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Guryleva A, Machikhin A, Toldanov A, Kulikova Y, Khokhlov D, Zolotukhina A, Svistushkin M, Svistushkin V. Post-Surgical Non-Invasive Wound Healing Monitoring in Oropharyngeal Mucosa. JOURNAL OF BIOPHOTONICS 2024; 17:e202400248. [PMID: 39210550 DOI: 10.1002/jbio.202400248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024]
Abstract
Postoperative bleeding is the most significant complication of tonsillectomy. Regular monitoring of post-surgical wound healing in the pharynx is required. For this purpose, we propose endoscope-based non-invasive perfusion mapping and quantification. The combination of imaging photoplethysmography and image processing provides automated wound area selection and microcirculation characterization. In this feasibility study, we demonstrate the first results of the proposed approach to wound monitoring in clinical trial on eight patients after tonsillectomy. Combination of probe-based optical system and image processing algorithms can provide the valuable and consistent data on perfusion distribution. The quantitative microcirculation data obtained 1, 4, and 7 days after surgery are in good agreement with existing monitoring protocols.
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Affiliation(s)
- Anastasia Guryleva
- Scientific and Technological Centre of Unique Instrumentation, Russian Academy of Sciences, Moscow, Russia
| | - Alexander Machikhin
- Scientific and Technological Centre of Unique Instrumentation, Russian Academy of Sciences, Moscow, Russia
| | | | - Yevgeniya Kulikova
- Scientific and Technological Centre of Unique Instrumentation, Russian Academy of Sciences, Moscow, Russia
| | - Demid Khokhlov
- Scientific and Technological Centre of Unique Instrumentation, Russian Academy of Sciences, Moscow, Russia
| | - Anastasia Zolotukhina
- Scientific and Technological Centre of Unique Instrumentation, Russian Academy of Sciences, Moscow, Russia
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Tomanic T, Bozic T, Markelc B, Stergar J, Sersa G, Milanic M. Hyperspectral imaging of 4T1 mammary carcinomas grown in dorsal skinfold window chambers: spectral renormalization and fluorescence modeling. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:093504. [PMID: 39040986 PMCID: PMC11262746 DOI: 10.1117/1.jbo.29.9.093504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/24/2024]
Abstract
Significance Hyperspectral imaging (HSI) of murine tumor models grown in dorsal skinfold window chambers (DSWCs) offers invaluable insight into the tumor microenvironment. However, light loss in a glass coverslip is often overlooked, and particular tissue characteristics are improperly modeled, leading to errors in tissue properties extracted from hyperspectral images. Aim We highlight the significance of spectral renormalization in HSI of DSWC models and demonstrate the benefit of incorporating enhanced green fluorescent protein (EGFP) excitation and emission in the skin tissue model for tumors expressing genes to produce EGFP. Approach We employed an HSI system for intravital imaging of mice with 4T1 mammary carcinoma in a DSWC over 14 days. We performed spectral renormalization of hyperspectral images based on the measured reflectance spectra of glass coverslips and utilized an inverse adding-doubling (IAD) algorithm with a two-layer murine skin model, to extract tissue parameters, such as total hemoglobin concentration and tissue oxygenation (StO 2 ). The model was upgraded to consider EGFP fluorescence excitation and emission. Moreover, we conducted additional experiments involving tissue phantoms, human forearm skin imaging, and numerical simulations. Results Hyperspectral image renormalization and the addition of EGFP fluorescence in the murine skin model reduced the mean absolute percentage errors (MAPEs) of fitted and measured spectra by up to 10% in tissue phantoms, 0.55% to 1.5% in the human forearm experiment and numerical simulations, and up to 0.7% in 4T1 tumors. Similarly, the MAPEs for tissue parameters extracted by IAD were reduced by up to 3% in human forearms and numerical simulations. For some parameters, statistically significant differences ( p < 0.05 ) were observed in 4T1 tumors. Ultimately, we have shown that fluorescence emission could be helpful for 4T1 tumor segmentation. Conclusions The results contribute to improving intravital monitoring of DWSC models using HSI and pave the way for more accurate and precise quantitative imaging.
