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Dalli J, Joosten JJ, Jindal A, Hardy NP, Camilleri-Brennan J, Andrejevic P, Hompes R, Cahill RA. Impact of standardising indocyanine green fluorescence angiography technique for visual and quantitative interpretation on interuser variability in colorectal surgery. Surg Endosc 2024; 38:1306-1315. [PMID: 38110792 DOI: 10.1007/s00464-023-10564-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/24/2023] [Indexed: 12/20/2023]
Abstract
AIM/BACKGROUND Intra-operative colonic perfusion assessment via indocyanine green fluorescence angiography (ICGFA) aims to address malperfusion-related anastomotic complications; however, its interpretation suffers interuser variability (IUV), especially early in ICGFA experience. This work assesses the impact of a protocol developed for both operator-based judgement and computational development on interpretation consistency, focusing on senior surgeons yet to start using ICGFA. METHODS Experienced and junior gastrointestinal surgeons were invited to complete an ICGFA-experience questionnaire. They subsequently interpreted nine operative ICGFA videos regarding perfusion sufficiency of a surgically prepared distal colon during laparoscopic anterior resection by indicating their preferred site of proximal transection using an online annotation platform (mindstamp.com). Six ICGFA videos had been prepared with a clinical standardisation protocol controlling camera and patient positioning of which three each had monochrome near infrared (NIR) and overlay display. Three others were non-standardised controls with synchronous NIR and overlay picture-in-picture display. Differences in transection level between different cohorts were assessed for intraclass correlation coefficient (ICC) via ImageJ and IBM SPSS. RESULTS 58 clinicians (12 ICGFA experts, 46 ICGFA inexperienced of whom 23 were either finished or within one year of finishing training and 23 were junior trainees) participated as per power calculations. 63% felt that ICGFA should be routinely deployed with 57% believing interpretative competence requires 11-50 cases. Transection level concordance was generally good (ICC = 0.869) across all videos and levels of expertise (0.833-0.915). However, poor agreement was evident with the standardised protocol videos for overlay presentation (0.208-0.345). Similarly, poor agreement was seen for the monochrome display (0.392-0.517), except for those who were trained but ICG inexperienced (0.877) although even here agreement was less than with unstandardised videos (0.943). CONCLUSION Colorectal ICGFA acquisition and display standardisation impacts IUV with this specific protocol tending to diminish surgeon interpretation consistency. ICGFA video recording for computational development may require dedicated protocols.
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Affiliation(s)
- Jeffrey Dalli
- UCD Centre for Precision Surgery, Catherine McAuley Centre, University College Dublin, 21 Nelson St, Phibsborough, Dublin 7, D07 KX5K, Ireland
| | - Johanna J Joosten
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Abhinav Jindal
- UCD Centre for Precision Surgery, Catherine McAuley Centre, University College Dublin, 21 Nelson St, Phibsborough, Dublin 7, D07 KX5K, Ireland
| | - Niall P Hardy
- UCD Centre for Precision Surgery, Catherine McAuley Centre, University College Dublin, 21 Nelson St, Phibsborough, Dublin 7, D07 KX5K, Ireland
| | - John Camilleri-Brennan
- Forth Valley Royal Hospital, Larbert, Stirlingshire, Scotland, UK
- University of Glasgow, Glasgow, Scotland, UK
| | - Predrag Andrejevic
- Department of Surgery, Mater Dei Hospital, Msida, Malta
- University of Malta, Msida, Malta
| | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, Catherine McAuley Centre, University College Dublin, 21 Nelson St, Phibsborough, Dublin 7, D07 KX5K, Ireland.
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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2
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Jung JM, Park IJ, Park EJ, Son GM. Fluorescence-guided colorectal surgery: applications, clinical results, and protocols. Ann Surg Treat Res 2023; 105:252-263. [PMID: 38023438 PMCID: PMC10648611 DOI: 10.4174/astr.2023.105.5.252] [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: 09/29/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
In recent years, the rise of minimally invasive surgery has driven the development of surgical devices. Indocyanine green (ICG) fluorescence imaging is receiving increased attention in colorectal surgery for improved intraoperative visualization and decision-making. ICG, approved by the U.S. Food and Drug Administration in 1959, rapidly binds to plasma proteins and is primarily intravascular. ICG absorption of near-infrared light (750-800 nm) and emission as fluorescence (830 nm) when bound to tissue proteins enhances deep tissue visualization. Applications include assessing anastomotic perfusion, identifying sentinel lymph nodes, and detecting colorectal cancer metastasis. However, standardized protocols and research on clinical outcomes remain limited. This study explores ICG's role, advantages, disadvantages, and potential clinical impact in colorectal surgery.
