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Wityk M, Dowgiałło-Gornowicz N, Feszak I, Bobowicz M. Fluorescence use in minimally invasive metabolic and bariatric surgery - a systematic review of the literature. Langenbecks Arch Surg 2023; 408:216. [PMID: 37249703 PMCID: PMC10229673 DOI: 10.1007/s00423-023-02955-9] [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: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE This review aims to explore and summarise current knowledge of indocyanine green (ICG) fluorescence application in metabolic and bariatric surgery (MBS) and assess its potential in improving patient safety. METHODS The review was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Evidence from PubMed, ScienceDirect and Ovid MEDLINE databases was independently screened in October 2022. The primary information and outcomes were the type of fluorescence application with potential patient benefit and the complication rate. The secondary outcomes consisted of the kind of dye, the application protocol, and the equipment used. RESULTS Thirteen publications were included, with six prospective observational studies, five case reports and two retrospective cohort studies and involved a total of 424 patients. The publications were categorized into four groups based on the method of fluorescence application. Sixty-six percent of the cases used fluorescence for LSG, 32.3% used it for RYGB, 1.2% for revisional surgery, 0.2% during removal of an adjustable gastric band, and 0.2% for LSG combined with Rossetti fundoplication. ICG was used on its own in the majority of studies, although in one case, it was used in combination with methylene blue. ICG administration protocols varied significantly. Complications occurred in three patients (0.71%): leaks were diagnosed in two cases, and one patient required a blood transfusion. CONCLUSION The most popular type of use is intraoperative assessment of the blood supply. ICG application may reduce the risk of complications, with potential benefits in detecting ischemia and leaks, searching for bleeding in areas inaccessible to endoscopy, and non-invasive hepatopathy evaluation.
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Affiliation(s)
- Mateusz Wityk
- Department of General and Oncological Surgery, Voivodeship Specialist Hospital, 1 Hubalczykow Str. 76-200, Slupsk, Poland.
| | - Natalia Dowgiałło-Gornowicz
- Department of General, Minimally Invasive and Elderly Surgery, University of Warmia and Mazury in Olsztyn, Niepodleglosci 44 Str., 10-045, Olsztyn, Poland
| | - Igor Feszak
- Department of General and Oncological Surgery, Voivodeship Specialist Hospital, 1 Hubalczykow Str. 76-200, Slupsk, Poland
| | - Maciej Bobowicz
- Department of Radiology, Medical University of Gdansk, 17 Smoluchowskiego Str., 80-211, Gdansk, Poland
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Wu J, Xie F, Ji H, Zhang Y, Luo Y, Xia L, Lu T, He K, Sha M, Zheng Z, Yong J, Li X, Zhao D, Yang Y, Xia Q, Xue F. A Clinical-Radiomic Model for Predicting Indocyanine Green Retention Rate at 15 Min in Patients With Hepatocellular Carcinoma. Front Surg 2022; 9:857838. [PMID: 35402498 PMCID: PMC8987271 DOI: 10.3389/fsurg.2022.857838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose: The indocyanine green retention rate at 15 min (ICG-R15) is of great importance in the accurate assessment of hepatic functional reserve for safe hepatic resection. To assist clinicians to evaluate hepatic functional reserve in medical institutions that lack expensive equipment, we aimed to explore a novel approach to predict ICG-R15 based on CT images and clinical data in patients with hepatocellular carcinoma (HCC). Methods In this retrospective study, 350 eligible patients were enrolled and randomly assigned to the training cohort (245 patients) and test cohort (105 patients). Radiomics features and clinical factors were analyzed to pick out the key variables, and based on which, we developed the random forest regression, extreme gradient boosting regression (XGBR), and artificial neural network models for predicting ICG-R15, respectively. Pearson's correlation coefficient (R) was adopted to evaluate the performance of the models. Results We extracted 660 CT image features in total from each patient. Fourteen variables significantly associated with ICG-R15 were picked out for model development. Compared to the other two models, the XGBR achieved the best performance in predicting ICG-R15, with a mean difference of 1.59% (median, 1.53%) and an R-value of 0.90. Delong test result showed no significant difference in the area under the receiver operating characteristic (AUROCs) for predicting post hepatectomy liver failure between actual and estimated ICG-R15. Conclusion The proposed approach that incorporates the optimal radiomics features and clinical factors can allow for individualized prediction of ICG-R15 value of patients with HCC, regardless of the specific equipment and detection reagent (NO. ChiCTR2100053042; URL, http://www.chictr.org.cn).