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Affiliation(s)
- Tadej Tomanic
- University of Ljubljana, Faculty of Mathematics and Physics, Ljubljana, Slovenia
| | - Tim Bozic
- Institute of Oncology Ljubljana, Department of Experimental Oncology, Ljubljana, Slovenia
| | - Bostjan Markelc
- Institute of Oncology Ljubljana, Department of Experimental Oncology, Ljubljana, Slovenia
| | - Jost Stergar
- University of Ljubljana, Faculty of Mathematics and Physics, Ljubljana, Slovenia
- Jozef Stefan Institute, Ljubljana, Slovenia
| | - Gregor Sersa
- Institute of Oncology Ljubljana, Department of Experimental Oncology, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Health Sciences, Ljubljana, Slovenia
| | - Matija Milanic
- University of Ljubljana, Faculty of Mathematics and Physics, Ljubljana, Slovenia
- Jozef Stefan Institute, Ljubljana, Slovenia
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Mun NE, Tran TKC, Park DH, Im JH, Park JI, Le TD, Moon YJ, Kwon SY, Yoo SW. Endoscopic Hyperspectral Imaging System to Discriminate Tissue Characteristics in Tissue Phantom and Orthotopic Mouse Pancreatic Tumor Model. Bioengineering (Basel) 2024; 11:208. [PMID: 38534482 DOI: 10.3390/bioengineering11030208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/28/2024] Open
Abstract
In this study, we developed an endoscopic hyperspectral imaging (eHSI) system and evaluated its performance in analyzing tissues within tissue phantoms and orthotopic mouse pancreatic tumor models. Our custom-built eHSI system incorporated a liquid crystal tunable filter. To assess its tissue discrimination capabilities, we acquired images of tissue phantoms, distinguishing between fat and muscle regions. The system underwent supervised training using labeled samples, and this classification model was then applied to other tissue phantom images for evaluation. In the tissue phantom experiment, the eHSI effectively differentiated muscle from fat and background tissues. The precision scores regarding fat tissue classification were 98.3% for the support vector machine, 97.7% for the neural network, and 96.0% with a light gradient-boosting machine algorithm, respectively. Furthermore, we applied the eHSI system to identify tumors within an orthotopic mouse pancreatic tumor model. The F-score of each pancreatic tumor-bearing model reached 73.1% for the KPC tumor model and 63.1% for the Pan02 tumor models. The refined imaging conditions and optimization of the fine-tuning of classification algorithms enhance the versatility and diagnostic efficacy of eHSI in biomedical applications.
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Affiliation(s)
- Na Eun Mun
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Republic of Korea
- Institute for Molecular Imaging and Theranostics, Chonnam National University Medical School, Hwasun-gun 58128, Republic of Korea
| | - Thi Kim Chi Tran
- Institute for Molecular Imaging and Theranostics, Chonnam National University Medical School, Hwasun-gun 58128, Republic of Korea
- Biomedical Science Graduate Program, Chonnam National University, Hwasun-gun 58128, Republic of Korea
| | - Dong Hui Park
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Republic of Korea
- Institute for Molecular Imaging and Theranostics, Chonnam National University Medical School, Hwasun-gun 58128, Republic of Korea
| | - Jin Hee Im
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Republic of Korea
- Institute for Molecular Imaging and Theranostics, Chonnam National University Medical School, Hwasun-gun 58128, Republic of Korea
| | - Jae Il Park
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Republic of Korea
- Institute for Molecular Imaging and Theranostics, Chonnam National University Medical School, Hwasun-gun 58128, Republic of Korea
| | - Thanh Dat Le
- Institute for Molecular Imaging and Theranostics, Chonnam National University Medical School, Hwasun-gun 58128, Republic of Korea
- Department of Artificial Intelligence Convergence, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Young Jin Moon
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Republic of Korea
- Institute for Molecular Imaging and Theranostics, Chonnam National University Medical School, Hwasun-gun 58128, Republic of Korea
| | - Seong-Young Kwon
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Republic of Korea
- Institute for Molecular Imaging and Theranostics, Chonnam National University Medical School, Hwasun-gun 58128, Republic of Korea
| | - Su Woong Yoo
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Republic of Korea
- Institute for Molecular Imaging and Theranostics, Chonnam National University Medical School, Hwasun-gun 58128, Republic of Korea