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Affiliation(s)
- Jin-Min Jung
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jung Park
- Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Gyung Mo Son
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Faber RA, Tange FP, Galema HA, Zwaan TC, Holman FA, Peeters KCMJ, Tanis PJ, Verhoef C, Burggraaf J, Mieog JSD, Hutteman M, Keereweer S, Vahrmeijer AL, van der Vorst JR, Hilling DE. Quantification of indocyanine green near-infrared fluorescence bowel perfusion assessment in colorectal surgery. Surg Endosc 2023; 37:6824-6833. [PMID: 37286750 PMCID: PMC10462565 DOI: 10.1007/s00464-023-10140-8] [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: 01/08/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Indocyanine green near-infrared fluorescence bowel perfusion assessment has shown its potential benefit in preventing anastomotic leakage. However, the surgeon's subjective visual interpretation of the fluorescence signal limits the validity and reproducibility of the technique. Therefore, this study aimed to identify objective quantified bowel perfusion patterns in patients undergoing colorectal surgery using a standardized imaging protocol. METHOD A standardized fluorescence video was recorded. Postoperatively, the fluorescence videos were quantified by drawing contiguous region of interests (ROIs) on the bowel. For each ROI, a time-intensity curve was plotted from which perfusion parameters (n = 10) were derived and analyzed. Furthermore, the inter-observer agreement of the surgeon's subjective interpretation of the fluorescence signal was assessed. RESULTS Twenty patients who underwent colorectal surgery were included in the study. Based on the quantified time-intensity curves, three different perfusion patterns were identified. Similar for both the ileum and colon, perfusion pattern 1 had a steep inflow that reached its peak fluorescence intensity rapidly, followed by a steep outflow. Perfusion pattern 2 had a relatively flat outflow slope immediately followed by its plateau phase. Perfusion pattern 3 only reached its peak fluorescence intensity after 3 min with a slow inflow gradient preceding it. The inter-observer agreement was poor-moderate (Intraclass Correlation Coefficient (ICC): 0.378, 95% CI 0.210-0.579). CONCLUSION This study showed that quantification of bowel perfusion is a feasible method to differentiate between different perfusion patterns. In addition, the poor-moderate inter-observer agreement of the subjective interpretation of the fluorescence signal between surgeons emphasizes the need for objective quantification.
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Affiliation(s)
- Robin A Faber
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Floris P Tange
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Hidde A Galema
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Thomas C Zwaan
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Fabian A Holman
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Pieter J Tanis
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jacobus Burggraaf
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Centre of Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands
| | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Merlijn Hutteman
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Stijn Keereweer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Alexander L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Joost R van der Vorst
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Denise E Hilling
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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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.
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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
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5
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Son GM, Nazir AM, Yun MS, Lee IY, Im SB, Kwak JY, Park SH, Baek KR, Gockel I. The Safe Values of Quantitative Perfusion Parameters of ICG Angiography Based on Tissue Oxygenation of Hyperspectral Imaging for Laparoscopic Colorectal Surgery: A Prospective Observational Study. Biomedicines 2023; 11:2029. [PMID: 37509667 PMCID: PMC10377371 DOI: 10.3390/biomedicines11072029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Safe values for quantitative perfusion parameters of indocyanine green (ICG) angiography have not been fully defined, and interpretation remains at the surgeon's discretion. This prospective observational study aimed to establish the safe values for the quantitative perfusion parameters by comparing tissue oxygenation levels from HSI images in laparoscopic colorectal surgery. METHODS ICG angiography was performed using a laparoscopic near-infrared (NIR) camera system with ICG diluted in 10 mL of distilled water. For quantitative perfusion parameters, the changes in fluorescence intensity with perfusion times were analyzed to plot a time-fluorescence intensity graph. To assess real-time tissue oxygen saturation (StO2) in the colon, the TIVITA® Tissue System was utilized for hyperspectral imaging (HSI) acquisition. The StO2 levels were compared with the quantitative perfusion parameters derived from ICG angiography at corresponding points to define the safe range of ICG parameters reflecting good tissue oxygenation. RESULTS In the regression analysis, T1/2MAX, TMAX, slope, and NIR perfusion index were correlated with tissue oxygen saturation. Using this regression model, the cutoff values of quantitative perfusion parameters were calculated as T1/2MAX ≤ 10 s, TMAX ≤ 30 s, slope ≥ 5, and NIR perfusion index ≥50, which best reflected colon StO2 higher than 60%. Diagnostic values were analyzed to predict colon StO2 of 60% or more, and the ICG perfusion parameters T1/2MAX, TMAX, and perfusion TR showed high sensitivity values of 97% or more, indicating their ability to correctly identify cases with acceptable StO2. CONCLUSION The safe values for quantitative perfusion parameters derived from ICG angiography were T1/2MAX ≤ 10 s and TMAX ≤ 30 s, which were associated with colon tissue oxygenation levels higher than 60% in the laparoscopic colorectal surgery.
