine Federation, Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France; (A.-L.C.); (B.G.)
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany
| | - Takeshi Urade
- Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, University of Strasbourg, 67091 Strasbourg, France; (M.B.); (T.U.); (R.P.); (P.M.); (E.F.)
| | - Raoul Pop
- Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, University of Strasbourg, 67091 Strasbourg, France; (M.B.); (T.U.); (R.P.); (P.M.); (E.F.)
| | - Emilie Seyller
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (T.W.); (E.S.); (M.P.); (J.M.)
| | - Margherita Pizzicannella
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (T.W.); (E.S.); (M.P.); (J.M.)
| | - Pietro Mascagni
- Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, University of Strasbourg, 67091 Strasbourg, France; (M.B.); (T.U.); (R.P.); (P.M.); (E.F.)
| | - Anne-Laure Charles
- Institute of Physiology, UR3072 ‘Mitochondria, Oxidative Stress and Muscle Protection’, Translational Medicine Federation, Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France; (A.-L.C.); (B.G.)
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan; (Y.A.); (Y.K.)
| | - Bernard Geny
- Institute of Physiology, UR3072 ‘Mitochondria, Oxidative Stress and Muscle Protection’, Translational Medicine Federation, Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France; (A.-L.C.); (B.G.)
| | - Andrea Baiocchini
- Department of Surgical Pathology, San Camillo Hospital, 00152 Rome, Italy;
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan; (Y.A.); (Y.K.)
| | - Jacques Marescaux
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (T.W.); (E.S.); (M.P.); (J.M.)
- Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, University of Strasbourg, 67091 Strasbourg, France; (M.B.); (T.U.); (R.P.); (P.M.); (E.F.)
- General, Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, 67000 Strasbourg, France
| | - Eric Felli
- Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, University of Strasbourg, 67091 Strasbourg, France; (M.B.); (T.U.); (R.P.); (P.M.); (E.F.)
| | - Michele Diana
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (T.W.); (E.S.); (M.P.); (J.M.)
- Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, University of Strasbourg, 67091 Strasbourg, France; (M.B.); (T.U.); (R.P.); (P.M.); (E.F.)
- General, Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, 67000 Strasbourg, France
- ICube Lab, Photonics for Health, University of Strasbourg, 67000 Strasbourg, France
| |
Collapse
|
|
48
|
Lin J, Zheng B, Lin S, Chen Z, Chen S. The efficacy of intraoperative ICG fluorescence angiography on anastomotic leak after resection for colorectal cancer: a meta-analysis. Int J Colorectal Dis 2021; 36:27-39. [PMID: 32886195 DOI: 10.1007/s00384-020-03729-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate whether intraoperative indocyanine green fluorescence angiography can reduce the incidence of anastomotic leak. METHODS Present authors conducted a systematic search of PubMed, EMBASE, and Cochrane databases for randomized controlled trials (RCTs), prospective nonrandomized trials, and retrospective trials up to March 2020. Eleven papers fulfilling the screening criteria were included. INTERVENTION Indocyanine green was injected intravenously after the division of the mesentery and colon but before anastomosis. The primary outcome measure was AL rate with at least 3 months of follow-up. Secondary outcome measure was operation time, postoperative complications, surgical site infection, reoperation, and ileus rate. The results were analyzed using STATA 12.0 software (Stata Corp, College Station, TX, USA). RESULT A total of 3137 patients were collected in 11 studies. Meta-analysis showed that compared with conventional surgery, the ICG fluorescence angiography resulted in a fewer AL rate (OR = 0.31; 95% CI 0.21 to 0.44; P < 0.0001), postoperative complications (OR = 0.70; 95% CI 0.51 to 0.96; P < 0.025), and reoperation rate (OR = 0.334; 95% CI 0.16 to 0.68; P = 0.003). Operation time (weighted mean difference - 25.162 min; 95% CI - 58.7 to 8.375; P = 0.141), surgical site infection rate (OR = 1.11; 95% CI 0.59 to 2.09; P = 0.742) did not differ between the two groups. CONCLUSION The result revealed that indocyanine green was associated with a lower anastomotic leakage rate after colorectal cancer resection. However, larger, multicentered, high-quality randomized controlled trials are needed to confirm the benefit of indocyanine green fluorescence angiography.
