1
|
Ceccarelli G, Catena F, Avella P, Tian BW, Rondelli F, Guerra G, De Rosa M, Rocca A. Emergency robotic surgery: the experience of a single center and review of the literature. World J Emerg Surg 2024; 19:28. [PMID: 39154016 PMCID: PMC11330055 DOI: 10.1186/s13017-024-00555-6] [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: 05/14/2024] [Accepted: 07/22/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUNDS Laparoscopic surgery is widely used in abdominal emergency surgery (AES), and the possibility of extending this approach to the more recent robotic surgery (RS) arouses great interest. The slow diffusion of robotic technology mainly due to high costs and the longer RS operative time when compared to laparoscopy may represent disincentives, especially in AES. This study aims to report our experience in the use of RS in AES assessing its safety and feasibility, with particular focus on intra- and post-operative complications, conversion rate, and surgical learning curve. Our data were also compared to other experiences though an extensive literature review. METHODS We retrospectively analysed a single surgeon series of the last 10 years. From January 2014 to December 2023, 36 patients underwent urgent or emergency RS. The robotic devices used were Da Vinci Si (15 cases) and Xi (21 cases). RESULTS 36 (4.3%) out of 834 robotic procedures were included in our analysis: 20 (56.56%) females. The mean age was 63 years and 30% of patients were ≥ 70 years. 2 (5.55%) procedures were performed at night. No conversions to open were reported in this series. According to the Clavien-Dindo classification, 2 (5.5%) major complications were collected. Intraoperative and 30-day mortality were 0%. CONCLUSIONS Our study demonstrates that RS may be a useful and reliable approach also to AES and intraoperative laparoscopic complications when performed in selected hemodynamically stable patients in very well-trained robotic centers. The technology may increase the minimally invasive use and conversion rate in emergent settings in a completely robotic or hybrid approach.
Collapse
Affiliation(s)
- Graziano Ceccarelli
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Fausto Catena
- Division of General Surgery, Bufalini Hospital, Cesena, Italy
| | - Pasquale Avella
- Department of General Surgery and Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy.
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy.
| | - Brian Wca Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Fabio Rondelli
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Germano Guerra
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Michele De Rosa
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Aldo Rocca
- Department of General Surgery and Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| |
Collapse
|
2
|
Fabbri N, Pesce A, Raimondi E, Virgilio F, Iroatulam A, Feo CV. Quantitative fluorescence angiography versus hyperspectral imaging to assess bowel ischemia: What is the best choice? Surgery 2024:S0039-6060(24)00453-7. [PMID: 39013676 DOI: 10.1016/j.surg.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Nicolò Fabbri
- Unit of General Surgery, Azienda USL di Ferrara, Ferrara, Italy.
| | - Antonio Pesce
- Unit of General Surgery, Azienda USL di Ferrara, Ferrara, Italy
| | - Edoardo Raimondi
- Department of Diagnostic and Interventional Radiology, Azienda USL di Ferrara, Ferrara, Italy
| | | | | | - Carlo Vittorio Feo
- Unit of General Surgery, Azienda USL di Ferrara, Ferrara, Italy; Department of Surgery, University of Ferrara, Azienda USL di Ferrara, Ferrara, Italy
| |
Collapse
|
3
|
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
|
4
|
Simion L, Ionescu S, Chitoran E, Rotaru V, Cirimbei C, Madge OL, Nicolescu AC, Tanase B, Dicu-Andreescu IG, Dinu DM, Luca DC, Stanculeanu DL, Gheorghe AS, Zob D, Marincas M. Indocyanine Green (ICG) and Colorectal Surgery: A Literature Review on Qualitative and Quantitative Methods of Usage. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1530. [PMID: 37763651 PMCID: PMC10536016 DOI: 10.3390/medicina59091530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
Background: Due to its many benefits, indocyanine green (ICG) has gained progressive popularity in operating rooms (ORs) globally. This literature review examines its qualitative and quantitative usage in surgical treatment. Method: Relevant terms were searched in five international databases (1. Pubmed, 2. Sciencedirect, 3. Scopus, 4. Oxfordjournals, 5. Reaxys) for a comprehensive literature review. The main benefits of using ICG in colorectal surgery are: intraoperative fluorescence angiography; fluorescence-guided lymph node involvement detection and the sentinel technique; the fluorescent emphasis of a minute liver tumour, counting just 200 tumour cells; facilitation of fistula diagnosis; and tumour tattooing. This methodology can also be used with quantitative characteristics such as maximum intensity, relative maximum intensity, and in-flow parameters such as time-to-peak, slope, and t1/2max. This article concludes that fluorescence surgery with ICG and near-infrared (NIR) light is a relatively new technology that improves anatomical and functional information, allowing more comprehensive and safer tumour removal and the preservation of important structures.
Collapse
Affiliation(s)
- Laurentiu Simion
- Ist Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania; (L.S.)
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Sinziana Ionescu
- Ist Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania; (L.S.)
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Elena Chitoran
- Ist Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania; (L.S.)
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Ph.D. Studies, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Vlad Rotaru
- Ist Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania; (L.S.)
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Ph.D. Studies, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ciprian Cirimbei
- Ist Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania; (L.S.)
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Octavia-Luciana Madge
- Ist Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania; (L.S.)
- University of Bucharest, 030018 Bucharest, Romania
| | - Alin Codrut Nicolescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Ph.D. Studies, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Emergency Hospital “Prof. Dr. Agrippa Ionescu”, 011356 Bucharest, Romania
| | - Bogdan Tanase
- Clinic of Thoracic Surgery, Bucharest Oncology Institute, 022328 Bucharest, Romania
| | - Irinel-Gabriel Dicu-Andreescu
- Ist Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania; (L.S.)
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Ph.D. Studies, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Denisa Mihaela Dinu
- Surgery Clinic, Bucharest Emergency University Hospital, 050098 Bucharest, Romania
| | - Dan Cristian Luca
- Ist Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania; (L.S.)
| | - Dana Lucia Stanculeanu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Oncology Clinic, “Prof. Dr. Al. Trestioreanu” Bucharest Oncology Institute, 022328 Bucharest, Romania
| | - Adelina Silvana Gheorghe
- Ph.D. Studies in Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniela Zob
- Oncology Department, “Prof. Dr. Al. Trestioreanu” Bucharest Oncology Institute, 022328 Bucharest, Romania
| | - Marian Marincas
- Ist Clinic of General Surgery and Surgical Oncology, Bucharest Oncology Institute, 022328 Bucharest, Romania; (L.S.)
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| |
Collapse
|
5
|
Studier-Fischer A, Seidlitz S, Sellner J, Bressan M, Özdemir B, Ayala L, Odenthal J, Knoedler S, Kowalewski KF, Haney CM, Salg G, Dietrich M, Kenngott H, Gockel I, Hackert T, Müller-Stich BP, Maier-Hein L, Nickel F. HeiPorSPECTRAL - the Heidelberg Porcine HyperSPECTRAL Imaging Dataset of 20 Physiological Organs. Sci Data 2023; 10:414. [PMID: 37355750 PMCID: PMC10290660 DOI: 10.1038/s41597-023-02315-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023] Open
Abstract
Hyperspectral Imaging (HSI) is a relatively new medical imaging modality that exploits an area of diagnostic potential formerly untouched. Although exploratory translational and clinical studies exist, no surgical HSI datasets are openly accessible to the general scientific community. To address this bottleneck, this publication releases HeiPorSPECTRAL ( https://www.heiporspectral.org ; https://doi.org/10.5281/zenodo.7737674 ), the first annotated high-quality standardized surgical HSI dataset. It comprises 5,758 spectral images acquired with the TIVITA® Tissue and annotated with 20 physiological porcine organs from 8 pigs per organ distributed over a total number of 11 pigs. Each HSI image features a resolution of 480 × 640 pixels acquired over the 500-1000 nm wavelength range. The acquisition protocol has been designed such that the variability of organ spectra as a function of several parameters including the camera angle and the individual can be assessed. A comprehensive technical validation confirmed both the quality of the raw data and the annotations. We envision potential reuse within this dataset, but also its reuse as baseline data for future research questions outside this dataset. Measurement(s) Spectral Reflectance Technology Type(s) Hyperspectral Imaging Sample Characteristic - Organism Sus scrofa.
Collapse
Affiliation(s)
- Alexander Studier-Fischer
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Silvia Seidlitz
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany
- HIDSS4Health - Helmholtz Information and Data Science School for Health, Karlsruhe, Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Sellner
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany
- HIDSS4Health - Helmholtz Information and Data Science School for Health, Karlsruhe, Heidelberg, Germany
| | - Marc Bressan
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Berkin Özdemir
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Leonardo Ayala
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Jan Odenthal
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Samuel Knoedler
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Karl-Friedrich Kowalewski
- Department of Urology, Medical Faculty of Mannheim at the University of Heidelberg, Mannheim, Germany
| | - Caelan Max Haney
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Gabriel Salg
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Maximilian Dietrich
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hannes Kenngott
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of General, Visceral, and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Lena Maier-Hein
- Division of Intelligent Medical Systems, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany
- HIDSS4Health - Helmholtz Information and Data Science School for Health, Karlsruhe, Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
- HIDSS4Health - Helmholtz Information and Data Science School for Health, Karlsruhe, Heidelberg, Germany.
- Department of General, Visceral, and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
6
|
Liu YZ, Mehrotra S, Nwaiwu CA, Buharin VE, Oberlin J, Stolyarov R, Schwaitzberg SD, Kim PCW. Real-time quantification of intestinal perfusion and arterial versus venous occlusion using laser speckle contrast imaging in porcine model. Langenbecks Arch Surg 2023; 408:114. [PMID: 36859714 DOI: 10.1007/s00423-023-02845-0] [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: 09/01/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Real-time intraoperative perfusion assessment may reduce anastomotic leaks. Laser speckle contrast imaging (LSCI) provides dye-free visualization of perfusion by capturing coherent laser light scatter from red blood cells and displays perfusion as a colormap. Herein, we report a novel method to precisely quantify intestinal perfusion using LSCI. METHODS ActivSight™ is an FDA-cleared multi-modal visualization system that can detect and display perfusion via both indocyanine green imaging (ICG) and LSCI in minimally invasive surgery. An experimental prototype LSCI perfusion quantification algorithm was evaluated in porcine models. Porcine small bowel was selectively devascularized to create regions of perfused/watershed/ischemic bowel, and progressive aortic inflow/portal vein outflow clamping was performed to study arterial vs. venous ischemia. Continuous arterial pressure was monitored via femoral line. RESULTS LSCI perfusion colormaps and quantification distinguished between perfused, watershed, and ischemic bowel in all vascular control settings: no vascular occlusion (p < 0.001), aortic occlusion (p < 0.001), and portal venous occlusion (p < 0.001). LSCI quantification demonstrated similar levels of ischemia induced both by states of arterial inflow and venous outflow occlusion. LSCI-quantified perfusion values correlated positively with higher mean arterial pressure and with increasing distance from ischemic bowel. CONCLUSION LSCI relative perfusion quantification may provide more objective real-time assessment of intestinal perfusion compared to conventional naked eye assessment by quantifying currently subjective gradients of bowel ischemia and identifying both arterial/venous etiologies of ischemia.