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Affiliation(s)
- Gyung Mo Son
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (M.S.Y.); (I.Y.L.)
| | - Armaan M. Nazir
- School of Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland;
| | - Mi Sook Yun
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (M.S.Y.); (I.Y.L.)
| | - In Young Lee
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (M.S.Y.); (I.Y.L.)
| | - Sun Bin Im
- Department of Medicine, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea;
| | - Jae Yeong Kwak
- Department of Electronics Engineering, Pusan National University, Busan 46241, Republic of Korea; (J.Y.K.); (S.-H.P.); (K.-R.B.)
| | - Sang-Ho Park
- Department of Electronics Engineering, Pusan National University, Busan 46241, Republic of Korea; (J.Y.K.); (S.-H.P.); (K.-R.B.)
| | - Kwang-Ryul Baek
- Department of Electronics Engineering, Pusan National University, Busan 46241, Republic of Korea; (J.Y.K.); (S.-H.P.); (K.-R.B.)
| | - Ines Gockel
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, 04103 Leipzig, Germany;
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Pollmann L, Juratli M, Roushansarai N, Pascher A, Hölzen JP. Quantification of Indocyanine Green Fluorescence Imaging in General, Visceral and Transplant Surgery. J Clin Med 2023; 12:jcm12103550. [PMID: 37240657 DOI: 10.3390/jcm12103550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Near-infrared (NIR) imaging with indocyanine green (ICG) has proven to be useful in general, visceral, and transplant surgery. However, most studies have performed only qualitative assessments. Therefore, a systematic overview of all studies performing quantitative indocyanine green evaluation in general, visceral, and transplant surgeries should be conducted. Free term and medical subject heading (MeSH) term searches were performed in the Medline and Cochrane databases until October 2022. The main categories of ICG quantification were esophageal surgery (24.6%), reconstructive surgery (24.6%), and colorectal surgery (21.3%). Concordantly, anastomotic leak (41%) was the main endpoint, followed by the assessment of flap perfusion (23%) and the identification of structures and organs (14.8%). Most studies examined open surgery (67.6%) or laparoscopic surgery (23.1%). The analysis was mainly carried out using manufacturer software (44.3%) and open-source software (15.6%). The most frequently analyzed parameter was intensity over time for blood flow assessment, followed by intensity alone or intensity-to-background ratios for structure and organ identification. Intraoperative ICG quantification could become more important with the increasing impact of robotic surgery and machine learning algorithms for image and video analysis.
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Affiliation(s)
- Lukas Pollmann
- Department for General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Munster, Germany
| | - Mazen Juratli
- Department for General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Munster, Germany
| | - Nicola Roushansarai
- Department for General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Munster, Germany
| | - Andreas Pascher
- Department for General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Munster, Germany
| | - Jens Peter Hölzen
- Department for General, Visceral and Transplant Surgery, University Hospital Münster, 48149 Munster, Germany
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7
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Flores-Rodríguez E, Garrido-López L, Sánchez-Santos R, Cano-Valderrama O, Rodríguez-Fernández L, Nogueira-Sixto M, Paniagua-García Señorans M, Vigorita V, Moncada-Iribarren E. Is ICG essential in all colorectal surgery? A 3-year experience in a single center: a cohort study. Int J Colorectal Dis 2023; 38:67. [PMID: 36897439 DOI: 10.1007/s00384-023-04363-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Indocyanine green (ICG) was introduced as a promising diagnostic tool to provide real-time assessment of intestinal vascularization. Nevertheless, it remains unclear whether ICG could reduce the rate of postoperative AL. The objective of this study is to assess its usefulness and to determine in which patients is most useful and would benefit the most from the use of ICG for intraoperative assessment of colon perfusion. METHODS A retrospective cohort study was conducted in a single center, including all patients who underwent colorectal surgery with intestinal anastomosis between January 2017 and December 2020. The results of patients in whom ICG was used prior to bowel transection were compared with the results of the patients in whom this technique was not used. Propensity score matching (PSM) was employed to compare groups with and without ICG. RESULTS A total of 785 patients who underwent colorectal surgery were included. The operations performed were right colectomies (35.0%), left colectomies (48.3%), and rectal resections (16.7%). ICG was used in 280 patients. The mean time since the infusion of ICG until detection of fluorescence in the colon wall was 26.9 ± 1.2 s. The section line was modified in 4 cases (1.4%) after ICG due to a lack of perfusion in the chosen section line. Globally, a non-statistically significant increase in anastomotic leak rate was observed in the group without ICG (9.3% vs. 7.5%; p = 0.38). The result of the PSM was a coefficient of 0.026 (CI - 0.014 to 0.065, p = 0.207). CONCLUSIONS ICG is a safe and useful tool to assess the perfusion of the colon prior to performing the anastomosis in colorectal surgery. However, in our experience, it did not significantly lower the anastomotic leakage rate.
