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Tamburini N, Chiozza M, Maniscalco P, Resta G, Marino S, Quarantotto F, Anania G, Cavallesco G. Application of Indocyanine Green Enhanced Fluorescence in Esophageal Surgery: A Mini Review. Front Surg 2022; 9:961856. [PMID: 35874138 PMCID: PMC9304659 DOI: 10.3389/fsurg.2022.961856] [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: 06/05/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Despite recent technological innovations and the development of minimally invasive surgery, esophagectomy remains an operation burdened with severe postoperative complications. Fluorescence imaging, particularly using indocyanine green (ICG), offers the ability to address a number of issues faced during esophagectomy. The three main indications for the intraoperative use of ICG during esophagectomy are visualization of conduit vascular supply, allow identification of sentinel nodes and visualization of the thoracic duct. The purpose of this mini review is to present an overview of current practice in fluorescence imaging utilizing ICG during esophagectomy, as well as to demonstrate how this technology can guide lymphadenectomy and reduce surgical morbidity such as anastomotic leaking and chylothorax.
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Comparison of Optical Imaging Techniques to Quantitatively Assess the Perfusion of the Gastric Conduit during Oesophagectomy. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10165522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this study, four optical techniques—Optical Coherence Tomography, Sidestream Darkfield Microscopy, Laser Speckle Contrast Imaging, and Fluorescence Angiography (FA)—were compared on performing an intraoperative quantitative perfusion assessment of the gastric conduit during oesophagectomy. We hypothesised that the quantitative parameters show decreased perfusion towards the fundus in the gastric conduit and in patients with anastomotic leakage. In a prospective study in patients undergoing oesophagectomy with gastric conduit reconstruction, measurements were taken with all four optical techniques at four locations from the base towards the fundus in the gastric conduit (Loc1, Loc2, Loc3, Loc4). The primary outcome included 14 quantitative parameters and the anastomotic leakage rate. Imaging was performed in 22 patients during oesophagectomy. Ten out of 14 quantitative parameters significantly indicated a reduced perfusion towards the fundus of the gastric conduit. Anastomotic leakage occurred in 4/22 patients (18.4%). At Loc4, the FA quantitative values for “T1/2” and “mean slope” differed between patients with and without anastomotic leakage (p = 0.025 and p = 0.041, respectively). A quantitative perfusion assessment during oesophagectomy is feasible using optical imaging techniques, of which FA is the most promising for future research.
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Gong P, Almasian M, van Soest G, de Bruin DM, van Leeuwen TG, Sampson DD, Faber DJ. Parametric imaging of attenuation by optical coherence tomography: review of models, methods, and clinical translation. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:1-34. [PMID: 32246615 PMCID: PMC7118361 DOI: 10.1117/1.jbo.25.4.040901] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/28/2020] [Indexed: 05/07/2023]
Abstract
SIGNIFICANCE Optical coherence tomography (OCT) provides cross-sectional and volumetric images of backscattering from biological tissue that reveal the tissue morphology. The strength of the scattering, characterized by an attenuation coefficient, represents an alternative and complementary tissue optical property, which can be characterized by parametric imaging of the OCT attenuation coefficient. Over the last 15 years, a multitude of studies have been reported seeking to advance methods to determine the OCT attenuation coefficient and developing them toward clinical applications. AIM Our review provides an overview of the main models and methods, their assumptions and applicability, together with a survey of preclinical and clinical demonstrations and their translation potential. RESULTS The use of the attenuation coefficient, particularly when presented in the form of parametric en face images, is shown to be applicable in various medical fields. Most studies show the promise of the OCT attenuation coefficient in differentiating between tissues of clinical interest but vary widely in approach. CONCLUSIONS As a future step, a consensus on the model and method used for the determination of the attenuation coefficient is an important precursor to large-scale studies. With our review, we hope to provide a basis for discussion toward establishing this consensus.