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Ilgen A, Köhler H, Pfahl A, Stelzner S, Mehdorn M, Jansen-Winkeln B, Gockel I, Moulla Y. Intraoperative Laparoscopic Hyperspectral Imaging during Esophagectomy-A Pilot Study Evaluating Esophagogastric Perfusion at the Anastomotic Sites. Bioengineering (Basel) 2024; 11:69. [PMID: 38247946 PMCID: PMC10812999 DOI: 10.3390/bioengineering11010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/01/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Hyperspectral imaging (HSI) is a non-invasive and contactless technique that enables the real-time acquisition of comprehensive information on tissue within the surgical field. In this pilot study, we investigated whether a new HSI system for minimally-invasive surgery, TIVITA® Mini (HSI-MIS), provides reliable insights into tissue perfusion of the proximal and distal esophagogastric anastomotic sites during 21 laparoscopic/thoracoscopic or robotic Ivor Lewis esophagectomies of patients with cancer to minimize the risk of dreaded anastomotic insufficiency. In this pioneering investigation, physiological tissue parameters were derived from HSI measurements of the proximal site of the anastomosis (esophageal stump) and the distal site of the anastomosis (tip of the gastric conduit) during the thoracic phase of the procedure. Tissue oxygenation (StO2), Near Infrared Perfusion Index (NIR-PI), and Tissue Water Index (TWI) showed similar median values at both anastomotic sites. Significant differences were observed only for NIR-PI (median: 76.5 vs. 63.9; p = 0.012) at the distal site (gastric conduit) compared to our previous study using an HSI system for open surgery. For all 21 patients, reliable and informative measurements were attainable, confirming the feasibility of HSI-MIS to assess anastomotic viability. Further studies on the added benefit of this new technique aiming to reduce anastomotic insufficiency are warranted.
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Affiliation(s)
- Annalena Ilgen
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (A.I.); (S.S.); (I.G.)
| | - Hannes Köhler
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103 Leipzig, Germany; (H.K.); (A.P.)
| | - Annekatrin Pfahl
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103 Leipzig, Germany; (H.K.); (A.P.)
| | - Sigmar Stelzner
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (A.I.); (S.S.); (I.G.)
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (A.I.); (S.S.); (I.G.)
| | - Boris Jansen-Winkeln
- Department of General, Visceral, Thoracic and Vascular Surgery, Klinikum St. Georg, Delitzscher Str. 141, 04129 Leipzig, Germany;
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (A.I.); (S.S.); (I.G.)
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (A.I.); (S.S.); (I.G.)
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Pruitt K, Rathgeb A, Gahan JC, Johnson BA, Strand DW, Fei B. A dual-camera hyperspectral laparoscopic imaging system. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2024; 12831:1283107. [PMID: 38708175 PMCID: PMC11069412 DOI: 10.1117/12.3005893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Minimally invasive surgery (MIS) has expanded broadly in the field of abdominal and pelvic surgery. However, there are still prevalent issues surrounding intracorporeal surgery, such as iatrogenic injury, anastomotic leakage, or the presence of positive tumor margins after resection. Current approaches to address these issues and advance laparoscopic imaging techniques often involve fluorescence imaging agents, such as indocyanine green (ICG), to improve visualization, but these have drawbacks. Hyperspectral imaging (HSI) is an emerging optical imaging modality that takes advantage of spectral characteristics of different tissues. Various applications include tissue classification and digital pathology. In this study, we developed a dual-camera system for high-speed hyperspectral imaging. This includes the development of a custom application interface and corresponding hardware setup. Characterization of the system was performed, including spectral accuracy and spatial resolution, showing little sacrifice in speed for the approximate doubling of the covered spectral range, with our system acquiring 29 spectral images from 460-850 nm. Reference color tiles with various reflectance profiles were imaged and a RMSE of 3.56 ± 1.36% was achieved. Sub-millimeter resolution was shown at 7 cm working distance for both hyperspectral cameras. Finally, we image ex vivo tissues, including porcine stomach, liver, intestine, and kidney with our system and use a high-resolution, radiometrically calibrated spectrometer for comparison and evaluation of spectral fidelity. The dual-camera hyperspectral laparoscopic imaging system can have immediate applications in various surgeries.