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Affiliation(s)
- Erene Flores-Rodríguez
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/ Clara Campoamor 341, Vigo, Pontevedra, Zip Code: 36213, Spain.
| | - Lucia Garrido-López
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/ Clara Campoamor 341, Vigo, Pontevedra, Zip Code: 36213, Spain
| | - Raquel Sánchez-Santos
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/ Clara Campoamor 341, Vigo, Pontevedra, Zip Code: 36213, Spain.,Instituto de Investigación Galicia Sur, Pontevedra, Spain
| | - Oscar Cano-Valderrama
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/ Clara Campoamor 341, Vigo, Pontevedra, Zip Code: 36213, Spain.,Instituto de Investigación Galicia Sur, Pontevedra, Spain
| | - Laura Rodríguez-Fernández
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/ Clara Campoamor 341, Vigo, Pontevedra, Zip Code: 36213, Spain
| | - Manuel Nogueira-Sixto
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/ Clara Campoamor 341, Vigo, Pontevedra, Zip Code: 36213, Spain
| | - Marta Paniagua-García Señorans
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/ Clara Campoamor 341, Vigo, Pontevedra, Zip Code: 36213, Spain
| | - Vincenzo Vigorita
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/ Clara Campoamor 341, Vigo, Pontevedra, Zip Code: 36213, Spain.,Instituto de Investigación Galicia Sur, Pontevedra, Spain
| | - Enrique Moncada-Iribarren
- Department of Surgery, Complejo Hospitalario Universitario de Vigo, C/ Clara Campoamor 341, Vigo, Pontevedra, Zip Code: 36213, Spain
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8
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Hardy NP, MacAonghusa P, Dalli J, Gallagher G, Epperlein JP, Shields C, Mulsow J, Rogers AC, Brannigan AE, Conneely JB, Neary PM, Cahill RA. Clinical application of machine learning and computer vision to indocyanine green quantification for dynamic intraoperative tissue characterisation: how to do it. Surg Endosc 2023:10.1007/s00464-023-09963-2. [PMID: 36894810 PMCID: PMC10338552 DOI: 10.1007/s00464-023-09963-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 02/12/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Indocyanine green (ICG) quantification and assessment by machine learning (ML) could discriminate tissue types through perfusion characterisation, including delineation of malignancy. Here, we detail the important challenges overcome before effective clinical validation of such capability in a prospective patient series of quantitative fluorescence angiograms regarding primary and secondary colorectal neoplasia. METHODS ICG perfusion videos from 50 patients (37 with benign (13) and malignant (24) rectal tumours and 13 with colorectal liver metastases) of between 2- and 15-min duration following intravenously administered ICG were formally studied (clinicaltrials.gov: NCT04220242). Video quality with respect to interpretative ML reliability was studied observing practical, technical and technological aspects of fluorescence signal acquisition. Investigated parameters included ICG dosing and administration, distance-intensity fluorescent signal variation, tissue and camera movement (including real-time camera tracking) as well as sampling issues with user-selected digital tissue biopsy. Attenuating strategies for the identified problems were developed, applied and evaluated. ML methods to classify extracted data, including datasets with interrupted time-series lengths with inference simulated data were also evaluated. RESULTS Definable, remediable challenges arose across both rectal and liver cohorts. Varying ICG dose by tissue type was identified as an important feature of real-time fluorescence quantification. Multi-region sampling within a lesion mitigated representation issues whilst distance-intensity relationships, as well as movement-instability issues, were demonstrated and ameliorated with post-processing techniques including normalisation and smoothing of extracted time-fluorescence curves. ML methods (automated feature extraction and classification) enabled ML algorithms glean excellent pathological categorisation results (AUC-ROC > 0.9, 37 rectal lesions) with imputation proving a robust method of compensation for interrupted time-series data with duration discrepancies. CONCLUSION Purposeful clinical and data-processing protocols enable powerful pathological characterisation with existing clinical systems. Video analysis as shown can inform iterative and definitive clinical validation studies on how to close the translation gap between research applications and real-world, real-time clinical utility.
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Affiliation(s)
- Niall P Hardy
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Jeffrey Dalli
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, Dublin, Ireland
| | - Gareth Gallagher
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Conor Shields
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jurgen Mulsow
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ailín C Rogers
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ann E Brannigan
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John B Conneely
- Department of Hepatobiliary, Foregut and Bariatric Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter M Neary
- Department of General and Colorectal Surgery, University Hospital Waterford, University College Cork, Waterford, Ireland
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, School of Medicine, University College Dublin, Dublin, Ireland.