Collapse
Affiliation(s)
- Yao Z Liu
- Department of Surgery, Brown University, Providence, RI, USA
- Activ Surgical, 30 Thomson Pl, 2nd Floor, Boston, MA, 02210, USA
| | - Saloni Mehrotra
- Activ Surgical, 30 Thomson Pl, 2nd Floor, Boston, MA, 02210, USA
- Department of Surgery, University of Buffalo, Buffalo, NY, USA
| | - Chibueze A Nwaiwu
- Department of Surgery, Brown University, Providence, RI, USA
- Activ Surgical, 30 Thomson Pl, 2nd Floor, Boston, MA, 02210, USA
| | | | - John Oberlin
- Activ Surgical, 30 Thomson Pl, 2nd Floor, Boston, MA, 02210, USA
| | - Roman Stolyarov
- Activ Surgical, 30 Thomson Pl, 2nd Floor, Boston, MA, 02210, USA
| | | | - Peter C W Kim
- Department of Surgery, Brown University, Providence, RI, USA.
- Activ Surgical, 30 Thomson Pl, 2nd Floor, Boston, MA, 02210, USA.
| |
Collapse
|
7
|
Rodríguez-Luna MR, Okamoto N, Cinelli L, Baratelli L, Ségaud S, Rodríguez-Gómez A, Keller DS, Zonoobi E, Bannone E, Marescaux J, Diana M, Gioux S. Quantification of bowel ischaemia using real-time multispectral Single Snapshot Imaging of Optical Properties (SSOP). Surg Endosc 2023; 37:2395-2403. [PMID: 36443562 PMCID: PMC10017661 DOI: 10.1007/s00464-022-09764-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Single snapshot imaging of optical properties (SSOP) is a relatively new non-invasive, real-time, contrast-free optical imaging technology, which allows for the real-time quantitative assessment of physiological properties, including tissue oxygenation (StO2). This study evaluates the accuracy of multispectral SSOP in quantifying bowel ischaemia in a preclinical experimental model. METHODS In six pigs, an ischaemic bowel segment was created by dividing the arcade branches. Five regions of interest (ROIs) were identified on the bowel loop, as follows: ROI 1: central ischaemic; ROI 2: left marginal; ROI 3: left vascularised; ROI 4: right marginal; and ROI 5: right vascularised. The Trident imaging system, specifically developed for real-time tissue oxygenation imaging using SSOP, was used to image before (T0) and after ischaemia induction. Capillary and systemic lactates were measured at each time point (T0, T15, T30, T45, T60), as well as StO2 values acquired by means of SSOP (SSOP-StO2). RESULTS The mean value of SSOP-StO2 in ROI 1 was 30.08 ± 6.963 and was significantly lower when compared to marginal ROIs (ROI 2 + ROI 4: 45.67 ± 10.02 p = < 0.0001), and to vascularised ROIs (ROI 3 + ROI 5: 48.08 ± 7.083 p = < 0.0001). SSOP-StO2 was significantly correlated with normalised lactates r = - 0.5892 p < 0.0001 and with histology r =- 0.6251 p = 0.0002. CONCLUSION Multispectral SSOP allows for a contrast-free accurate assessment of small bowel perfusion identifying physiological tissue oxygenation as confirmed with perfusion biomarkers.
Collapse
Affiliation(s)
- María Rita Rodríguez-Luna
- Research Institute Against Digestive Cancer (IRCAD), 1, place de l'Hôpital, 67000, Strasbourg Cedex, France.
- University of Strasbourg, ICube Laboratory, Strasbourg, France.
| | - Nariaki Okamoto
- Research Institute Against Digestive Cancer (IRCAD), 1, place de l'Hôpital, 67000, Strasbourg Cedex, France
- University of Strasbourg, ICube Laboratory, Strasbourg, France
| | - Lorenzo Cinelli
- Research Institute Against Digestive Cancer (IRCAD), 1, place de l'Hôpital, 67000, Strasbourg Cedex, France
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, Milan, Italy
| | | | - Silvère Ségaud
- University of Strasbourg, ICube Laboratory, Strasbourg, France
| | | | - Deborah S Keller
- Marks Colorectal Surgical Associates, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA
| | - Elham Zonoobi
- Edinburgh Molecular Imaging Ltd. (EMI), Edinburgh, EH16 4UX, UK
- Department of Surgery, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Elisa Bannone
- Research Institute Against Digestive Cancer (IRCAD), 1, place de l'Hôpital, 67000, Strasbourg Cedex, France
- Department of General and Pancreatic surgery - The Pancreas Institute, University of Verona, Verona, Italy
| | - Jacques Marescaux
- Research Institute Against Digestive Cancer (IRCAD), 1, place de l'Hôpital, 67000, Strasbourg Cedex, France
| | - Michele Diana
- Research Institute Against Digestive Cancer (IRCAD), 1, place de l'Hôpital, 67000, Strasbourg Cedex, France
- University of Strasbourg, ICube Laboratory, Strasbourg, France
| | - Sylvain Gioux
- University of Strasbourg, ICube Laboratory, Strasbourg, France
- Intuitive Surgical Sàrl, Aubonne, Switzerland
| |
Collapse
|
8
|
Pruitt K, Johnson B, Gahan J, Ma L, Fei B. A High-Speed Hyperspectral Laparoscopic Imaging System. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2023; 12466:1246608. [PMID: 38524190 PMCID: PMC10961180 DOI: 10.1117/12.2653922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Minimally invasive surgery (MIS) has expanded broadly in the field of abdominal and pelvic surgery. Laparoscopic and robotic surgery has improved surgeon ergonomics, instrument precision, operative time, and postoperative recovery across various abdominal procedures. The goal of this study is to establish the feasibility of implementing high-speed hyperspectral imaging into a standard laparoscopic setup and exploring its benefit to common intracorporeal procedures. A hyperspectral laparoscopic imaging system was constructed using a customized hyperspectral camera alongside a standard rigid laparoscope and was validated for both spectral and spatial accuracy. Demosaicing methods were investigated for improved full-resolution visualization. Hyperspectral cameras with different spectral ranges were considered and compared with one another alongside two different light sources to determine the most effective configuration. Finally, different porcine tissues were imaged ex-vivo to test the capabilities of the system and spectral footprints of the various tissues were extracted. The tissue was also imaged in a phantom to simulate the system's use in MIS. The results demonstrated a hyperspectral laparoscopic imaging system that could provide quantitative, diagnostic information while not disrupting normal workflow nor adding excessive weight to the laparoscopic setup. The high-speed hyperspectral laparoscopic imaging system can have immediate applications in image-guided surgery.
Collapse
Affiliation(s)
- Kelden Pruitt
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX
- Center for Imaging and Surgical Innovation, University of Texas at Dallas, Richardson, TX
| | - Brett Johnson
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Jeffrey Gahan
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Ling Ma
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX
- Center for Imaging and Surgical Innovation, University of Texas at Dallas, Richardson, TX
| | - Baowei Fei
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX
- Center for Imaging and Surgical Innovation, University of Texas at Dallas, Richardson, TX
- University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX
| |
Collapse
|
9
|
In vivo evaluation of a hyperspectral imaging system for minimally invasive surgery (HSI-MIS). Surg Endosc 2023; 37:3691-3700. [PMID: 36645484 PMCID: PMC10156625 DOI: 10.1007/s00464-023-09874-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hyperspectral Imaging (HSI) is a reliable and safe imaging method for taking intraoperative perfusion measurements. This is the first study translating intraoperative HSI to an in vivo laparoscopic setting using a CE-certified HSI-system for minimally invasive surgery (HSI-MIS). We aim to compare it to an established HSI-system for open surgery (HSI-Open). METHODS Intraoperative HSI was done using the HSI-MIS and HSI-Open at the Region of Interest (ROI). 19 patients undergoing gastrointestinal resections were analyzed in this study. The HSI-MIS-acquired images were aligned with those from the HSI-Open, and spectra and parameter images were compared pixel-wise. We calculated the Mean Absolute Error (MAE) for Tissue Oxygen Saturation (StO2), Near-Infrared Perfusion Index (NIR-PI), Tissue Water Index (TWI), and Organ Hemoglobin Index (OHI), as well as the Root Mean Squared Error (RMSE) over the whole spectrum. Our analysis of parameters was optimized using partial least squares (PLS) regression. Two experienced surgeons carried out an additional color-change analysis, comparing the ROI images and deciding whether they provided the same (acceptable) or different visual information (rejected). RESULTS HSI and subsequent image registration was possible in 19 patients. MAE results for the original calculation were StO2 orig. 17.2% (± 7.7%), NIR-PIorig. 16.0 (± 9.5), TWIorig. 18.1 (± 7.9), OHIorig. 14.4 (± 4.5). For the PLS calculation, they were StO2 PLS 12.6% (± 5.2%), NIR-PIPLS 10.3 (± 6.0), TWIPLS 10.6 (± 5.1), and OHIPLS 11.6 (± 3.0). The RMSE between both systems was 0.14 (± 0.06). In the color-change analysis; both surgeons accepted more images generated using the PLS method. CONCLUSION Intraoperative HSI-MIS is a new technology and holds great potential for future applications in surgery. Parameter deviations are attributable to technical differences and can be reduced by applying improved calculation methods. This study is an important step toward the clinical implementation of HSI for minimally invasive surgery.