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Affiliation(s)
- Ji Wu
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Xie
- Department of Instrument Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Ji
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiyang Zhang
- Department of Instrument Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Luo
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tianfei Lu
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kang He
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Meng Sha
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhigang Zheng
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Junekong Yong
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinming Li
- Department of Medical Imaging, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Di Zhao
- Institute of Computing Technology, Chinese Academy of Sciences, Beijing, China
| | - Yuting Yang
- Department of Instrument Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Yuting Yang
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Xue
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Feng Xue
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Huang S, Blutke A, Feuchtinger A, Klemm U, Zachariah Tom R, Hofmann SM, Stiel AC, Ntziachristos V. Functional multispectral optoacoustic tomography imaging of hepatic steatosis development in mice. EMBO Mol Med 2021; 13:e13490. [PMID: 34411447 PMCID: PMC8422073 DOI: 10.15252/emmm.202013490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
The increasing worldwide prevalence of obesity, fatty liver diseases and the emerging understanding of the important roles lipids play in various other diseases is generating significant interest in lipid research. Lipid visualization in particular can play a critical role in understanding functional relations in lipid metabolism. We investigated the potential of multispectral optoacoustic tomography (MSOT) as a novel modality to non-invasively visualize lipids in laboratory mice around the 930nm spectral range. Using an obesity-induced non-alcoholic fatty liver disease (NAFLD) mouse model, we examined whether MSOT could detect and differentiate different grades of hepatic steatosis and monitor the accumulation of lipids in the liver quantitatively over time, without the use of contrast agents, i.e. in label-free mode. Moreover, we demonstrate the efficacy of using the real-time clearance kinetics of indocyanine green (ICG) in the liver, monitored by MSOT, as a biomarker to evaluate the organ's function and assess the severity of NAFLD. This study establishes MSOT as an efficient imaging tool for lipid visualization in preclinical studies, particularly for the assessment of NAFLD.
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Affiliation(s)
- Shan Huang
- Chair of Biological ImagingSchool of Medicine, Central Institute for Translational Cancer Research (TranslaTUM)Technical University of MunichGermany
- Institute of Biological and Medical ImagingHelmholtz Zentrum München (GmbH)NeuherbergGermany
| | - Andreas Blutke
- Research Unit Analytical PathologyHelmholtz Zentrum München (GmbH)NeuherbergGermany
| | - Annette Feuchtinger
- Research Unit Analytical PathologyHelmholtz Zentrum München (GmbH)NeuherbergGermany
| | - Uwe Klemm
- Chair of Biological ImagingSchool of Medicine, Central Institute for Translational Cancer Research (TranslaTUM)Technical University of MunichGermany
| | - Robby Zachariah Tom
- Institute of Diabetes and Regeneration ResearchHelmholtz Zentrum München (GmbH)NeuherbergGermany
- Medizinische Klinik und Poliklinik IVLudwig‐Maximilians‐Universität MünchenMunichGermany
| | - Susanna M Hofmann
- Institute of Diabetes and Regeneration ResearchHelmholtz Zentrum München (GmbH)NeuherbergGermany
| | - Andre C Stiel
- Chair of Biological ImagingSchool of Medicine, Central Institute for Translational Cancer Research (TranslaTUM)Technical University of MunichGermany
| | - Vasilis Ntziachristos
- Chair of Biological ImagingSchool of Medicine, Central Institute for Translational Cancer Research (TranslaTUM)Technical University of MunichGermany
- Institute of Biological and Medical ImagingHelmholtz Zentrum München (GmbH)NeuherbergGermany
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Møller S, Kimer N, Kronborg T, Grandt J, Hove JD, Barløse M, Gluud LL. Nonalcoholic Fatty Liver Disease and Cardiovascular Disease: Overlapping Mechanisms. Semin Liver Dis 2021; 41:235-247. [PMID: 33992031 DOI: 10.1055/s-0041-1725022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) denotes a condition with excess fat in the liver. The prevalence of NAFLD is increasing, averaging > 25% of the Western population. In 25% of the patients, NAFLD progresses to its more severe form: nonalcoholic steatohepatitis and >25% of these progress to cirrhosis following activation of inflammatory and fibrotic processes. NAFLD is associated with obesity, type 2 diabetes, and the metabolic syndrome and represents a considerable and increasing health burden. In the near future, NAFLD cirrhosis is expected to be the most common cause for liver transplantation. NAFLD patients have an increased risk of developing cardiovascular disease as well as liver-related morbidity. In addition, hepatic steatosis itself appears to represent an independent cardiovascular risk factor. In the present review, we provide an overview of the overlapping mechanisms and prevalence of NAFLD and cardiovascular disease.