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Affiliation(s)
- Kelden Pruitt
- Center for Imaging and Surgical Innovation, University of Texas at Dallas, Richardson, TX
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX
| | - Armand Rathgeb
- Center for Imaging and Surgical Innovation, University of Texas at Dallas, Richardson, TX
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX
| | - Jeffrey C. Gahan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brett A. Johnson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Douglas W. Strand
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Baowei Fei
- Center for Imaging and Surgical Innovation, University of Texas at Dallas, Richardson, TX
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
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Pfahl A, Polat ST, Köhler H, Gockel I, Melzer A, Chalopin C. Switchable LED-based laparoscopic multispectral system for rapid high-resolution perfusion imaging. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:126002. [PMID: 38094710 PMCID: PMC10718192 DOI: 10.1117/1.jbo.28.12.126002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Abstract
Significance Multispectral imaging (MSI) is an approach for real-time, quantitative, and non-invasive tissue perfusion measurements. Current laparoscopic systems based on mosaic sensors or filter wheels lack high spatial resolution or acceptable frame rates. Aim To develop a laparoscopic system for MSI-based color video and tissue perfusion imaging during gastrointestinal surgery without compromising spatial or temporal resolution. Approach The system was built with 14 switchable light-emitting diodes in the visible and near-infrared spectral range, a 4K image sensor, and a 10 mm laparoscope. Illumination patterns were created for tissue oxygenation and hemoglobin content monitoring. The system was calibrated to a clinically approved laparoscopic hyperspectral system using linear regression models and evaluated in an occlusion study with 36 volunteers. Results The root mean squared errors between the MSI and reference system were 0.073 for hemoglobin content, 0.039 for oxygenation in deeper tissue layers, and 0.093 for superficial oxygenation. The spatial resolution at a working distance of 45 mm was 156 μ m . The effective frame rate was 20 fps. Conclusions High-resolution perfusion monitoring was successfully achieved. Hardware optimizations will increase the frame rate. Parameter optimizations through alternative illumination patterns, regression, or assumed tissue models are planned. Intraoperative measurements must confirm the suitability during surgery.
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Affiliation(s)
- Annekatrin Pfahl
- Leipzig University, Faculty of Medicine, Innovation Center Computer Assisted Surgery, Leipzig, Germany
| | - Süleyman T. Polat
- Leipzig University, Faculty of Medicine, Innovation Center Computer Assisted Surgery, Leipzig, Germany
| | - Hannes Köhler
- Leipzig University, Faculty of Medicine, Innovation Center Computer Assisted Surgery, Leipzig, Germany
| | - Ines Gockel
- University Hospital of Leipzig, Department of Visceral, Transplant, Thoracic, and Vascular Surgery, Leipzig, Germany
| | - Andreas Melzer
- Leipzig University, Faculty of Medicine, Innovation Center Computer Assisted Surgery, Leipzig, Germany
- University of Dundee, School of Medicine, Institute for Medical Science and Technology, Dundee, United Kingdom
| | - Claire Chalopin
- Leipzig University, Faculty of Medicine, Innovation Center Computer Assisted Surgery, Leipzig, Germany
- University of Applied Sciences and Arts, Faculty of Engineering and Health, Göttingen, Germany
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Kashchenko VA, Lodygin AV, Krasnoselsky KY, Zaytsev VV, Kamshilin AA. Intra-abdominal laparoscopic assessment of organs perfusion using imaging photoplethysmography. Surg Endosc 2023; 37:8919-8929. [PMID: 37872427 DOI: 10.1007/s00464-023-10506-y] [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: 07/28/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND An objective evaluation of the functional state and viability of biological tissues during minimally invasive surgery remains unsolved task. Various non-contact methods for evaluating perfusion during laparoscopic surgery are discussed in the literature, but so far there have been no reports of their use in clinical settings. METHODS AND PATIENTS Imaging photoplethysmography (iPPG) is a new method for quantitative assessment of perfusion distribution along the tissue. This is the first study in which we demonstrate successful use of iPPG to assess perfusion of organs during laparoscopic surgery in an operation theater. We used a standard rigid laparoscope connected to a standard digital monochrome camera, and abdominal organs were illuminated by green light. A distinctive feature is the synchronous recording of video frames and electrocardiogram with subsequent correlation data processing. During the laparoscopically assisted surgeries in nine cancer patients, the gradient of perfusion of the affected organs was evaluated. In particular, measurements were carried out before preparing a part of the intestine or stomach for resection, after anastomosis, or during physiological tests. RESULTS The spatial distribution of perfusion and its changes over time were successfully measured in all surgical cases. In particular, perfusion gradient of an intestine before resection was visualized and quantified by our iPPG laparoscope in all respective cases. It was also demonstrated that systemic administration of norepinephrine leads to a sharper gradient between well and poorly perfused areas of the colon. In four surgical cases, we have shown capability of the laparoscopic iPPG system for intra-abdominal assessment of perfusion in the anastomosed organs. Moreover, good repeatability of continuous long-term measurements of tissue perfusion inside the abdominal cavity was experimentally demonstrated. CONCLUSION Our study carried out in real clinical settings has shown that iPPG laparoscope is feasible for intra-abdominal visualization and quantitative assessment of perfusion distribution.