Collapse
|
10
|
Felli E, Cinelli L, Bannone E, Giannone F, Muttillo EM, Barberio M, Keller DS, Rodríguez-Luna MR, Okamoto N, Collins T, Hostettler A, Schuster C, Mutter D, Pessaux P, Marescaux J, Gioux S, Felli E, Diana M. Hyperspectral Imaging in Major Hepatectomies: Preliminary Results from the Ex-Machyna Trial. Cancers (Basel) 2022; 14:cancers14225591. [PMID: 36428685 PMCID: PMC9688371 DOI: 10.3390/cancers14225591] [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: 08/03/2022] [Revised: 10/07/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022] Open
Abstract
Ischemia-reperfusion injury during major hepatic resections is associated with high rates of post-operative complications and liver failure. Real-time intra-operative detection of liver dysfunction could provide great insight into clinical outcomes. In the present study, we demonstrate the intra-operative application of a novel optical technology, hyperspectral imaging (HSI), to predict short-term post-operative outcomes after major hepatectomy. We considered fifteen consecutive patients undergoing major hepatic resection for malignant liver lesions from January 2020 to June 2021. HSI measures included tissue water index (TWI), organ hemoglobin index (OHI), tissue oxygenation (StO2%), and near infrared (NIR). Pre-operative, intra-operative, and post-operative serum and clinical outcomes were collected. NIR values were higher in unhealthy liver tissue (p = 0.003). StO2% negatively correlated with post-operative serum ALT values (r = -0.602), while ΔStO2% positively correlated with ALP (r = 0.594). TWI significantly correlated with post-operative reintervention and OHI with post-operative sepsis and liver failure. In conclusion, the HSI imaging system is accurate and precise in translating from pre-clinical to human studies in this first clinical trial. HSI indices are related to serum and outcome metrics. Further experimental and clinical studies are necessary to determine clinical value of this technology.
Collapse
Affiliation(s)
- Emanuele Felli
- Digestive and Endocrine Surgery, Nouvel Hopital Civil, University of Strasbourg, 67000 Strasbourg, France
- University Hospital Institute (IHU), Institut de Chirurgie Guidée par l’image, University of Strasbourg, 67000 Strasbourg, France
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- Institut of Viral and Liver Disease, Inserm U1110, University of Strasbourg, 67000 Strasbourg, France
| | - Lorenzo Cinelli
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, 20132 Milan, Italy
| | - Elisa Bannone
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- Department of Surgery, Istituto Fondazione Poliambulanza, 25124 Brescia, Italy
- Department of Pancreatic Surgery, Verona University, 37134 Verona, Italy
| | - Fabio Giannone
- Digestive and Endocrine Surgery, Nouvel Hopital Civil, University of Strasbourg, 67000 Strasbourg, France
- University Hospital Institute (IHU), Institut de Chirurgie Guidée par l’image, University of Strasbourg, 67000 Strasbourg, France
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- Institut of Viral and Liver Disease, Inserm U1110, University of Strasbourg, 67000 Strasbourg, France
| | - Edoardo Maria Muttillo
- Dipartimento di Scienze Medico Chirurgiche e Medicina Traslazionale, Sapienza Università di Roma, 00189 Roma, Italy
| | - Manuel Barberio
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- Ospedale Cardinale G. Panico, General Surgery Department, 73039 Tricase, Italy
| | | | - María Rita Rodríguez-Luna
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67400 Strasbourg, France
| | - Nariaki Okamoto
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Toby Collins
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | | | - Catherine Schuster
- Institut of Viral and Liver Disease, Inserm U1110, University of Strasbourg, 67000 Strasbourg, France
| | - Didier Mutter
- Digestive and Endocrine Surgery, Nouvel Hopital Civil, University of Strasbourg, 67000 Strasbourg, France
- University Hospital Institute (IHU), Institut de Chirurgie Guidée par l’image, University of Strasbourg, 67000 Strasbourg, France
| | - Patrick Pessaux
- Digestive and Endocrine Surgery, Nouvel Hopital Civil, University of Strasbourg, 67000 Strasbourg, France
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- Institut of Viral and Liver Disease, Inserm U1110, University of Strasbourg, 67000 Strasbourg, France
| | - Jacques Marescaux
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Sylvain Gioux
- ICube Laboratory, Photonics Instrumentation for Health, 67400 Strasbourg, France
| | - Eric Felli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
- Department for BioMedical Research, Hepatology, University of Bern, 3012 Bern, Switzerland
| | - Michele Diana
- Digestive and Endocrine Surgery, Nouvel Hopital Civil, University of Strasbourg, 67000 Strasbourg, France
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67400 Strasbourg, France
- Correspondence:
| |
Collapse
|
11
|
Barberio M, Lapergola A, Benedicenti S, Mita M, Barbieri V, Rubichi F, Altamura A, Giaracuni G, Tamburini E, Diana M, Pizzicannella M, Viola MG. Intraoperative bowel perfusion quantification with hyperspectral imaging: a guidance tool for precision colorectal surgery. Surg Endosc 2022; 36:8520-8532. [PMID: 35836033 DOI: 10.1007/s00464-022-09407-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/19/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Poor anastomotic perfusion can cause anastomotic leaks (AL). Hyperspectral imaging (HSI), previously validated experimentally, provides accurate, real-time, contrast-free intestinal perfusion quantification. Clinical experience with HSI is limited. In this study, HSI was used to evaluate bowel perfusion intraoperatively. METHODS Fifty-two patients undergoing elective colorectal surgeries for neoplasia (n = 40) or diverticular disease (n = 12), were enrolled. Intestinal perfusion was assessed with HSI (TIVITA®, Diaspective Vision, Am Salzhaff, Germany). This device generates a perfusion heat map reflecting the tissue oxygen saturation (StO2) amount. Prior to anastomose creation, the clinical transection line (CTL) was highlighted on the proximal bowel and imaged with HSI. Upon StO2 heat map evaluation, the hyperspectral transection line (HTL) was identified. In case of CTL/HTL discrepancy > 5 mm, the bowel was always resected at the HTL. HSI outcomes were compared to the clinical ones. RESULTS AL occurred in one patient who underwent neoadjuvant radiochemotherapy and ultralow anterior resection for rectal cancer. HSI assessment was feasible in all patients, and StO2-values were significantly higher at proximal segments than distal ones. Twenty-six patients showed CTL/HTL discrepancy, and these patients had a lower mean StO2 (54.55 ± 21.30%) than patients without discrepancy (65.10 ± 21.30%, p = 0.000). Patients undergoing neoadjuvant radiochemotherapy showed a lower StO2 (51.41 ± 23.41%) than non-neoadjuvated patients (60.51 ± 24.98%, p = 0.010). CONCLUSION HSI is useful in detecting intraoperatively marginally perfused segments, for which the clinical appreciation is unreliable. Intestinal vascular supply is lower in patients undergoing neoadjuvant radiochemotherapy, and this novel finding together with the clinical impact of HSI perfusion quantification deserves further investigation in larger trials.
Collapse
Affiliation(s)
- Manuel Barberio
- Department of Surgery, Ospedale Card. G. Panico, Tricase, Italy.
- Department of Research, Research Institute Against Digestive Cancer (IRCAD), 1, place de l'Hôpital, 67091, Strasbourg, France.
| | - Alfonso Lapergola
- Department of Visceral and Digestive, Nouvel Hôpital Civil (NHC), Strasbourg, France
| | | | | | | | | | - Amedeo Altamura
- Department of Surgery, Ospedale Card. G. Panico, Tricase, Italy
| | | | | | - Michele Diana
- Department of Research, Research Institute Against Digestive Cancer (IRCAD), 1, place de l'Hôpital, 67091, Strasbourg, France
| | | | | |
Collapse
|
12
|
Utility and usability of laser speckle contrast imaging (LSCI) for displaying real-time tissue perfusion/blood flow in robot-assisted surgery (RAS): comparison to indocyanine green (ICG) and use in laparoscopic surgery. Surg Endosc 2022:10.1007/s00464-022-09590-3. [PMID: 36109357 PMCID: PMC9483347 DOI: 10.1007/s00464-022-09590-3] [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: 04/04/2022] [Accepted: 08/25/2022] [Indexed: 11/12/2022]
Abstract
Background Utility and usability of laser speckle contrast imaging (LSCI) in detecting real-time tissue perfusion in robot-assisted surgery (RAS) and laparoscopic surgery are not known. LSCI displays a color heatmap of real-time tissue blood flow by capturing the interference of coherent laser light on red blood cells. LSCI has advantages in perfusion visualization over indocyanine green imaging (ICG) including repeat use on demand, no need for dye, and no latency between injection and display. Herein, we report the first-in-human clinical comparison of a novel device combining proprietary LSCI processing and ICG for real-time perfusion assessment during RAS and laparoscopic surgeries. Methods ActivSight™ imaging module is integrated between a standard laparoscopic camera and scope, capable of detecting tissue blood flow via LSCI and ICG in laparoscopic surgery. From November 2020 to July 2021, we studied its use during elective robotic-assisted and laparoscopic cholecystectomies, colorectal, and bariatric surgeries (NCT# 04633512). For RAS, an ancillary laparoscope with ActivSight imaging module was used for LSCI/ICG visualization. We determined safety, usability, and utility of LSCI in RAS vs. laparoscopic surgery using end-user/surgeon human factor testing (Likert scale 1–5) and compared results with two-tailed t tests. Results 67 patients were included in the study—40 (60%) RAS vs. 27 (40%) laparoscopic surgeries. Patient demographics were similar in both groups. No adverse events to patients and surgeons were observed in both laparoscopic and RAS groups. Use of an ancillary laparoscopic system for LSCI/ICG visualization had minimal impact on usability in RAS as evidenced by surgeon ratings of device usability (set-up 4.2/5 and form-factor 3.8/5). LSCI ability to detect perfusion (97.5% in RAS vs 100% in laparoscopic cases) was comparable in both RAS and laparoscopic cases. Conclusions LSCI demonstrates comparable utility and usability in detecting real-time tissue perfusion/blood flow in RAS and laparoscopic surgery. Graphical abstract ![]()
Collapse
|
13
|
Spectral organ fingerprints for machine learning-based intraoperative tissue classification with hyperspectral imaging in a porcine model. Sci Rep 2022; 12:11028. [PMID: 35773276 PMCID: PMC9247052 DOI: 10.1038/s41598-022-15040-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/16/2022] [Indexed: 12/26/2022] Open
Abstract
Visual discrimination of tissue during surgery can be challenging since different tissues appear similar to the human eye. Hyperspectral imaging (HSI) removes this limitation by associating each pixel with high-dimensional spectral information. While previous work has shown its general potential to discriminate tissue, clinical translation has been limited due to the method’s current lack of robustness and generalizability. Specifically, the scientific community is lacking a comprehensive spectral tissue atlas, and it is unknown whether variability in spectral reflectance is primarily explained by tissue type rather than the recorded individual or specific acquisition conditions. The contribution of this work is threefold: (1) Based on an annotated medical HSI data set (9059 images from 46 pigs), we present a tissue atlas featuring spectral fingerprints of 20 different porcine organs and tissue types. (2) Using the principle of mixed model analysis, we show that the greatest source of variability related to HSI images is the organ under observation. (3) We show that HSI-based fully-automatic tissue differentiation of 20 organ classes with deep neural networks is possible with high accuracy (> 95%). We conclude from our study that automatic tissue discrimination based on HSI data is feasible and could thus aid in intraoperative decisionmaking and pave the way for context-aware computer-assisted surgery systems and autonomous robotics.