- Department of General and Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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9
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Dalli J, Jindal A, Gallagher G, Epperlein JP, Hardy NP, Malallah R, O’Donoghue K, Cantillon-Murphy P, Mac Aonghusa PG, Cahill RA. Evaluating clinical near-infrared surgical camera systems with a view to optimizing operator and computational signal analysis. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:035002. [PMID: 37009578 PMCID: PMC10050972 DOI: 10.1117/1.jbo.28.3.035002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/14/2023] [Indexed: 06/19/2023]
Abstract
SIGNIFICANCE As clinical evidence on the colorectal application of indocyanine green (ICG) perfusion angiography accrues, there is also interest in computerizing decision support. However, user interpretation and software development may be impacted by system factors affecting the displayed near-infrared (NIR) signal. AIM We aim to assess the impact of camera positioning on the displayed NIR signal across different open and laparoscopic camera systems. APPROACH The effects of distance, movement, and target location (center versus periphery) on the displayed fluorescence signal of different systems were measured under electromagnetic stereotactic guidance from an ICG-albumin model and in vivo during surgery. RESULTS Systems displayed distinct fluorescence performances with variance apparent with scope optical lens configuration (0 deg versus 30 deg), movement, target positioning, and distance. Laparoscopic system readings fitted inverse square function distance-intensity curves with one device and demonstrated a direction dependent sigmoid curve. Laparoscopic cameras presented central targets as brighter than peripheral ones, and laparoscopes with angled optical lens configurations had a diminished field of view. One handheld open system also showed a distance-intensity relationship, whereas the other maintained a consistent signal despite distance, but both presented peripheral targets brighter than central ones. CONCLUSIONS Optimal clinical use and signal computational development requires detailed appreciation of system behaviors.
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Affiliation(s)
- Jeffrey Dalli
- University College, UCD Centre for Precision Surgery, Dublin, Ireland
| | - Abhinav Jindal
- University College, UCD Centre for Precision Surgery, Dublin, Ireland
| | - Gareth Gallagher
- University College, UCD Centre for Precision Surgery, Dublin, Ireland
| | | | - Niall P. Hardy
- University College, UCD Centre for Precision Surgery, Dublin, Ireland
| | - Ra’ed Malallah
- University College, UCD Centre for Precision Surgery, Dublin, Ireland
- University of Basrah, Physics Department, Faculty of Science, Basrah, Iraq
| | | | - Padraig Cantillon-Murphy
- University College Cork, School of Engineering, Cork, Ireland
- Tyndall National Institute, Cork, Ireland
| | | | - Ronan A. Cahill
- University College, UCD Centre for Precision Surgery, Dublin, Ireland
- Mater Misericordiae University Hospital, Department of Surgery, Dublin, Ireland
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10
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Dalli J, Shanahan S, Hardy NP, Chand M, Hompes R, Jayne D, Ris F, Spinelli A, Wexner S, Cahill RA. Deconstructing mastery in colorectal fluorescence angiography interpretation. Surg Endosc 2022; 36:8764-8773. [PMID: 35543771 PMCID: PMC9652172 DOI: 10.1007/s00464-022-09299-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/23/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Indocyanine green fluorescence angiography (ICGFA) is commonly used in colorectal anastomotic practice with limited pre-training. Recent work has shown that there is considerable inconsistency in signal interpretation between surgeons with minimal or no experience versus those consciously invested in mastery of the technique. Here, we deconstruct the fluorescence signal patterns of expert-annotated surgical ICGFA videos to understand better their correlation and combine this with structured interviews to ascertain whether such interpretative capability is conscious or unconscious. METHODS For fluorescence signal analysis, expert-annotated ICGFA videos (n = 24) were quantitatively interrogated using a boutique intensity tracker (IBM Research) to generate signal time plots. Such fluorescence intensity data were examined for inter-observer correlation (Intraclass Correlation Coefficients, ICC) at specific curve milestones: the maximum fluorescence signal (Fmax), the times to both achieve this maximum (Tmax), as well as half this maximum (T1/2max) and the ratio between these (T1/2/Tmax). Formal tele-interview with contributing experts (n = 6) was conducted with the narrative transcripts being thematically mapped, plotted, and qualitatively analyzed. RESULTS Correlation by mathematical measures was excellent (ICC0.9-1.0) for Fmax, Tmax, and T1/2max (0.95, 0.938, and 0.925, respectively) and moderate (0.5-0.75) for T1/2/Tmax (0.729). While all experts narrated a deliberate viewing strategy, their specific dynamic signal appreciation differed in the manner of description. CONCLUSION Expert ICGFA users demonstrate high correlation in mathematical measures of their signal interpretation although do so tacitly. Computational quantification of expert behavior can help develop the necessary lexicon and training sets as well as computer vision methodology to better exploit ICGFA technology.