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Affiliation(s)
- Søren Møller
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Nina Kimer
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark.,Bridge Translational Excellence Program, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark
| | - Thit Kronborg
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark
| | - Josephine Grandt
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark
| | - Jens Dahlgaard Hove
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Cardiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Mads Barløse
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lise Lotte Gluud
- Department of Clinical Medicine, University of Copenhagen, Denmark.,Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark
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Vildhede A, Kimoto E, Pelis RM, Rodrigues AD, Varma MV. Quantitative Proteomics and Mechanistic Modeling of Transporter‐Mediated Disposition in Nonalcoholic Fatty Liver Disease. Clin Pharmacol Ther 2019; 107:1128-1137. [DOI: 10.1002/cpt.1699] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/23/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Anna Vildhede
- Medicine Design Worldwide R&D Pfizer Inc. Groton Connecticut USA
| | - Emi Kimoto
- Medicine Design Worldwide R&D Pfizer Inc. Groton Connecticut USA
| | - Ryan M. Pelis
- Department of Pharmaceutical Sciences Binghamton University Binghamton New York USA
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Schwarz C, Plass I, Fitschek F, Punzengruber A, Mittlböck M, Kampf S, Asenbaum U, Starlinger P, Stremitzer S, Bodingbauer M, Kaczirek K. The value of indocyanine green clearance assessment to predict postoperative liver dysfunction in patients undergoing liver resection. Sci Rep 2019; 9:8421. [PMID: 31182746 PMCID: PMC6557886 DOI: 10.1038/s41598-019-44815-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/21/2019] [Indexed: 12/27/2022] Open
Abstract
Postoperative liver dysfunction remains a major concern following hepatic resection. In order to identify patients who are at risk of developing liver dysfunction, indocyanine green (ICG) clearance has been proposed to predict postoperative liver function. All patients who underwent liver resection at the Medical University Vienna, Austria between 2006 and 2015 with preoperative ICG clearance testing (PDR, R15) were analyzed in this study. Postoperative liver dysfunction was analyzed as defined by the International Study Group of Liver Surgery. Overall, 698 patients (male: 394 (56.4%); female: 304 (43.6%)) with a mean age of 61.3 years (SD: 12.9) were included in this study, including 313 minor liver resections (44.8%) and 385 major liver resections (55.2%). One hundred and seven patients developed postoperative liver dysfunction after liver resection (15.3%). Factors associated with liver dysfunction were: male sex (p = 0.043), major liver resection (p < 0.0001), and preoperative ICG clearance (PDR (p = 0.002) and R15 (p < 0.0001)). Notably ICG clearance was significantly associated with liver dysfunction in minor and major liver resections respectively and remained a predictor upon multivariable analysis. An optimal cut-off for preoperative ICG clearance to accurately predict liver dysfunction was PDR < 19.5%/min and R15 > 5.6%. To the best of our knowledge, this is the largest study analyzing the predictive value of preoperative ICG clearance assessment in patients undergoing liver resection. ICG clearance is useful to identify patients at risk of postoperative liver dysfunction.
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Affiliation(s)
- Christoph Schwarz
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Immanuel Plass
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Fabian Fitschek
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Antonia Punzengruber
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Martina Mittlböck
- Section for Medical Statistics, Medical University Vienna, Vienna, Austria
| | - Stephanie Kampf
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Ulrika Asenbaum
- Department of Biomedical Imaging and Image Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Patrick Starlinger
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Stefan Stremitzer
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Martin Bodingbauer
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - Klaus Kaczirek
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria.