Collapse
|
14
|
Wu Y, Xu Z, Yang W, Ning Z, Dong H. Review on the Application of Hyperspectral Imaging Technology of the Exposed Cortex in Cerebral Surgery. Front Bioeng Biotechnol 2022; 10:906728. [PMID: 35711634 PMCID: PMC9196632 DOI: 10.3389/fbioe.2022.906728] [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: 03/29/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
The study of brain science is vital to human health. The application of hyperspectral imaging in biomedical fields has grown dramatically in recent years due to their unique optical imaging method and multidimensional information acquisition. Hyperspectral imaging technology can acquire two-dimensional spatial information and one-dimensional spectral information of biological samples simultaneously, covering the ultraviolet, visible and infrared spectral ranges with high spectral resolution, which can provide diagnostic information about the physiological, morphological and biochemical components of tissues and organs. This technology also presents finer spectral features for brain imaging studies, and further provides more auxiliary information for cerebral disease research. This paper reviews the recent advance of hyperspectral imaging in cerebral diagnosis. Firstly, the experimental setup, image acquisition and pre-processing, and analysis methods of hyperspectral technology were introduced. Secondly, the latest research progress and applications of hyperspectral imaging in brain tissue metabolism, hemodynamics, and brain cancer diagnosis in recent years were summarized briefly. Finally, the limitations of the application of hyperspectral imaging in cerebral disease diagnosis field were analyzed, and the future development direction was proposed.
Collapse
Affiliation(s)
- Yue Wu
- Research Center for Intelligent Sensing Systems, Zhejiang Lab, Hangzhou, China
| | - Zhongyuan Xu
- Research Center for Intelligent Sensing Systems, Zhejiang Lab, Hangzhou, China
| | - Wenjian Yang
- Research Center for Intelligent Sensing Systems, Zhejiang Lab, Hangzhou, China
| | - Zhiqiang Ning
- Anhui Institute of Optics and Fine Mechanics, Chinese Academy of Sciences (CAS), Hefei, China.,Science Island Branch, Graduate School of USTC, Hefei, China
| | - Hao Dong
- Research Center for Sensing Materials and Devices, Zhejiang Lab, Hangzhou, China
| |
Collapse
|
15
|
Pfahl A, Köhler H, Thomaßen MT, Maktabi M, Bloße AM, Mehdorn M, Lyros O, Moulla Y, Niebisch S, Jansen-Winkeln B, Chalopin C, Gockel I. Video: Clinical evaluation of a laparoscopic hyperspectral imaging system. Surg Endosc 2022; 36:7794-7799. [PMID: 35546207 PMCID: PMC9485189 DOI: 10.1007/s00464-022-09282-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/16/2022] [Indexed: 11/30/2022]
Abstract
Background Hyperspectral imaging (HSI) during surgical procedures is a new method for perfusion quantification and tissue discrimination. Its use has been limited to open surgery due to large camera sizes, missing color video, or long acquisition times. A hand-held, laparoscopic hyperspectral camera has been developed now to overcome those disadvantages and evaluated clinically for the first time. Methods In a clinical evaluation study, gastrointestinal resectates of ten cancer patients were investigated using the laparoscopic hyperspectral camera. Reference data from corresponding anatomical regions were acquired with a clinically approved HSI system. An image registration process was executed that allowed for pixel-wise comparisons of spectral data and parameter images (StO2: oxygen saturation of tissue, NIR PI: near-infrared perfusion index, OHI: organ hemoglobin index, TWI: tissue water index) provided by both camera systems. The mean absolute error (MAE) and root mean square error (RMSE) served for the quantitative evaluations. Spearman’s rank correlation between factors related to the study design like the time of spectral white balancing and MAE, respectively RMSE, was calculated. Results The obtained mean MAEs between the TIVITA® Tissue and the laparoscopic hyperspectral system resulted in StO2: 11% ± 7%, NIR PI: 14±3, OHI: 14± 5, and TWI: 10 ± 2. The mean RMSE between both systems was 0.1±0.03 from 500 to 750 nm and 0.15 ±0.06 from 750 to 1000 nm. Spearman’s rank correlation coefficients showed no significant correlation between MAE or RMSE and influencing factors related to the study design. Conclusion Qualitatively, parameter images of the laparoscopic system corresponded to those of the system for open surgery. Quantitative deviations were attributed to technical differences rather than the study design. Limitations of the presented study are addressed in current large-scale in vivo trials. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09282-y.
Collapse
Affiliation(s)
- Annekatrin Pfahl
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany.
| | - Hannes Köhler
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Madeleine T Thomaßen
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Marianne Maktabi
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Albrecht M Bloße
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Orestis Lyros
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Stefan Niebisch
- 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.,Department of General, Visceral, Thoracic, and Vascular Surgery, Klinikum St. Georg, Leipzig, Germany
| | - Claire Chalopin
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| |
Collapse
|
16
|
Pfahl A, Radmacher GK, Köhler H, Maktabi M, Neumuth T, Melzer A, Gockel I, Chalopin C, Jansen-Winkeln B. Combined indocyanine green and quantitative perfusion assessment with hyperspectral imaging during colorectal resections. BIOMEDICAL OPTICS EXPRESS 2022; 13:3145-3160. [PMID: 35774324 PMCID: PMC9203086 DOI: 10.1364/boe.452076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 05/26/2023]
Abstract
Anastomotic insufficiencies still represent one of the most severe complications in colorectal surgery. Since tissue perfusion highly affects anastomotic healing, its objective assessment is an unmet clinical need. Indocyanine green-based fluorescence angiography (ICG-FA) and hyperspectral imaging (HSI) have received great interest in recent years but surgeons have to decide between both techniques. For the first time, two data processing pipelines capable of reconstructing an ICG-FA correlating signal from hyperspectral data were developed. Results were technically evaluated and compared to ground truth data obtained during colorectal resections. In 87% of 46 data sets, the reconstructed images resembled the ground truth data. The combined applicability of ICG-FA and HSI within one imaging system might provide supportive and complementary information about tissue vascularization, shorten surgery time, and reduce perioperative mortality.
Collapse
Affiliation(s)
- A. Pfahl
- Innovation Center Computer Assisted Surgery
(ICCAS), Faculty of Medicine, Leipzig
University, Leipzig, 04103, Germany
- Contributed equally
| | - G. K. Radmacher
- Department of Visceral, Thoracic,
Transplant, and Vascular Surgery, University Hospital of
Leipzig, Leipzig, 04103, Germany
- Contributed equally
| | - H. Köhler
- Innovation Center Computer Assisted Surgery
(ICCAS), Faculty of Medicine, Leipzig
University, Leipzig, 04103, Germany
| | - M. Maktabi
- Innovation Center Computer Assisted Surgery
(ICCAS), Faculty of Medicine, Leipzig
University, Leipzig, 04103, Germany
| | - T. Neumuth
- Innovation Center Computer Assisted Surgery
(ICCAS), Faculty of Medicine, Leipzig
University, Leipzig, 04103, Germany
| | - A. Melzer
- Innovation Center Computer Assisted Surgery
(ICCAS), Faculty of Medicine, Leipzig
University, Leipzig, 04103, Germany
- Institute for Medical Science and
Technology (IMSaT), University of Dundee,
Dundee, DD2 1FD, United Kingdom
| | - I. Gockel
- Department of Visceral, Thoracic,
Transplant, and Vascular Surgery, University Hospital of
Leipzig, Leipzig, 04103, Germany
| | - C. Chalopin
- Innovation Center Computer Assisted Surgery
(ICCAS), Faculty of Medicine, Leipzig
University, Leipzig, 04103, Germany
| | - B. Jansen-Winkeln
- Department of Visceral, Thoracic,
Transplant, and Vascular Surgery, University Hospital of
Leipzig, Leipzig, 04103, Germany
- Department of General, Visceral, Thoracic,
and Vascular Surgery, Klinikum St. Georg,
Leipzig, 04129, Germany
| |
Collapse
|
17
|
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: 2.5] [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
|
18
|
Near-infrared fluorescence imaging with indocyanine green to assess the blood supply of the reconstructed gastric conduit to reduce anastomotic leakage after esophagectomy: a literature review. Surg Today 2022; 53:399-408. [PMID: 35182253 DOI: 10.1007/s00595-022-02474-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/09/2022] [Indexed: 02/05/2023]
Abstract
The blood supply of the right gastroepiploic artery after esophagectomy with gastric tube reconstruction is essential for avoiding anastomotic leakage. Near-infrared fluorescence (NIRF) imaging with indocyanine green is widely used to assess the blood supply because it can visualize it in real-time during navigation surgery. However, there is no established protocol for this modality. One reason for this lack of protocol is that NIRF provides subjective information. This study aimed to evaluate NIRF quantification. We conducted a literature review of risk factors for anastomotic leakage after esophagectomy, NIRF procedures, NIRF quantification, and new methods to compensate for NIRF limitations. Major methods for the quantification of NIRF include measuring the blood flow speed, visualization time, and fluorescence intensity. The cutoff value for the blood flow speed is 2.07 cm/s, and that for the visualization time is 30-90 s. Although the time-intensity curve provided patterns of change in the blood flow, it did not show an association with anastomotic leakage. However, to compensate for the limitations of NIRF, new devices have been reported that can assess tissue oxygenation perfusion, organ hemoglobin concentration, and microcirculation.