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Affiliation(s)
- Jeffrey Dalli
- UCD Centre for Precision Surgery, School of Medicine, Catherine McAuley Centre, University College Dublin, 21 Nelson St, Phibsborough, Dublin 7, D07 KX5K, Ireland
| | - Sarah Shanahan
- UCD Centre for Precision Surgery, School of Medicine, Catherine McAuley Centre, University College Dublin, 21 Nelson St, Phibsborough, Dublin 7, D07 KX5K, Ireland
| | - Niall P Hardy
- UCD Centre for Precision Surgery, School of Medicine, Catherine McAuley Centre, University College Dublin, 21 Nelson St, Phibsborough, Dublin 7, D07 KX5K, Ireland
| | - Manish Chand
- UCL Division of Surgery and Interventional Sciences, WEISS Centre, University College London, London, UK
| | - Roel Hompes
- Department of Surgery, Amsterdam UMC (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - David Jayne
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
| | - Frederic Ris
- Service of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Steven Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, 33331, USA
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, School of Medicine, Catherine McAuley Centre, University College Dublin, 21 Nelson St, Phibsborough, Dublin 7, D07 KX5K, Ireland.
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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11
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Kong W, Wang B, Niu Q, Lin C, Fan D. Quantitative evaluation of anastomotic perfusion during colorectal surgery via indocyanine green fluorescence angiography: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1402. [PMID: 36660668 PMCID: PMC9843406 DOI: 10.21037/atm-22-5312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
Background and Objective Quantitative studies of indocyanine green (ICG) are needed to optimize its evaluative potential in anastomotic perfusion during colorectal surgery. However, some limitations still existed in current studies about qualitative evaluations such as small-scale studies, the inconsistent concentration of the drug, the method of injection, etc. Therefore, this review summarized the primary quantitative parameters, image, method, and so on, during ICG fluorescence angiography aiming to further provide a theoretical basis for the application of ICG in laparoscopic colorectal surgery. Methods The following keywords "indocyanine green or ICG", "anastomotic perfusion", and "colorectal surgery" were applied to search for literature published from 2002 to 2022 in the PubMed, Web of Science, and Medline databases. Then, the information about ICG fluorescence angiography in quantitative evaluation of anastomotic perfusion during colorectal surgery was summarized. Through integrating the experiences derived from the literature and our research center, the crucial quantitative parameters [such as T0, Tmax, Fmax, and S (Fmax/Tmax)], image characteristics, and standard operational process for ICG fluorescence angiography were summarized. Key Content and Findings Firstly, quantitative parameters, including T0, Tmax, Fmax, and S (Fmax/Tmax) during the ICG fluorescence angiography could predict anastomotic leakage, and thus should be recorded. Secondly, the image curve generated by the software might differ among patients, which included a filling period, reducing period, and platform period; some patients even presented a second fluorescence intensity peak. Finally, present studies presented great heterogeneity regarding the injection dose of ICG, observation distance from the laparoscope to the anastomotic site, software, and so on, during ICG fluorescence angiography in quantitatively evaluating the intestinal blood perfusion. Conclusions This review points out the challenges of ICG fluorescence angiography in quantitative evaluation of anastomotic perfusion and gives some advice. However, some difficulties and issues are non-neglectable during the clinical implications of the quantitative evaluation of ICG, such as standardizing the specific cut-off value about the quantitative parameters, injection dose of ICG, observation distance from the laparoscope to the anastomotic site, software, and so on, during ICG fluorescence angiography in quantitatively evaluating the intestinal blood perfusion to eliminate heterogeneity.
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Affiliation(s)
- Weiqi Kong
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bingyi Wang
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiguang Niu
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chaoyi Lin
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Donglai Fan
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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12
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A Narrative Review of the Usefulness of Indocyanine Green Fluorescence Angiography for Perfusion Assessment in Colorectal Surgery. Cancers (Basel) 2022; 14:cancers14225623. [PMID: 36428716 PMCID: PMC9688558 DOI: 10.3390/cancers14225623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Anastomotic leakage is one of the most dreaded complications of colorectal surgery and is strongly associated with tissue perfusion. Indocyanine green fluorescence angiography (ICG-FA) using indocyanine green and near-infrared systems is an innovative technique that allows the visualization of anastomotic perfusion. Based on this information on tissue perfusion status, surgeons will be able to clearly identify colorectal segments with good blood flow for safer colorectal anastomosis. The results of several clinical trials indicate that ICG-FA may reduce the risk of AL in colorectal resection; however, the level of evidence is not high, as several other studies have failed to demonstrate a reduction in the risk of AL. Several large-scale RCTs are currently underway, and their results will determine whether ICG-FA is, indeed, useful. The major limitation of the current ICG-FA evaluation method, however, is that it is subjective and based on visual assessment by the surgeon. To complement this, the utility of objective evaluation methods for fluorescence using quantitative parameters is being investigated. Promising results have been reported from several clinical trials, but all trials are preliminary owing to their small sample size and lack of standardized protocols for quantitative evaluation. Therefore, appropriately standardized, high-quality, large-scale studies are warranted.
