☆ 4.6 Article

Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES (2014)

Journal

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES

Volume 28, Issue 11, Pages 3108-3118

Publisher

SPRINGER

DOI: 10.1007/s00464-014-3592-9

Keywords

Fluorescence-guided surgery; Indocyanine green; Near-infrared fluorescence videography; Augmented reality; Enhanced reality; Bowel perfusion

Funding

Karl Storz, Tuttlingen, Germany

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Abstract

Fluorescence-based enhanced reality (FLER) is a technique to evaluate intestinal perfusion based on the elaboration of the Indocyanine Green fluorescence signal. The aim of the study was to assess FLER's performances in evaluating perfusion in an animal model of long-lasting intestinal ischemia. An ischemic segment was created in 18 small bowel loops in 6 pigs. After 2 h (n = 6), 4 h (n = 6), and 6 h (n = 6), loops were evaluated clinically and by FLER to delineate five regions of interest (ROIs): ischemic zone (ROI 1), presumed viable margins (ROI 2a-2b), and vascularized areas (3a-3b). Capillary lactates were measured to compare clinical vs. FLER assessment. Basal (V (0) ) and maximal (V (max)) mitochondrial respiration rates were determined according to FLER. Lactates (mmol/L) at clinically identified resection lines were significantly higher when compared to those identified by FLER (2.43 +/- A 0.95 vs. 1.55 +/- A 0.33 p = 0.02) after 4 h of ischemia. Lactates at 2 h at ROI 1 were 5.45 +/- A 2.44 vs. 1.9 +/- A 0.6 (2a-2b; p < 0.0001) vs. 1.2 +/- A 0.3 (3a-3b; p < 0.0001). At 4 h, lactates were 4.36 +/- A 1.32 (ROI 1) vs. 1.83 +/- A 0.81 (2a-2b; p < 0.0001) vs. 1.35 +/- A 0.67 (3a-3b; p < 0.0001). At 6 h, lactates were 4.16 +/- A 2.55 vs. 1.8 +/- A 1.2 vs. 1.45 +/- A 0.83 at ROI 1 vs. 2a--2b (p = 0.013) vs. 3a-3b (p = 0.0035). Mean V (0) and V (max) (pmolO2/second/mg of tissue) were significantly impaired after 4 and 6 h at ROI 1 (V (0) (4h) = 34.83 +/- A 10.39; V (max) (4h) = 76.6 +/- A 29.09; V (0) (6h) = 44.1 +/- A 12.37 and V (max) (6h) = 116.1 +/- A 40.1) when compared to 2a--2b (V (0) (4h) = 67.1 +/- A 17.47 p = 0.00039; V (max) (4h) = 146.8 +/- A 55.47 p = 0.0054; V (0) (6h) = 63.9 +/- A 28.99 p = 0.03; V (max) (6h) = 167.2 +/- A 56.96 p = 0.01). V (0) and V (max) were significantly higher at 3a-3b. FLER may identify the future anastomotic site even after repetitive assessments and long-standing bowel ischemia.

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Quantitative dynamic near-infrared fluorescence imaging using indocyanine green for analysis of bowel perfusion after mesenteric resection

Ruben P. J. Meijer, Labrinus van Manen, Henk H. Hartgrink, Jacobus Burggraaf, Sylvain Gioux, Alexander L. Vahrmeijer, J. Sven D. Mieog

Summary: This study highlights the challenges in quantifying NIR fluorescence imaging for perfusion analysis through the description of four patients with possible compromised bowel perfusion. Different fluorescence dynamics patterns were observed in affected bowel segments compared to unaffected reference segments, suggesting difficulties in interpreting uncorrected fluorescence signals. Real-time quantification and standardization of NIR fluorescence perfusion imaging could potentially assist surgeons in making informed treatment decisions.

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