Collapse
|
19
|
de’Angelis N, Khan J, Marchegiani F, Bianchi G, Aisoni F, Alberti D, Ansaloni L, Biffl W, Chiara O, Ceccarelli G, Coccolini F, Cicuttin E, D’Hondt M, Di Saverio S, Diana M, De Simone B, Espin-Basany E, Fichtner-Feigl S, Kashuk J, Kouwenhoven E, Leppaniemi A, Beghdadi N, Memeo R, Milone M, Moore E, Peitzmann A, Pessaux P, Pikoulis M, Pisano M, Ris F, Sartelli M, Spinoglio G, Sugrue M, Tan E, Gavriilidis P, Weber D, Kluger Y, Catena F. Robotic surgery in emergency setting: 2021 WSES position paper. World J Emerg Surg 2022; 17:4. [PMID: 35057836 PMCID: PMC8781145 DOI: 10.1186/s13017-022-00410-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/27/2021] [Indexed: 12/11/2022] Open
Abstract
Background Robotics represents the most technologically advanced approach in minimally invasive surgery (MIS). Its application in general surgery has increased progressively, with some early experience reported in emergency settings. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a systematic review of the literature to develop consensus statements about the potential use of robotics in emergency general surgery.
Methods This position paper was conducted according to the WSES methodology. A steering committee was constituted to draft the position paper according to the literature review. An international expert panel then critically revised the manuscript. Each statement was voted through a web survey to reach a consensus.
Results Ten studies (3 case reports, 3 case series, and 4 retrospective comparative cohort studies) have been published regarding the applications of robotics for emergency general surgery procedures. Due to the paucity and overall low quality of evidence, 6 statements are proposed as expert opinions. In general, the experts claim for a strict patient selection while approaching emergent general surgery procedures with robotics, eventually considering it for hemodynamically stable patients only. An emergency setting should not be seen as an absolute contraindication for robotic surgery if an adequate training of the operating surgical team is available. In such conditions, robotic surgery can be considered safe, feasible, and associated with surgical outcomes related to an MIS approach. However, there are some concerns regarding the adoption of robotic surgery for emergency surgeries associated with the following: (i) the availability and accessibility of the robotic platform for emergency units and during night shifts, (ii) expected longer operative times, and (iii) increased costs. Further research is necessary to investigate the role of robotic surgery in emergency settings and to explore the possibility of performing telementoring and telesurgery, which are particularly valuable in emergency situations. Conclusions Many hospitals are currently equipped with a robotic surgical platform which needs to be implemented efficiently. The role of robotic surgery for emergency procedures remains under investigation. However, its use is expanding with a careful assessment of costs and timeliness of operations. The proposed statements should be seen as a preliminary guide for the surgical community stressing the need for reevaluation and update processes as evidence expands in the relevant literature.
Collapse
|
20
|
Cinelli L, Felli E, Baratelli L, Ségaud S, Baiocchini A, Okamoto N, Rodríguez-Luna MR, Elmore U, Rosati R, Partelli S, Marescaux J, Gioux S, Diana M. Single Snapshot Imaging of Optical Properties (SSOP) for Perfusion Assessment during Gastric Conduit Creation for Esophagectomy: An Experimental Study on Pigs. Cancers (Basel) 2021; 13:cancers13236079. [PMID: 34885189 PMCID: PMC8656795 DOI: 10.3390/cancers13236079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 01/03/2023] Open
Abstract
Simple Summary Anastomotic leak is the most dangerous complication occurring after esophagectomy and its relationship with inadequate visceral perfusion is widely recognized. Currently, the adequate perfusion of the gastric conduit is intraoperatively assessed by surgeons using subjective indicators (e.g., serosal color or pulsatile flow of vessels). During the last decades, several innovative optical techniques based on the interaction of light with tissue have been developed to monitor perfusion in esophagogastric surgery. However, these innovative approaches are characterized by a lack of video rate and reproducibility. They also provide operator-dependent results and lengthen the surgical workflow. Single Snapshot imaging of Optical Properties (SSOP) is an optical technique, which can overcome such limitations, providing quantitative information on the optical properties of biological tissues over a large field of view. It is the first study to demonstrate the accuracy of SSOP in the quantification of serosal StO2% in a porcine gastric conduit model. Abstract Anastomotic leakage (AL) is a serious complication occurring after esophagectomy. The current knowledge suggests that inadequate intraoperative perfusion in the anastomotic site contributes to an increase in the AL rate. Presently, clinical estimation undertaken by surgeons is not accurate and new technology is necessary to improve the intraoperative assessment of tissue oxygenation. In the present study, we demonstrate the application of a novel optical technology, namely Single Snapshot imaging of Optical Properties (SSOP), used to quantify StO2% in an open surgery experimental gastric conduit (GC) model. After the creation of a gastric conduit, local StO2% was measured with a preclinical SSOP system for 60 min in the antrum (ROI-A), corpus (ROI-C), and fundus (ROI-F). The removed region (ROI-R) acted as ischemic control. ROI-R had statistically significant lower StO2% when compared to all other ROIs at T15, T30, T45, and T60 (p < 0.0001). Local capillary lactates (LCLs) and StO2% correlation was statistically significant (R = −0.8439, 95% CI −0.9367 to −0.6407, p < 0.0001). Finally, SSOP could discriminate resected from perfused regions and ROI-A from ROI-F (the future anastomotic site). In conclusion, SSOP could well be a suitable technology to assess intraoperative perfusion of GC, providing consistent StO2% quantification and ROIs discrimination.
Collapse
Affiliation(s)
- Lorenzo Cinelli
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, 20132 Milan, Italy; (U.E.); (R.R.)
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (N.O.); (M.R.R.-L.); (J.M.); (M.D.)
- Correspondence: ; Tel.: +39-02-2643-2270
| | - Eric Felli
- Department of Visceral Surgery and Medicine, Inselspital, University of Bern, 3010 Bern, Switzerland;
- Department of BioMedical Research, Visceral Surgery and Medicine, University of Bern, 3010 Bern, Switzerland
| | - Luca Baratelli
- ICube Laboratory, University of Strasbourg, 67400 Strasbourg, France; (L.B.); (S.S.); (S.G.)
| | - Silvère Ségaud
- ICube Laboratory, University of Strasbourg, 67400 Strasbourg, France; (L.B.); (S.S.); (S.G.)
| | - Andrea Baiocchini
- Department of Surgical Pathology, San Camillo Hospital, 00152 Rome, Italy;
| | - Nariaki Okamoto
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (N.O.); (M.R.R.-L.); (J.M.); (M.D.)
| | - María Rita Rodríguez-Luna
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (N.O.); (M.R.R.-L.); (J.M.); (M.D.)
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, 20132 Milan, Italy; (U.E.); (R.R.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, 20132 Milan, Italy; (U.E.); (R.R.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Stefano Partelli
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy;
- Pancreas Translational & Clinical Research Center, Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Jacques Marescaux
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (N.O.); (M.R.R.-L.); (J.M.); (M.D.)
| | - Sylvain Gioux
- ICube Laboratory, University of Strasbourg, 67400 Strasbourg, France; (L.B.); (S.S.); (S.G.)
| | - Michele Diana
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (N.O.); (M.R.R.-L.); (J.M.); (M.D.)
- ICube Laboratory, University of Strasbourg, 67400 Strasbourg, France; (L.B.); (S.S.); (S.G.)
- Department of General, Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, 67000 Strasbourg, France
| |
Collapse
|
21
|
Dietrich M, Marx S, von der Forst M, Bruckner T, Schmitt FCF, Fiedler MO, Nickel F, Studier-Fischer A, Müller-Stich BP, Hackert T, Brenner T, Weigand MA, Uhle F, Schmidt K. Hyperspectral imaging for perioperative monitoring of microcirculatory tissue oxygenation and tissue water content in pancreatic surgery - an observational clinical pilot study. Perioper Med (Lond) 2021; 10:42. [PMID: 34847953 PMCID: PMC8638177 DOI: 10.1186/s13741-021-00211-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hyperspectral imaging (HSI) could provide extended haemodynamic monitoring of perioperative tissue oxygenation and tissue water content to visualize effects of haemodynamic therapy and surgical trauma. The objective of this study was to assess the capacity of HSI to monitor skin microcirculation and possible relations to perioperative organ dysfunction in patients undergoing pancreatic surgery. METHODS The hyperspectral imaging TIVITA® Tissue System was used to evaluate superficial tissue oxygenation (StO2), deeper layer tissue oxygenation (near-infrared perfusion index (NPI)), haemoglobin distribution (tissue haemoglobin index (THI)) and tissue water content (tissue water index (TWI)) in 25 patients undergoing pancreatic surgery. HSI parameters were measured before induction of anaesthesia (t1), after induction of anaesthesia (t2), postoperatively before anaesthesia emergence (t3), 6 h after emergence of anaesthesia (t4) and three times daily (08:00, 14:00, 20:00 ± 1 h) at the palm and the fingertips until the second postoperative day (t5-t10). Primary outcome was the correlation of HSI with perioperative organ dysfunction assessed with the perioperative change of SOFA score. RESULTS Two hundred and fifty HSI measurements were performed in 25 patients. Anaesthetic induction led to a significant increase of tissue oxygenation parameters StO2 and NPI (t1-t2). StO2 and NPI decreased significantly from t2 until the end of surgery (t3). THI of the palm showed a strong correlation with haemoglobin levels preoperatively (t2: r = 0.83, p < 0.001) and 6 h postoperatively (t4: r = 0.71, p = 0.001) but not before anaesthesia emergence (t3: r = 0.35, p = 0.10). TWI of the palm and the fingertip rose significantly between pre- and postoperative measurements (t2-t3). Higher blood loss, syndecan level and duration of surgery were associated with a higher increase of TWI. The perioperative change of HSI parameters (∆t1-t3) did not correlate with the perioperative change of the SOFA score. CONCLUSION This is the first study using HSI skin measurements to visualize tissue oxygenation and tissue water content in patients undergoing pancreatic surgery. HSI was able to measure short-term changes of tissue oxygenation during anaesthetic induction and pre- to postoperatively. TWI indicated a perioperative increase of tissue water content. Perioperative use of HSI could be a useful extension of haemodynamic monitoring to assess the microcirculatory response during haemodynamic therapy and major surgery. TRIAL REGISTRATION German Clinical Trial Register, DRKS00017313 on 5 June 2019.