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Affiliation(s)
- Peijun Gong
- The University of Western Australia, Department of Electrical, Electronic and Computer Engineering, Optical+Biomedical Engineering Laboratory, Perth, Western Australia, Australia
- Address all correspondence to Peijun Gong, E-mail:
| | - Mitra Almasian
- University of Amsterdam, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam Cardiovascular Sciences, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
| | - Gijs van Soest
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam, The Netherlands
| | - Daniel M. de Bruin
- University of Amsterdam, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam Cardiovascular Sciences, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
| | - Ton G. van Leeuwen
- University of Amsterdam, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam Cardiovascular Sciences, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
| | - David D. Sampson
- The University of Western Australia, Department of Electrical, Electronic and Computer Engineering, Optical+Biomedical Engineering Laboratory, Perth, Western Australia, Australia
- University of Surrey, Surrey Biophotonics, Guildford, Surrey, United Kingdom
| | - Dirk J. Faber
- University of Amsterdam, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam Cardiovascular Sciences, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
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Ferris NG, Cannon TM, Villiger M, Bouma BE, Uribe-Patarroyo N. Forward multiple scattering dominates speckle decorrelation in whole-blood flowmetry using optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2020; 11:1947-1966. [PMID: 32341859 PMCID: PMC7173878 DOI: 10.1364/boe.384539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 05/22/2023]
Abstract
Quantitative blood flow measurements using optical coherence tomography (OCT) have a wide potential range of medical research and clinical applications. Flowmetry based on the temporal dynamics of the OCT signal may have the ability to measure three-dimensional flow profiles regardless of the flow direction. State-of-the-art models describing the OCT signal temporal statistics are based on dynamic light scattering (DLS), a model which is inherently limited to single scattering regimes. DLS methods continue to be applied to OCT despite the knowledge that red blood cells produce strong forward multiple scattering. Here, we postulate that forward multiple scattering is the primary mechanism causing the rate of speckle-decorrelation derived from data acquired in vivo to deviate from the rate of decorrelation determined in phantom experiments. We also postulate that multiple scattering contributions to decorrelation are only present when the sample exhibits velocity field inhomogeneities larger than the scale of a resolution volume and are thus absent in rigid bulk motion. To test these hypotheses, we performed a systematic study of the effects of forward multiple scattering on OCT signal decorrelation with phantom experiments under physiologically relevant flow conditions and relative bulk motion. Our experimental results confirm that the amount of forward multiple scattering affects the proportionality between lateral flow and decorrelation. We propose that multiply scattered light carries information from different locations in the sample and each location imprints scattering dynamics on the scattered light causing increased decorrelation rates. Our analysis confirms that the detection of forward scattered light inside the vessel lumen causes an increase in the rate of decorrelation which results in an overestimation of blood flow velocities at depths as shallow as 40 µm into whole blood for OCT systems with typical numerical apertures used in retinal imaging.
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Affiliation(s)
- Natalie G. Ferris
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, Boston, Massachusetts 02114, USA
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, Massachusetts 02139, USA
- Harvard Graduate Program in Biophysics, Harvard University Cambridge, Massachusetts 02139, USA
| | - Taylor M. Cannon
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, Boston, Massachusetts 02114, USA
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, Massachusetts 02139, USA
| | - Martin Villiger
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, Boston, Massachusetts 02114, USA
| | - Brett E. Bouma
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, Boston, Massachusetts 02114, USA
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, Massachusetts 02139, USA
- Institute for Medical Engineering and Science, MIT, Massachusetts 02139, USA
| | - Néstor Uribe-Patarroyo
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, 40 Blossom Street, Boston, Massachusetts 02114, USA
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5
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Baum OI, Zaitsev VY, Yuzhakov AV, Sviridov AP, Novikova ML, Matveyev AL, Matveev LA, Sovetsky AA, Sobol EN. Interplay of temperature, thermal-stresses and strains in laser-assisted modification of collagenous tissues: Speckle-contrast and OCT-based studies. JOURNAL OF BIOPHOTONICS 2020; 13:e201900199. [PMID: 31568651 DOI: 10.1002/jbio.201900199] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/22/2019] [Accepted: 09/15/2019] [Indexed: 05/25/2023]
Abstract
Moderate heating of collagenous tissues such as cartilage and cornea by infrared laser irradiation can produce biologically nondestructive structural rearrangements and relaxation of internal stresses resulting in the tissue reshaping. The reshaping results and eventual changes in optical and biological properties of the tissue strongly depend on the laser-irradiation regime. Here, a speckle-contrast technique based on monochromatic illumination of the tissue in combination with strain mapping by means of optical coherence elastography (OCE) is applied to reveal the interplay between the temperature and thermal stress fields producing tissue modifications. The speckle-based technique ensured en face visualization of cross correlation and contrast of speckle images, with evolving proportions between contributions of temperature increase and thermal-stresses determined by temperature gradients. The speckle-technique findings are corroborated by quantitative OCE-based depth-resolved imaging of irradiation-induced strain-evolution. The revealed relationships can be used for real-time control of the reshaping procedures (e.g., for laser shaping of cartilaginous implants in otolaryngology and maxillofacial surgery) and optimization of the laser-irradiation regimes to ensure the desired reshaping using lower and biologically safer temperatures. The figure of waterfall OCE-image demonstrates how the strain-rate maximum arising in the heating-beam center gradually splits and drifts towards the zones of maximal thermal stresses located at the temperature-profile slopes.