Collapse
Affiliation(s)
- Jiajing Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Taijiang, Fuzhou, Fujian, 350004, People's Republic of China
| | - Bingqiu Zheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Taijiang, Fuzhou, Fujian, 350004, People's Republic of China
| | - Suyong Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Taijiang, Fuzhou, Fujian, 350004, People's Republic of China
| | - Zhihua Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Taijiang, Fuzhou, Fujian, 350004, People's Republic of China
| | - Shaoqin Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Taijiang, Fuzhou, Fujian, 350004, People's Republic of China.
| |
Collapse
|
|
49
|
Seeliger B, Alesina PF, Walz MK, Pop R, Charles AL, Geny B, Messaddeq N, Kontogeorgos G, Mascagni P, Seyller E, Marescaux J, Agnus V, Diana M. Intraoperative imaging for remnant viability assessment in bilateral posterior retroperitoneoscopic partial adrenalectomy in an experimental model. Br J Surg 2020; 107:1780-1790. [PMID: 32869868 DOI: 10.1002/bjs.11839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/16/2020] [Accepted: 05/31/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND A surgical approach preserving functional adrenal tissue allows biochemical cure while avoiding the need for lifelong steroid replacement. The aim of this experimental study was to evaluate the impact of intraoperative imaging during bilateral partial adrenalectomy on remnant perfusion and function. METHODS Five pigs underwent bilateral posterior retroperitoneoscopic central adrenal gland division (9 divided glands, 1 undivided). Intraoperative perfusion assessment included computer-assisted quantitative fluorescence imaging, contrast-enhanced CT, confocal laser endomicroscopy (CLE) and local lactate sampling. Specimen analysis after completion adrenalectomy (10 adrenal glands) comprised mitochondrial activity and electron microscopy. RESULTS Fluorescence signal intensity evolution over time was significantly lower in the cranial segment of each adrenal gland (mean(s.d.) 0·052(0·057) versus 0·133(0·057) change in intensity per s for cranial versus caudal parts respectively; P = 0·020). Concordantly, intraoperative CT in the portal phase demonstrated significantly lower contrast uptake in cranial segments (P = 0·031). In CLE, fluorescein contrast was observed in all caudal segments, but in only four of nine cranial segments (P = 0·035). Imaging findings favouring caudal perfusion were congruent, with significantly lower local capillary lactate levels caudally (mean(s.d.) 5·66(5·79) versus 11·58(6·53) mmol/l for caudal versus cranial parts respectively; P = 0·008). Electron microscopy showed more necrotic cells cranially (P = 0·031). There was no disparity in mitochondrial activity (respiratory rates, reactive oxygen species and hydrogen peroxide production) between the different segments. CONCLUSION In a model of bilateral partial adrenalectomy, three intraoperative imaging modalities consistently discriminated between regular and reduced adrenal remnant perfusion. By avoiding circumferential dissection, mitochondrial function was preserved in each segment of the adrenal glands. Surgical relevance Preservation of adrenal tissue to maintain postoperative function is essential in bilateral and hereditary adrenal pathologies. There is interindividual variation in residual adrenocortical stress capacity, and the minimal functional remnant size is unknown. New intraoperative imaging technologies allow improved remnant size and perfusion assessment. Fluorescence imaging and contrast-enhanced intraoperative CT showed congruent results in evaluation of perfusion. Intraoperative imaging can help to visualize the remnant vascular supply in partial adrenalectomy. Intraoperative assessment of perfusion may foster maximal functional tissue preservation in bilateral adrenal pathologies and procedures.