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Malagón-López P, Vilà J, Carrasco-López C, García-Senosiain O, Priego D, Julian Ibañez JF, Higueras-Suñe C. Intraoperative Indocyanine Green Angiography for Fat Necrosis Reduction in the Deep Inferior Epigastric Perforator (DIEP) Flap. Aesthet Surg J 2019; 39:NP45-NP54. [PMID: 30358820 DOI: 10.1093/asj/sjy256] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Fat necrosis is a frequent complication (up to 62.5%) of microsurgical breast reconstruction using the deep inferior epigastric perforator (DIEP) flap. This could have important clinical and psychological repercussions, deteriorating the results and increasing reconstruction costs. OBJECTIVES The aim of this study was to demonstrate the intraoperative use of indocyanine green angiography (ICGA) to reduce fat necrosis in DIEP flap. METHODS Sixty-one patients who underwent unilateral DIEP flap procedures for breast reconstruction after oncological mastectomy were included (24 cases with intraoperative use of ICGA during surgery, 37 cases in the control group). The follow-up period was 1 year after surgery. The association between the use of ICGA and the incidence of fat necrosis in the first postoperative year, differences in fat necrosis grade (I-V), differences in fat necrosis requiring reoperation, quality of life, and patient satisfaction were analyzed. RESULTS The incidence of fat necrosis was reduced from 59.5% (control group) to 29% (ICG-group) (P = 0.021) (relative risk = 0.49 [95% CI, 0.25-0.97]). The major difference was in grade II (27% vs 2.7%, P = 0.038). The number of second surgeries for fat necrosis treatment was also reduced (45.9% vs 20.8%, P = 0.046). The ICG group had higher scores on the BREAST-Q. CONCLUSIONS Intraoperative ICGA is a useful technique for reconstructive microsurgery that might improve patient satisfaction and reduce the incidence of fat necrosis by half as well as reduce its grade, especially in small fat necrosis cases; consequently, ICGA could reduce the number of secondary surgeries for treatment of fat necrosis. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Jordi Vilà
- Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | | | - David Priego
- Hospital Germans Trias i Pujol, Barcelona, Spain
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Noninvasive Evaluation of Liver Function in Morbidly Obese Patients. Gastroenterol Res Pract 2019; 2019:4307462. [PMID: 30863439 PMCID: PMC6378040 DOI: 10.1155/2019/4307462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/30/2018] [Indexed: 12/12/2022] Open
Abstract
Background More than half of the obese patients develop nonalcoholic fatty liver disease (NAFLD), which may further progress to nonalcoholic steatohepatitis (NASH) and cirrhosis. The aim of this study was to assess alterations in liver function in obese patients with a noninvasive liver function test. Methods In a prospective cohort study 102 morbidly obese patients undergoing bariatric surgery were evaluated for their liver function. Liver function capacity was determined by the LiMAx® test (enzymatic capacity of cytochrome P450 1A2). Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score (NAS). NASH clinical score was additionally calculated from laboratory and clinical parameters. Results Median liver function capacity was 286 (IQR = 141) μg/kg/h. 27% of patients were histologically categorized as definite NASH, 39% as borderline, and 34% as not NASH. A significant correlation was observed between liver function capacity and NAS (r = −0.492; p < 0.001). The sensitivity and specificity of the LiMAx® test to distinguish between definite NASH and not NASH were 85.2% and 82.9% (AUROC 0.859), respectively. According to the NASH clinical scoring system, 14% were classified as low risk, 31% as intermediate, 26% as high, and 29% as very high risk. Liver function capacity is also significantly correlated with the NASH clinical scoring system (r = −0.411; p < 0.001). Conclusions Obese patients show a diminished liver function capacity, especially those suffering from type 2 diabetes. The liver function capacity correlates with histological and clinical scoring systems. The LiMAx® test may be a valuable tool for noninvasive screening for NASH in obese patients.
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Comment on: utility of transient elastography (fibroscan) and impact of bariatric surgery on nonalcoholic fatty liver disease (NAFLD) in morbidly obese patients. Surg Obes Relat Dis 2017; 14:91-92. [PMID: 29104002 DOI: 10.1016/j.soard.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 11/20/2022]
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