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Affiliation(s)
- Olga I Baum
- Federal Scientific Research Center "Crystallography and Photonics," Russian Academy of Sciences, Institute of Photon Technologies, Moscow, Russia
| | - Vladimir Y Zaitsev
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod, Russia
| | - Alexey V Yuzhakov
- Federal Scientific Research Center "Crystallography and Photonics," Russian Academy of Sciences, Institute of Photon Technologies, Moscow, Russia
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod, Russia
| | - Alexander P Sviridov
- Federal Scientific Research Center "Crystallography and Photonics," Russian Academy of Sciences, Institute of Photon Technologies, Moscow, Russia
| | - Maria L Novikova
- Federal Scientific Research Center "Crystallography and Photonics," Russian Academy of Sciences, Institute of Photon Technologies, Moscow, Russia
| | - Alexander L Matveyev
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod, Russia
| | - Lev A Matveev
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod, Russia
| | - Alexander A Sovetsky
- Institute of Applied Physics, Russian Academy of Sciences, Nizhny Novgorod, Russia
| | - Emil N Sobol
- IPG Medical Corporation, Marlborough, Massachusetts
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6
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Jansen SM, de Bruin DM, van Berge Henegouwen MI, Bloemen PR, Strackee SD, Veelo DP, van Leeuwen TG, Gisbertz SS. Effect of ephedrine on gastric conduit perfusion measured by laser speckle contrast imaging after esophagectomy: a prospective in vivo cohort study. Dis Esophagus 2018; 31:4969976. [PMID: 29668909 DOI: 10.1093/dote/doy031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/13/2018] [Indexed: 12/11/2022]
Abstract
Compromised perfusion due to ligation of arteries and veins in esophagectomy with gastric tube reconstruction often (5-20%) results in necrosis and anastomotic leakage, which relate to high morbidity and mortality (3-4%). Ephedrine is used widely in anesthesia to treat intraoperative hypotension and may improve perfusion by the increase of cardiac output and mean arterial pressure (MAP). This study tests the effect of ephedrine on perfusion of the future anastomotic site of the gastric conduit, measured by laser speckle contrast imaging (LSCI). This prospective, observational, in vivo pilot study includes 26 patients undergoing esophagectomy with gastric tube reconstruction from October 2015 to June 2016 in the Academic Medical Center (Amsterdam). Perfusion of the gastric conduit was measured with LSCI directly after reconstruction and after an increase of MAP by ephedrine 5 mg. Perfusion was quantified in flux (laser speckle perfusion units, LSPU) in four perfusion locations, from good perfusion (base of the gastric tube) toward decreased perfusion (fundus). Intrapatient differences before and after ephedrine in terms flux were statistically tested for significance with a paired t-test. LSCI was feasible to image gastric microcirculation in all patients. Flux (LSPU) was significantly higher in the base of the gastric tube (791 ± 442) compared to the fundus (328 ± 187) (P < 0.001). After administration of ephedrine, flux increased significantly in the fundus (P < 0.05) measured intrapatients. Three patients developed anastomotic leakage. In these patients, the difference between measured flux in the fundus compared to the base of the gastric tube was high. This study presents the effect of ephedrine on perfusion of the gastric tissue measured with LSCI in terms of flux (LSPU) after esophagectomy with gastric tube reconstruction. We show a small but significant difference between flux measured before and after administration of ephedrine in the future anastomotic tissue (313 ± 178 vs. 397 ± 290). We also show a significant decrease of flux toward the fundus.