Collapse
Affiliation(s)
- Maximilian Dietrich
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Marx
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Maik von der Forst
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Felix C F Schmitt
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Mascha O Fiedler
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Studier-Fischer
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Uhle
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Karsten Schmidt
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| |
Collapse
|
22
|
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:diagnostics11112066. [PMID: 34829413 PMCID: PMC8624094 DOI: 10.3390/diagnostics11112066] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [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.)
- Correspondence:
| | - 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
|
23
|
Felli E, Al-Taher M, Collins T, Nkusi R, Felli E, Baiocchini A, Lindner V, Vincent C, Barberio M, Geny B, Ettorre GM, Hostettler A, Mutter D, Gioux S, Schuster C, Marescaux J, Gracia-Sancho J, Diana M. Automatic Liver Viability Scoring with Deep Learning and Hyperspectral Imaging. Diagnostics (Basel) 2021; 11:diagnostics11091527. [PMID: 34573869 PMCID: PMC8472457 DOI: 10.3390/diagnostics11091527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/12/2021] [Accepted: 08/21/2021] [Indexed: 12/24/2022] Open
Abstract
Hyperspectral imaging (HSI) is a non-invasive imaging modality already applied to evaluate hepatic oxygenation and to discriminate different models of hepatic ischemia. Nevertheless, the ability of HSI to detect and predict the reperfusion damage intraoperatively was not yet assessed. Hypoxia caused by hepatic artery occlusion (HAO) in the liver brings about dreadful vascular complications known as ischemia-reperfusion injury (IRI). Here, we show the evaluation of liver viability in an HAO model with an artificial intelligence-based analysis of HSI. We have combined the potential of HSI to extract quantitative optical tissue properties with a deep learning-based model using convolutional neural networks. The artificial intelligence (AI) score of liver viability showed a significant correlation with capillary lactate from the liver surface (r = −0.78, p = 0.0320) and Suzuki’s score (r = −0.96, p = 0.0012). CD31 immunostaining confirmed the microvascular damage accordingly with the AI score. Our results ultimately show the potential of an HSI-AI-based analysis to predict liver viability, thereby prompting for intraoperative tool development to explore its application in a clinical setting.
Collapse
Affiliation(s)
- Eric Felli
- Hepatology, Department of Biomedical Research, Inselspital, University of Bern, 3008 Bern, Switzerland;
- IHU-Strasbourg, Institute of Image-Guided Surgery, 67000 Strasbourg, France;
- Institute of Physiology, EA3072 Mitochondria Respiration and Oxidative Stress, University of Strasbourg, 67000 Strasbourg, France;
- Correspondence: ; Tel.: +41-3-1632-3598
| | - Mahdi Al-Taher
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (M.A.-T.); (T.C.); (R.N.); (A.H.); (J.M.); (M.D.)
| | - Toby Collins
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (M.A.-T.); (T.C.); (R.N.); (A.H.); (J.M.); (M.D.)
| | - Richard Nkusi
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (M.A.-T.); (T.C.); (R.N.); (A.H.); (J.M.); (M.D.)
| | - Emanuele Felli
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, 67000 Strasbourg, France; (E.F.); (D.M.)
| | - Andrea Baiocchini
- Department of Pathology, San Camillo Forlanini Hospital, 00152 Rome, Italy;
| | - Veronique Lindner
- Department of Pathology, University Hospital of Strasbourg, 67000 Strasbourg, France;
| | - Cindy Vincent
- IHU-Strasbourg, Institute of Image-Guided Surgery, 67000 Strasbourg, France;
| | - Manuel Barberio
- Department of General Surgery, Cardinale Giovanni Panico Hospital, 73039 Tricase, Italy;
| | - Bernard Geny
- Institute of Physiology, EA3072 Mitochondria Respiration and Oxidative Stress, University of Strasbourg, 67000 Strasbourg, France;
| | - Giuseppe Maria Ettorre
- San Camillo Forlanini Hospital, Department of Transplantation and General Surgery, 00152 Rome, Italy;
| | - Alexandre Hostettler
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (M.A.-T.); (T.C.); (R.N.); (A.H.); (J.M.); (M.D.)
| | - Didier Mutter
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, 67000 Strasbourg, France; (E.F.); (D.M.)
| | - Sylvain Gioux
- Photonics Instrumentation for Health, iCube Laboratory, University of Strasbourg, 67000 Strasbourg, France;
| | - Catherine Schuster
- INSERM, Institute of Viral and Liver Disease, U1110, 67000 Strasbourg, France;
| | - Jacques Marescaux
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (M.A.-T.); (T.C.); (R.N.); (A.H.); (J.M.); (M.D.)
| | - Jordi Gracia-Sancho
- Hepatology, Department of Biomedical Research, Inselspital, University of Bern, 3008 Bern, Switzerland;
- Liver Vascular Biology, IDIBAPS Biomedical Research Institute and CIBEREHD, 08036 Barcelona, Spain
| | - Michele Diana
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (M.A.-T.); (T.C.); (R.N.); (A.H.); (J.M.); (M.D.)
- Liver Vascular Biology, IDIBAPS Biomedical Research Institute and CIBEREHD, 08036 Barcelona, Spain
| |
Collapse
|
24
|
Lee S, Namgoong JM, Kim Y, Cha J, Kim JK. Multimodal imaging of laser speckle contrast imaging combined with mosaic filter-based hyperspectral imaging for precise surgical guidance. IEEE Trans Biomed Eng 2021; 69:443-452. [PMID: 34260344 DOI: 10.1109/tbme.2021.3097122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To enable a real-time surgical guidance system that simultaneously monitors blood vessel perfusion, oxygen saturation, thrombosis, and tissue recovery by combining multiple optical imaging techniques into a single system: visible imaging, mosaic filter-based snapshot hyperspectral imaging (HSI), and laser speckle contrast imaging (LSCI). METHODS The multimodal optical imaging system was demonstrated by clamping blood vessels in the small intestines of rats to create areas of restricted blood flow. Subsequent tissue damage and regeneration were monitored during procedures. Using LSCI, vessel perfusion was measured, revealing the biological activity and survival of organ tissues. Blood oxygen saturation was monitored using HSI in the near-infrared region. Principal component analysis was used over the spectral dimension to identify an HSI wavelength combination optimized for hemodynamic biomarker visualization. HSI and LSCI were complimentary, identifying thrombus generation and tissue recovery, which was not possible in either modality alone. RESULTS AND CONCLUSION By analyzing multimodal tissue information from visible imaging, LSCI perfusion imaging, and HSI, a recovery prognosis could be determined based on the blood supply to the organ. The unique combination of the complementary imaging techniques into a single surgical microscope holds promise for improving the real-time determination of blood supply and tissue prognosis during surgery. SIGNIFICANCE Precise real-time monitoring for vascular anomalies promises to reduce the risk of organ damage in precise surgical operations such as tissue resection and transplantation. In addition, the convergence of label-free imaging technologies removes delays associated with the injection and diffusion of vascular monitoring dyes.
Collapse
|
25
|
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
|
26
|
Kiseleva E, Ryabkov M, Baleev M, Bederina E, Shilyagin P, Moiseev A, Beschastnov V, Romanov I, Gelikonov G, Gladkova N. Prospects of Intraoperative Multimodal OCT Application in Patients with Acute Mesenteric Ischemia. Diagnostics (Basel) 2021; 11:705. [PMID: 33920827 PMCID: PMC8071199 DOI: 10.3390/diagnostics11040705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Despite the introduction of increasingly multifaceted diagnostic techniques and the general advances in emergency abdominal and vascular surgery, the outcome of treatment of patients with acute impaired intestinal circulation remains unsatisfactory. The non-invasive and high-resolution technique of optical coherence tomography (OCT) can be used intraoperatively to assess intestine viability and associated conditions that frequently emerge under conditions of impaired blood circulation. This study aims to demonstrate the effectiveness of multimodal (MM) OCT for intraoperative diagnostics of both the microstructure (cross-polarization OCT mode) and microcirculation (OCT angiography mode) of the small intestine wall in patients with acute mesenteric ischemia (AMI). METHODS AND PARTICIPANTS A total of 18 patients were enrolled in the study. Nine of them suffered from AMI in segments II-III of the superior mesenteric artery (AMI group), whereby the ischemic segments of the intestine were examined. Nine others were operated on for adenocarcinoma of the colon (control group), thus allowing areas of their normal small intestine to be examined for comparison. Data on the microstructure and microcirculation in the walls of the small intestine were obtained intraoperatively from the side of the serous membrane using the MM OCT system (IAP RAS, Russia) before bowel resection. The MM OCT data were compared with the results of histological examination. RESULTS The study finds that MM OCT visualized the damage to serosa, muscularis externa, and blood vessels localized in these layers in 100% of AMI cases. It also visualized the submucosa in 33.3% of AMI cases. The MM OCT images of non-ischemic (control group), viable ischemic, and necrotic small intestines (AMI group) differed significantly across stratification of the distinguishable layers, the severity of intermuscular fluid accumulations, and the type and density of the vasculature. CONCLUSION The MM OCT diagnostic procedure optimally meets the requirements of emergency surgery. Data on the microstructure and microcirculation of the intestinal wall can be obtained simultaneously in real time without requiring contrast agent injections. The depth of visualization of the intestinal wall from the side of the serous membrane is sufficient to assess the volume of the affected tissues. However, the methodology for obtaining MM OCT data needs to be improved to minimize the motion artefacts generated in actual clinical conditions.