Collapse
Affiliation(s)
- B Seeliger
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Institute of Physiology, EA3072 'Mitochondria, Oxidative Stress and Muscle Protection', Translational Medicine Federation, Faculty of Medicine, University of Strasbourg, Strasbourg, France
- Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France
- Department of Surgery and Centre of Minimally Invasive Surgery, Evangelische Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany
| | - P F Alesina
- Department of Surgery and Centre of Minimally Invasive Surgery, Evangelische Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany
| | - M K Walz
- Department of Surgery and Centre of Minimally Invasive Surgery, Evangelische Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany
| | - R Pop
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Department of Interventional Radiology, Strasbourg University Hospitals, Strasbourg, France
| | - A-L Charles
- Institute of Physiology, EA3072 'Mitochondria, Oxidative Stress and Muscle Protection', Translational Medicine Federation, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - B Geny
- Institute of Physiology, EA3072 'Mitochondria, Oxidative Stress and Muscle Protection', Translational Medicine Federation, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - N Messaddeq
- Institute of Genetics and Molecular and Cellular Biology (IGBMC), Centre National de la Recherche Scientifique/Institut National de la Santé et de la Recherche Médicale/University of Strasbourg, Strasbourg, France
| | - G Kontogeorgos
- First Propaedeutic Department of Internal Medicine, Laikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Pathology, 'G. Gennimatas' Athens General Hospital, Athens, Greece
| | - P Mascagni
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - E Seyller
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - J Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France
| | - V Agnus
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - M Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Institute of Physiology, EA3072 'Mitochondria, Oxidative Stress and Muscle Protection', Translational Medicine Federation, Faculty of Medicine, University of Strasbourg, Strasbourg, France
- Institute for Research against Digestive Cancer (IRCAD), Strasbourg, France
| |
Collapse
|
|
50
|
Osterkamp J, Strandby R, Nerup N, Svendsen M, Svendsen L, Achiam M. Quantitative fluorescence angiography detects dynamic changes in gastric perfusion. Surg Endosc 2020; 35:6786-6795. [PMID: 33258036 DOI: 10.1007/s00464-020-08183-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The use of Indocyanine green (ICG) fluorescence angiography (ICG-FA) is an applied method to assess visceral perfusion during surgical procedures worldwide. Further development has entailed quantification of the fluorescence signal; however, whether quantified ICG-FA can detect intraoperative changes in perfusion after hemorrhage has not been investigated previously. In this study, we investigated whether a quantification method, developed and validated in our department (q-ICG), could detect changes in gastric perfusion induced by hemorrhage and resuscitation. METHODS Ten pigs were included in the study. Specific regions of interest of the stomach were chosen, and three q-ICG measurements of gastric perfusion obtained: 20 min after completion of the laparoscopic setup (baseline), after reducing the circulating blood volume by 30%, and after reinfusion of the withdrawn blood volume. Hemodynamic variables were recorded, and blood samples were collected every 10 min during the procedure. RESULTS The reduction in blood volume generated decreased gastric perfusion (q-ICG) from baseline (p = 0.023), and gastric perfusion subsequently increased (p < 0.001) after the reintroduction of the withdrawn blood volume. Cardiac output (CO) and mean arterial blood pressure (MAP) shifted correspondingly and the gastric perfusion correlated to CO (r = 0.575, p = 0.001) and MAP (r = 0.436, p = 0.018). CONCLUSION We present a novel study showing that the q-ICG method can detect dynamic changes in local tissue perfusion induced by hemorrhage and resuscitation. As regional gastrointestinal perfusion may be significantly reduced, while hemodynamic variables such as MAP or heart rate remain stable, q-ICG may provide an objective, non-invasive method for detecting regional early ischemia, strengthening surgical decision making.
Collapse
Affiliation(s)
- Jens Osterkamp
- Department of Surgical Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
| | - Rune Strandby
- Department of Surgical Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Nikolaj Nerup
- Department of Surgical Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Morten Svendsen
- Copenhagen Academy of Medical Education and Simulation, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Svendsen
- Department of Surgical Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| | - Michael Achiam
- Department of Surgical Gastroenterology, Rigshospitalet, University Hospital of Copenhagen, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark
| |
Collapse
|