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13
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Ileal long-segment ischemia after the unintended ligation of variant ileal branch during laparoscopic right hemicolectomy. JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:116-119. [PMID: 36177374 PMCID: PMC9494016 DOI: 10.7602/jmis.2022.25.3.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/24/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022]
Abstract
The variant terminal trunk of the superior mesenteric artery (SMA) could be confused with the ileocolic artery (ICA) as it runs on the right side of the superior mesenteric vein. If the variant ileal branch of SMA is mistaken for the ICA, unintentional ligation could cause long-segment ischemia in the ileum. We encountered a rare case of ileal ischemia caused by unintentional ligation of the variant ileal branch of the SMA during laparoscopic right hemicolectomy, which was confirmed by indocyanine green (ICG) angiography and hyperspectral imaging (HSI). Intraoperative real-time perfusion monitoring using ICG angiography and tissue oxygen saturation monitoring using HSI could help detect segments of hypoperfusion and prevent hypoperfusion-related anastomotic complications.
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14
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Arpaia P, Bracale U, Corcione F, De Benedetto E, Di Bernardo A, Di Capua V, Duraccio L, Peltrini R, Prevete R. Assessment of blood perfusion quality in laparoscopic colorectal surgery by means of Machine Learning. Sci Rep 2022; 12:14682. [PMID: 36038561 PMCID: PMC9424219 DOI: 10.1038/s41598-022-16030-8] [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: 11/30/2021] [Accepted: 07/04/2022] [Indexed: 11/20/2022] Open
Abstract
An innovative algorithm to automatically assess blood perfusion quality of the intestinal sector in laparoscopic colorectal surgery is proposed. Traditionally, the uniformity of the brightness in indocyanine green-based fluorescence consists only in a qualitative, empirical evaluation, which heavily relies on the surgeon’s subjective assessment. As such, this leads to assessments that are strongly experience-dependent. To overcome this limitation, the proposed algorithm assesses the level and uniformity of indocyanine green used during laparoscopic surgery. The algorithm adopts a Feed Forward Neural Network receiving as input a feature vector based on the histogram of the green band of the input image. It is used to (i) acquire information related to perfusion during laparoscopic colorectal surgery, and (ii) support the surgeon in assessing objectively the outcome of the procedure. In particular, the algorithm provides an output that classifies the perfusion as adequate or inadequate. The algorithm was validated on videos captured during surgical procedures carried out at the University Hospital Federico II in Naples, Italy. The obtained results show a classification accuracy equal to \documentclass[12pt]{minimal}
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\begin{document}$$1.9\%$$\end{document}1.9%. Finally, the real-time operation of the proposed algorithm was tested by analyzing the video streaming captured directly from an endoscope available in the OR.
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Affiliation(s)
- Pasquale Arpaia
- University of Naples Federico II - Interdepartmental Research Center in Health Management and Innovation in Healthcare (CIRMIS), Naples, 80131, Italy. .,Department of Information Technology and Electrical Engineering, University of Naples Federico II, Naples, 80125, Italy.
| | - Umberto Bracale
- University of Naples Federico II - Interdepartmental Research Center in Health Management and Innovation in Healthcare (CIRMIS), Naples, 80131, Italy.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, 80131, Italy
| | - Francesco Corcione
- University of Naples Federico II - Interdepartmental Research Center in Health Management and Innovation in Healthcare (CIRMIS), Naples, 80131, Italy.,Department of Public Health, University of Naples Federico II, Naples, 80131, Italy
| | - Egidio De Benedetto
- University of Naples Federico II - Interdepartmental Research Center in Health Management and Innovation in Healthcare (CIRMIS), Naples, 80131, Italy.,Department of Information Technology and Electrical Engineering, University of Naples Federico II, Naples, 80125, Italy
| | - Alessandro Di Bernardo
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, Naples, 80125, Italy
| | - Vincenzo Di Capua
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, Naples, 80125, Italy
| | - Luigi Duraccio
- Department of Electronics and Telecommunications, Polytechnic University of Turin, Turin, 10129, Italy
| | - Roberto Peltrini
- Department of Public Health, University of Naples Federico II, Naples, 80131, Italy
| | - Roberto Prevete
- University of Naples Federico II - Interdepartmental Research Center in Health Management and Innovation in Healthcare (CIRMIS), Naples, 80131, Italy.,Department of Information Technology and Electrical Engineering, University of Naples Federico II, Naples, 80125, Italy
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15
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Abstract
Lymph node mapping for tumor micrometastasis is of great significance for the prevention, prognosis, and treatment of cancer. Currently, the traditional clinical detection methods (computed tomography, magnetic resonance imaging, or positron emission tomography/computed tomography) in clinical lymph node mapping still have some inherent disadvantages, which have prompted the development of various fluorescent probes for lymph node mapping. However, the conventional fluorescent probes such as indocyanine green or methylene blue in lymph node mapping are still accompanied by several problems such as impaired surgical field vision due to dye staining or less accumulation and shorter retention time in the lymph node. In a recent achievement, newly designed nanoparticles are prepared with novel properties that could be attractive for lymph node mapping. In this review, we will provide details on the progress of various nanoparticles for lymph node mapping and emphasize other multivariant properties in different nanoparticles, including strong tumor-targeting affinity and specificity, self-luminescence, and even with the function to kill metastatic cancer cells.