Collapse
Affiliation(s)
- Elena Kiseleva
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia;
| | - Maxim Ryabkov
- Thermal Injury Group, University Clinic, Privolzhsky Research Medical University, 18/1 Verkhnevolzhskaya Naberezhnaja, 603155 Nizhny Novgorod, Russia;
| | - Mikhail Baleev
- City Clinical Hospital No.30, 85A Berezovskaya St., 605157 Nizhny Novgorod, Russia; (M.B.); (V.B.); (I.R.)
| | - Evgeniya Bederina
- The Department of Pathology, University Clinic, Privolzhsky Research Medical University, 18/1 Verkhnevolzhskaya Naberezhnaja, 603155 Nizhny Novgorod, Russia;
| | - Pavel Shilyagin
- Institute of Applied Physics of the RAS, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia; (P.S.); (A.M.); (G.G.)
| | - Alexander Moiseev
- Institute of Applied Physics of the RAS, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia; (P.S.); (A.M.); (G.G.)
| | - Vladimir Beschastnov
- City Clinical Hospital No.30, 85A Berezovskaya St., 605157 Nizhny Novgorod, Russia; (M.B.); (V.B.); (I.R.)
| | - Ivan Romanov
- City Clinical Hospital No.30, 85A Berezovskaya St., 605157 Nizhny Novgorod, Russia; (M.B.); (V.B.); (I.R.)
| | - Grigory Gelikonov
- Institute of Applied Physics of the RAS, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia; (P.S.); (A.M.); (G.G.)
| | - Natalia Gladkova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia;
| |
Collapse
|
27
|
Dietrich M, Marx S, von der Forst M, Bruckner T, Schmitt FCF, Fiedler MO, Nickel F, Studier-Fischer A, Müller-Stich BP, Hackert T, Brenner T, Weigand MA, Uhle F, Schmidt K. Bedside hyperspectral imaging indicates a microcirculatory sepsis pattern - an observational study. Microvasc Res 2021; 136:104164. [PMID: 33831406 DOI: 10.1016/j.mvr.2021.104164] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Microcirculatory alterations are key mechanisms in sepsis pathophysiology leading to tissue hypoxia, edema formation, and organ dysfunction. Hyperspectral imaging (HSI) is an emerging imaging technology that uses tissue-light interactions to evaluate biochemical tissue characteristics including tissue oxygenation, hemoglobin content and water content. Currently, clinical data for HSI technologies in critical ill patients are still limited. METHODS AND ANALYSIS TIVITA® Tissue System was used to measure Tissue oxygenation (StO2), Tissue Hemoglobin Index (THI), Near Infrared Perfusion Index (NPI) and Tissue Water Index (TWI) in 25 healthy volunteers and 25 septic patients. HSI measurement sites were the palm, the fingertip, and a suprapatellar knee area. Septic patients were evaluated on admission to the ICU (E), 6 h afterwards (E+6) and three times a day (t3-t9) within a total observation period of 72 h. Primary outcome was the correlation of HSI results with daily SOFA-scores. RESULTS Serial HSI at the three measurement sites in healthy volunteers showed a low mean variance expressing high retest reliability. HSI at E demonstrated significantly lower StO2 and NPI as well as higher TWI at the palm and fingertip in septic patients compared to healthy volunteers. StO2 and TWI showed corresponding results at the suprapatellar knee area. In septic patients, palm and fingertip THI identified survivors (E-t4) and revealed predictivity for 28-day mortality (E). Fingertip StO2 and THI correlated to SOFA-score on day 2. TWI was consistently increased in relation to the TWI range of healthy controls during the observation time. Palm TWI correlated positively with SOFA scores on day 3. DISCUSSION HSI results in septic patients point to a distinctive microcirculatory pattern indicative of reduced skin oxygenation and perfusion quality combined with increased blood pooling and tissue water content. THI might possess risk-stratification properties and TWI could allow tissue edema evaluation in critically ill patients. CONCLUSION HSI technologies could open new perspectives in microcirculatory monitoring by visualizing oxygenation and perfusion quality combined with tissue water content in critically ill patients - a prerequisite for future tissue perfusion guided therapy concepts in intensive care medicine.
Collapse
Affiliation(s)
- M Dietrich
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - S Marx
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M von der Forst
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - T Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - F C F Schmitt
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M O Fiedler
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - A Studier-Fischer
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - B P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Brenner
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - M A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - F Uhle
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - K Schmidt
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| |
Collapse
|
28
|
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
|
29
|
Jansen-Winkeln B, Barberio M, Chalopin C, Schierle K, Diana M, Köhler H, Gockel I, Maktabi M. Feedforward Artificial Neural Network-Based Colorectal Cancer Detection Using Hyperspectral Imaging: A Step towards Automatic Optical Biopsy. Cancers (Basel) 2021; 13:cancers13050967. [PMID: 33669082 PMCID: PMC7956537 DOI: 10.3390/cancers13050967] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Detection of colorectal carcinoma is performed visually by investigators and is confirmed pathologically. With hyperspectral imaging, an expanded spectral range of optical information is now available for analysis. The acquired recordings were analyzed with a neural network, and it was possible to differentiate tumor from healthy mucosa in colorectal carcinoma by automatic classification with high reliability. Classification and visualization were performed based on a four-layer perceptron neural network. Based on a neural network, the classification of CA or AD resulted in a sensitivity of 86% and a specificity of 95%, by means of leave-one-patient-out cross-validation. Additionally, significant differences in terms of perfusion parameters (e.g., oxygen saturation) related to tumor staging and neoadjuvant therapy were observed. This is a step towards optical biopsy. Abstract Currently, colorectal cancer (CRC) is mainly identified via a visual assessment during colonoscopy, increasingly used artificial intelligence algorithms, or surgery. Subsequently, CRC is confirmed through a histopathological examination by a pathologist. Hyperspectral imaging (HSI), a non-invasive optical imaging technology, has shown promising results in the medical field. In the current study, we combined HSI with several artificial intelligence algorithms to discriminate CRC. Between July 2019 and May 2020, 54 consecutive patients undergoing colorectal resections for CRC were included. The tumor was imaged from the mucosal side with a hyperspectral camera. The image annotations were classified into three groups (cancer, CA; adenomatous margin around the central tumor, AD; and healthy mucosa, HM). Classification and visualization were performed based on a four-layer perceptron neural network. Based on a neural network, the classification of CA or AD resulted in a sensitivity of 86% and a specificity of 95%, by means of leave-one-patient-out cross-validation. Additionally, significant differences in terms of perfusion parameters (e.g., oxygen saturation) related to tumor staging and neoadjuvant therapy were observed. Hyperspectral imaging combined with automatic classification can be used to differentiate between CRC and healthy mucosa. Additionally, the biological changes induced by chemotherapy to the tissue are detectable with HSI.
Collapse
Affiliation(s)
- Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (M.B.); (I.G.)
- Correspondence: ; Tel.: +49-341-9717211; Fax: +49-341-9728167
| | - Manuel Barberio
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (M.B.); (I.G.)
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France;
- Department of General Surgery, Hospital Card. G. Panico, 73039 Tricase, Italy
| | - Claire Chalopin
- Innovation Center Computer-Assisted Surgery (ICCAS), University of Leipzig, 04103 Leipzig, Germany; (C.C.); (H.K.); (M.M.)
| | - Katrin Schierle
- Institute of Pathology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Michele Diana
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France;
| | - Hannes Köhler
- Innovation Center Computer-Assisted Surgery (ICCAS), University of Leipzig, 04103 Leipzig, Germany; (C.C.); (H.K.); (M.M.)
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (M.B.); (I.G.)
| | - Marianne Maktabi
- Innovation Center Computer-Assisted Surgery (ICCAS), University of Leipzig, 04103 Leipzig, Germany; (C.C.); (H.K.); (M.M.)
| |
Collapse
|
30
|
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: 1.0] [Reference Citation Analysis] [Abstract] [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
|
31
|
De Landro M, Espíritu García-Molina I, Barberio M, Felli E, Agnus V, Pizzicannella M, Diana M, Zappa E, Saccomandi P. Hyperspectral Imagery for Assessing Laser-Induced Thermal State Change in Liver. SENSORS 2021; 21:s21020643. [PMID: 33477656 PMCID: PMC7831494 DOI: 10.3390/s21020643] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 12/16/2022]
Abstract
This work presents the potential of hyperspectral imaging (HSI) to monitor the thermal outcome of laser ablation therapy used for minimally invasive tumor removal. Our main goal is the establishment of indicators of the thermal damage of living tissues, which can be used to assess the effect of the procedure. These indicators rely on the spectral variation of temperature-dependent tissue chromophores, i.e., oxyhemoglobin, deoxyhemoglobin, methemoglobin, and water. Laser treatment was performed at specific temperature thresholds (from 60 to 110 °C) on in-vivo animal liver and was assessed with a hyperspectral camera (500-995 nm) during and after the treatment. The indicators were extracted from the hyperspectral images after the following processing steps: the breathing motion compensation and the spectral and spatial filtering, the selection of spectral bands corresponding to specific tissue chromophores, and the analysis of the areas under the curves for each spectral band. Results show that properly combining spectral information related to deoxyhemoglobin, methemoglobin, lipids, and water allows for the segmenting of different zones of the laser-induced thermal damage. This preliminary investigation provides indicators for describing the thermal state of the liver, which can be employed in the future as clinical endpoints of the procedure outcome.
Collapse
Affiliation(s)
- Martina De Landro
- Department of Mechanical Engineering, Politecnico di Milano, 20156 Milan, Italy; (M.D.L.); (I.E.G.-M.); (E.Z.)
| | | | - Manuel Barberio
- IHU-Strasbourg, 67000 Strasbourg, France; (M.B.); (E.F.); (V.A.); (M.P.); (M.D.)
- Department of General Surgery, Ospedale Card. G. Panico, 73039 Tricase, Italy
| | - Eric Felli
- IHU-Strasbourg, 67000 Strasbourg, France; (M.B.); (E.F.); (V.A.); (M.P.); (M.D.)
| | - Vincent Agnus
- IHU-Strasbourg, 67000 Strasbourg, France; (M.B.); (E.F.); (V.A.); (M.P.); (M.D.)
| | | | - Michele Diana
- IHU-Strasbourg, 67000 Strasbourg, France; (M.B.); (E.F.); (V.A.); (M.P.); (M.D.)