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Affiliation(s)
- Victor A Kashchenko
- First Surgical Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291
- Department of Faculty Surgery, St. Petersburg State University, Saint Petersburg, Russia, 199106
| | - Alexander V Lodygin
- First Surgical Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291
- Department of Faculty Surgery, St. Petersburg State University, Saint Petersburg, Russia, 199106
| | - Konstantin Yu Krasnoselsky
- First Surgical Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291
- Department of Anesthesiology-Resuscitation and Emergency Pediatrics, St. Petersburg State Pediatric Medical University, Saint Petersburg, Russia, 194100
| | - Valeriy V Zaytsev
- Laboratory of New Functional Materials for Photonics, Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok, Russia, 690041
- Organizational and Methodological Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291
| | - Alexei A Kamshilin
- Laboratory of New Functional Materials for Photonics, Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok, Russia, 690041.
- Organizational and Methodological Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291.
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Son GM, Nazir AM, Yun MS, Lee IY, Im SB, Kwak JY, Park SH, Baek KR, Gockel I. The Safe Values of Quantitative Perfusion Parameters of ICG Angiography Based on Tissue Oxygenation of Hyperspectral Imaging for Laparoscopic Colorectal Surgery: A Prospective Observational Study. Biomedicines 2023; 11:2029. [PMID: 37509667 PMCID: PMC10377371 DOI: 10.3390/biomedicines11072029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Safe values for quantitative perfusion parameters of indocyanine green (ICG) angiography have not been fully defined, and interpretation remains at the surgeon's discretion. This prospective observational study aimed to establish the safe values for the quantitative perfusion parameters by comparing tissue oxygenation levels from HSI images in laparoscopic colorectal surgery. METHODS ICG angiography was performed using a laparoscopic near-infrared (NIR) camera system with ICG diluted in 10 mL of distilled water. For quantitative perfusion parameters, the changes in fluorescence intensity with perfusion times were analyzed to plot a time-fluorescence intensity graph. To assess real-time tissue oxygen saturation (StO2) in the colon, the TIVITA® Tissue System was utilized for hyperspectral imaging (HSI) acquisition. The StO2 levels were compared with the quantitative perfusion parameters derived from ICG angiography at corresponding points to define the safe range of ICG parameters reflecting good tissue oxygenation. RESULTS In the regression analysis, T1/2MAX, TMAX, slope, and NIR perfusion index were correlated with tissue oxygen saturation. Using this regression model, the cutoff values of quantitative perfusion parameters were calculated as T1/2MAX ≤ 10 s, TMAX ≤ 30 s, slope ≥ 5, and NIR perfusion index ≥50, which best reflected colon StO2 higher than 60%. Diagnostic values were analyzed to predict colon StO2 of 60% or more, and the ICG perfusion parameters T1/2MAX, TMAX, and perfusion TR showed high sensitivity values of 97% or more, indicating their ability to correctly identify cases with acceptable StO2. CONCLUSION The safe values for quantitative perfusion parameters derived from ICG angiography were T1/2MAX ≤ 10 s and TMAX ≤ 30 s, which were associated with colon tissue oxygenation levels higher than 60% in the laparoscopic colorectal surgery.
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Affiliation(s)
- Gyung Mo Son
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (M.S.Y.); (I.Y.L.)
| | - Armaan M. Nazir
- School of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland;
| | - Mi Sook Yun
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (M.S.Y.); (I.Y.L.)
| | - In Young Lee
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (M.S.Y.); (I.Y.L.)
| | - Sun Bin Im
- Department of Medicine, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea;
| | - Jae Yeong Kwak
- Department of Electronics Engineering, Pusan National University, Busan 46241, Republic of Korea; (J.Y.K.); (S.-H.P.); (K.-R.B.)
| | - Sang-Ho Park
- Department of Electronics Engineering, Pusan National University, Busan 46241, Republic of Korea; (J.Y.K.); (S.-H.P.); (K.-R.B.)
| | - Kwang-Ryul Baek
- Department of Electronics Engineering, Pusan National University, Busan 46241, Republic of Korea; (J.Y.K.); (S.-H.P.); (K.-R.B.)
| | - Ines Gockel
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany;
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