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Affiliation(s)
- Meng Han
- Queen Mary School, Nanchang University, Nanchang, Jiangxi Province 330006, P.R. China
| | - Ruirui Kang
- The Department of Ultrasound, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province 330006, P.R. China
| | - Chunquan Zhang
- The Department of Ultrasound, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province 330006, P.R. China
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16
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Clinical effect and standardization of indocyanine green angiography in the laparoscopic colorectal surgery. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:113-122. [PMID: 35600102 PMCID: PMC8977386 DOI: 10.7602/jmis.2021.24.3.113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 02/07/2023]
Abstract
Anastomotic complications occur after 5% to 20% of operations for rectosigmoid colon cancer. The intestinal perfusion status at the anastomotic site is an important modifiable risk factor, and surgeons should carefully evaluate and optimize the perfusion at the intended site of anastomosis. Indocyanine green (ICG) angiography is a simple noninvasive perfusion assessment modality. The use of ICG angiography is rapidly spreading in the field of colorectal surgery. However, there is debate on its contribution to reducing anastomotic complications. In this review, we discuss the clinical utility and the standardization of ICG angiography. ICG angiography can unequivocally reveal unfavorable perfusion zones and provide quantitative parameters to predict the risk of hypoperfusion-related anastomotic complications. Many studies have demonstrated the clinical utility of ICG angiography for reducing anastomotic complications. Recently, two multicenter randomized clinical trials reported that ICG angiography did not significantly reduce the incidence of anastomotic leakage. Most previous studies have been small-scale single-center studies, and there is no standardized ICG angiography protocol to date. Additionally, ICG angiography evaluations have mostly relied on surgeons’ subjective judgment. For these reasons, it is necessary to establish a standardized ICG angiography protocol and develop a quantitative analysis protocol for the objective assessment. In conclusion, ICG angiography could be useful for detecting poorly perfused colorectal segments to prevent anastomotic leakage after colorectal surgery. An optimized and standardized ICG angiography protocol should be established to improve the reliability of perfusion assessments. In the future, artificial intelligence-based quantitative analyses could be used to easily assess colonic perfusion status.
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17
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Son GM, Ahn HM, Lee IY, Ha GW. Multifunctional Indocyanine Green Applications for Fluorescence-Guided Laparoscopic Colorectal Surgery. Ann Coloproctol 2021; 37:133-140. [PMID: 34102813 PMCID: PMC8273708 DOI: 10.3393/ac.2021.05.07] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/07/2021] [Indexed: 12/17/2022] Open
Abstract
Indocyanine green (ICG) could be applied for multiple functions such as fluorescent tumor localization, fluorescence lymph node mapping (FLNM), and intraoperative angiography in colorectal cancer surgery. With the near-infrared (NIR) systems, colonoscopic ICG tattooing can be used to define the early colorectal cancer that cannot be easily distinguished through the serosal surface. The lymphatic pathways can be visualized under the NIR system when ICG is injected through the submucosal or subserosal layer around the tumor. Intraoperative ICG angiography can be applied to find a favorable perfusion segment before the colon transection. Although all fluorescence functions are considered essential steps in image-guided surgery, it is difficult to perform multifunctional ICG applications in a single surgical procedure at once because complex protocols could interfere with each other. Therefore, we review the multifunctional ICG applications for fluorescent tumor localization, FLNM, and ICG angiography. We also discuss the optimal protocol for fluorescence-guided colorectal surgery.
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Affiliation(s)
- Gyung Mo Son
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Medical Research Center, Pusan National University School of Medicine, Yangsan, Korea
| | - Hong-Min Ahn
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - In Young Lee
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Medical Research Center, Pusan National University School of Medicine, Yangsan, Korea
| | - Gi Won Ha
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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