- Research Institute against Cancer of the Digestive System IRCAD, 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67400 Strasbourg, France
| | - Emanuele Zappa
- Department of Mechanical Engineering, Politecnico di Milano, 20156 Milan, Italy; (M.D.L.); (I.E.G.-M.); (E.Z.)
| | - Paola Saccomandi
- Department of Mechanical Engineering, Politecnico di Milano, 20156 Milan, Italy; (M.D.L.); (I.E.G.-M.); (E.Z.)
- Correspondence:
| |
Collapse
|
32
|
Intraoperative Perfusion Assessment in Enhanced Reality Using Quantitative Optical Imaging: An Experimental Study in a Pancreatic Partial Ischemia Model. Diagnostics (Basel) 2021; 11:diagnostics11010093. [PMID: 33430038 PMCID: PMC7826658 DOI: 10.3390/diagnostics11010093] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [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
|
33
|
Barberio M, Felli E, Pop R, Pizzicannella M, Geny B, Lindner V, Baiocchini A, Jansen-Winkeln B, Moulla Y, Agnus V, Marescaux J, Gockel I, Diana M. A Novel Technique to Improve Anastomotic Perfusion Prior to Esophageal Surgery: Hybrid Ischemic Preconditioning of the Stomach. Preclinical Efficacy Proof in a Porcine Survival Model. Cancers (Basel) 2020; 12:cancers12102977. [PMID: 33066529 PMCID: PMC7602144 DOI: 10.3390/cancers12102977] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Esophagectomy has a high rate of anastomotic complications thought to be caused by poor perfusion of the gastric graft, which is used to restore the continuity of the gastrointestinal tract. Ischemic gastric preconditioning (IGP), performed by partially destroying preoperatively the gastric vessels either by means of interventional radiology or surgically, might improve the gastric conduit perfusion. Both approaches have downsides. The timing, extent and mechanism of IGP remain unclear. A novel hybrid IGP method combining the advantages of the endovascular and surgical approach was introduced in this study. IGP improves unequivocally the mucosal and serosal blood-flow at the gastric conduit fundus by triggering new vessels formation. The proposed timing and extent of IGP were efficacious and might be easily applied to humans. This novel minimally invasive IGP technique might reduce the anastomotic leak rate of patients undergoing esophagectomy, thus improving their overall oncological outcome. Abstract Esophagectomy often presents anastomotic leaks (AL), due to tenuous perfusion of gastric conduit fundus (GCF). Hybrid (endovascular/surgical) ischemic gastric preconditioning (IGP), might improve GCF perfusion. Sixteen pigs undergoing IGP were randomized: (1) Max-IGP (n = 6): embolization of left gastric artery (LGA), right gastric artery (RGA), left gastroepiploic artery (LGEA), and laparoscopic division (LapD) of short gastric arteries (SGA); (2) Min-IGP (n = 5): LGA-embolization, SGA-LapD; (3) Sham (n = 5): angiography, laparoscopy. At day 21 gastric tubulation occurred and GCF perfusion was assessed as: (A) Serosal-tissue-oxygenation (StO2) by hyperspectral-imaging; (B) Serosal time-to-peak (TTP) by fluorescence-imaging; (C) Mucosal functional-capillary-density-area (FCD-A) index by confocal-laser-endomicroscopy. Local capillary lactates (LCL) were sampled. Neovascularization was assessed (histology/immunohistochemistry). Sham presented lower StO2 and FCD-A index (41 ± 10.6%; 0.03 ± 0.03 respectively) than min-IGP (66.2 ± 10.2%, p-value = 0.004; 0.22 ± 0.02, p-value < 0.0001 respectively) and max-IGP (63.8 ± 9.4%, p-value = 0.006; 0.2 ± 0.02, p-value < 0.0001 respectively). Sham had higher LCL (9.6 ± 4.8 mL/mol) than min-IGP (4 ± 3.1, p-value = 0.04) and max-IGP (3.4 ± 1.5, p-value = 0.02). For StO2, FCD-A, LCL, max- and min-IGP did not differ. Sham had higher TTP (24.4 ± 4.9 s) than max-IGP (10 ± 1.5 s, p-value = 0.0008) and min-IGP (14 ± 1.7 s, non-significant). Max- and min-IGP did not differ. Neovascularization was confirmed in both IGP groups. Hybrid IGP improves GCF perfusion, potentially reducing post-esophagectomy AL.
Collapse
Affiliation(s)
- Manuel Barberio
- IHU-Strasbourg, Institute of Image-Guided Surgery, 67000 Strasbourg, France; (E.F.); (R.P.); (M.P.); (V.A.)
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 4107 Leipzig, Germany; (B.J.-W.); (Y.M.); (I.G.)
- Physiology Institute, EA 3072, University of Strasbourg, 67000 Strasbourg, France;
- Correspondence:
| | - Eric Felli
- IHU-Strasbourg, Institute of Image-Guided Surgery, 67000 Strasbourg, France; (E.F.); (R.P.); (M.P.); (V.A.)
- Physiology Institute, EA 3072, University of Strasbourg, 67000 Strasbourg, France;
| | - Raoul Pop
- IHU-Strasbourg, Institute of Image-Guided Surgery, 67000 Strasbourg, France; (E.F.); (R.P.); (M.P.); (V.A.)
| | - Margherita Pizzicannella
- IHU-Strasbourg, Institute of Image-Guided Surgery, 67000 Strasbourg, France; (E.F.); (R.P.); (M.P.); (V.A.)
| | - Bernard Geny
- Physiology Institute, EA 3072, University of Strasbourg, 67000 Strasbourg, France;
| | - Veronique Lindner
- Department of Pathology, University Hospital of Strasbourg, 67000 Strasbourg, France;
| | - Andrea Baiocchini
- Department of Surgical Pathology, San Camillo Hospital, 00152 Rome, Italy;
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 4107 Leipzig, Germany; (B.J.-W.); (Y.M.); (I.G.)
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 4107 Leipzig, Germany; (B.J.-W.); (Y.M.); (I.G.)
| | - Vincent Agnus
- IHU-Strasbourg, Institute of Image-Guided Surgery, 67000 Strasbourg, France; (E.F.); (R.P.); (M.P.); (V.A.)
| | - Jacques Marescaux
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (J.M.); (M.D.)
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 4107 Leipzig, Germany; (B.J.-W.); (Y.M.); (I.G.)
| | - Michele Diana
- Research Institute against Digestive Cancer (IRCAD), 67000 Strasbourg, France; (J.M.); (M.D.)
| |
Collapse
|
34
|
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 2020; 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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/01/2020] [Indexed: 12/19/2022]
Abstract
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
|
35
|
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 2020; 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] [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
|
36
|
Felli E, Al-Taher M, Collins T, Baiocchini A, Felli E, Barberio M, Ettorre GM, Mutter D, Lindner V, Hostettler A, Gioux S, Schuster C, Marescaux J, Diana M. Hyperspectral evaluation of hepatic oxygenation in a model of total vs. arterial liver ischaemia. Sci Rep 2020; 10:15441. [PMID: 32963333 PMCID: PMC7509803 DOI: 10.1038/s41598-020-72915-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022] Open
Abstract
Liver ischaemia reperfusion injury (IRI) is a dreaded pathophysiological complication which may lead to an impaired liver function. The level of oxygen hypoperfusion affects the level of cellular damage during the reperfusion phase. Consequently, intraoperative localisation and quantification of oxygen impairment would help in the early detection of liver ischaemia. To date, there is no real-time, non-invasive, and intraoperative tool which can compute an organ oxygenation map, quantify and discriminate different types of vascular occlusions intraoperatively. Hyperspectral imaging (HSI) is a non-invasive optical methodology which can quantify tissue oxygenation and which has recently been applied to the medical field. A hyperspectral camera detects the relative reflectance of a tissue in the range of 500 to 1000 nm, allowing the quantification of organic compounds such as oxygenated and deoxygenated haemoglobin at different depths. Here, we show the first comparative study of liver oxygenation by means of HSI quantification in a model of total vascular inflow occlusion (VIO) vs. hepatic artery occlusion (HAO), correlating optical properties with capillary lactate and histopathological evaluation. We found that liver HSI could discriminate between VIO and HAO. These results were confirmed via cross-validation of HSI which detected and quantified intestinal congestion in VIO. A significant correlation between the near-infrared spectra and capillary lactate was found (r = − 0.8645, p = 0.0003 VIO, r = − 0.7113, p = 0.0120 HAO). Finally, a statistically significant negative correlation was found between the histology score and the near-infrared parameter index (NIR) (r = − 0.88, p = 0.004). We infer that HSI, by predicting capillary lactates and the histopathological score, would be a suitable non-invasive tool for intraoperative liver perfusion assessment.
Collapse
Affiliation(s)
- Eric Felli
- Institute of Physiology, EA3072 Mitochondria Respiration and Oxidative Stress, University of Strasbourg, Strasbourg, France. .,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.
| | - Mahdi Al-Taher
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Toby Collins
- Surgical Data Science Department, Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Andrea Baiocchini
- Department of Pathology, San Camillo Forlanini Hospital, Rome, Italy
| | - Emanuele Felli
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.,INSERM, Institute of Viral and Liver Disease, U1110, Strasbourg, France
| | - Manuel Barberio
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | | | - Didier Mutter
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.,Surgical Data Science Department, Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | | | - Alexandre Hostettler
- Surgical Data Science Department, Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Sylvain Gioux
- ICUBE Laboratory, Photonics Instrumentation for Health, University of Strasbourg, Strasbourg, France
| | - Catherine Schuster
- INSERM, Institute of Viral and Liver Disease, U1110, Strasbourg, France.,University of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,Surgical Data Science Department, Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Michele Diana
- Institute of Physiology, EA3072 Mitochondria Respiration and Oxidative Stress, University of Strasbourg, Strasbourg, France.,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.,Surgical Data Science Department, Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France.,ICUBE Laboratory, Photonics Instrumentation for Health, University of Strasbourg, Strasbourg, France
| |
Collapse
|
37
|
Computer-assisted quantification and visualization of bowel perfusion using fluorescence-based enhanced reality in left-sided colonic resections. Surg Endosc 2020; 35:4321-4331. [PMID: 32856153 DOI: 10.1007/s00464-020-07922-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [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
|
38
|
Hyperspectral enhanced reality (HYPER) for anatomical liver resection. Surg Endosc 2020; 35:1844-1850. [DOI: 10.1007/s00464-020-07586-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022]
|