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Affiliation(s)
- S M Jansen
- Departments of Biomedical Engineering and Physics.,Plastic, Reconstructive and Hand Surgery.,Surgery
| | - D M de Bruin
- Departments of Biomedical Engineering and Physics
| | | | - P R Bloemen
- Departments of Biomedical Engineering and Physics
| | | | - D P Veelo
- Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands
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Mascagni P, Longo F, Barberio M, Seeliger B, Agnus V, Saccomandi P, Hostettler A, Marescaux J, Diana M. New intraoperative imaging technologies: Innovating the surgeon’s eye toward surgical precision. J Surg Oncol 2018; 118:265-282. [DOI: 10.1002/jso.25148] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/04/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Pietro Mascagni
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | - Fabio Longo
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | - Manuel Barberio
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | - Barbara Seeliger
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | - Vincent Agnus
- IRCAD, Research Institute against Digestive Cancer; Strasbourg France
| | - Paola Saccomandi
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
| | | | - Jacques Marescaux
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
- IRCAD, Research Institute against Digestive Cancer; Strasbourg France
| | - Michele Diana
- IHU-Strasbourg; Institute of Image-Guided Surgery; Strasbourg France
- IRCAD, Research Institute against Digestive Cancer; Strasbourg France
- Department of General, Digestive and Endocrine Surgery; University of Strasbourg; Strasbourg France
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8
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Ghijsen M, Rice TB, Yang B, White SM, Tromberg BJ. Wearable speckle plethysmography (SPG) for characterizing microvascular flow and resistance. BIOMEDICAL OPTICS EXPRESS 2018; 9:3937-3952. [PMID: 30338166 PMCID: PMC6191642 DOI: 10.1364/boe.9.003937] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 05/04/2023]
Abstract
In this work we introduce a modified form of laser speckle imaging (LSI) referred to as affixed transmission speckle analysis (ATSA) that uses a single coherent light source to probe two physiological signals: one related to pulsatile vascular expansion (classically known as the photoplethysmographic (PPG) waveform) and one related to pulsatile vascular blood flow (named here the speckle plethysmographic (SPG) waveform). The PPG signal is determined by recording intensity fluctuations, and the SPG signal is determined via the LSI dynamic light scattering technique. These two co-registered signals are obtained by transilluminating a single digit (e.g. finger) which produces quasi-periodic waveforms derived from the cardiac cycle. Because PPG and SPG waveforms probe vascular expansion and flow, respectively, in cm-thick tissue, these complementary phenomena are offset in time and have rich dynamic features. We characterize the timing offset and harmonic content of the waveforms in 16 human subjects and demonstrate physiologic relevance for assessing microvascular flow and resistance.
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Affiliation(s)
- Michael Ghijsen
- Laser Microbeam and Medical Program, Beckman Laser Institute, 1002 Health Sciences Road, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
| | - Tyler B. Rice
- Laser Associated Sciences Inc., 16 Foxglove Way, Irvine, CA 92612, USA
| | - Bruce Yang
- Laser Associated Sciences Inc., 16 Foxglove Way, Irvine, CA 92612, USA
| | - Sean M. White
- Laser Associated Sciences Inc., 16 Foxglove Way, Irvine, CA 92612, USA
| | - Bruce J. Tromberg
- Laser Microbeam and Medical Program, Beckman Laser Institute, 1002 Health Sciences Road, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA 92868, USA
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9
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Jansen SM, Almasian M, Wilk LS, de Bruin DM, van Berge Henegouwen MI, Strackee SD, Bloemen PR, Meijer SL, Gisbertz SS, van Leeuwen TG. Feasibility of Optical Coherence Tomography (OCT) for Intra-Operative Detection of Blood Flow during Gastric Tube Reconstruction. SENSORS (BASEL, SWITZERLAND) 2018; 18:E1331. [PMID: 29693606 PMCID: PMC5982600 DOI: 10.3390/s18051331] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/15/2018] [Accepted: 04/21/2018] [Indexed: 01/09/2023]
Abstract
In this study; an OCT-based intra-operative imaging method for blood flow detection during esophagectomy with gastric tube reconstruction is investigated. Change in perfusion of the gastric tube tissue can lead to ischemia; with a high morbidity and mortality as a result. Anastomotic leakage (incidence 5⁻20%) is one of the most severe complications after esophagectomy with gastric tube reconstruction. Optical imaging techniques provide for minimal-invasive and real-time visualization tools that can be used in intraoperative settings. By implementing an optical technique for blood flow detection during surgery; perfusion can be imaged and quantified and; if needed; perfusion can be improved by either a surgical intervention or the administration of medication. The feasibility of imaging gastric microcirculation in vivo using optical coherence tomography (OCT) during surgery of patients with esophageal cancer by visualizing blood flow based on the speckle contrast from M-mode OCT images is studied. The percentage of pixels exhibiting a speckle contrast value indicative of flow was quantified to serve as an objective parameter to assess blood flow at 4 locations on the reconstructed gastric tube. Here; it was shown that OCT can be used for direct blood flow imaging during surgery and may therefore aid in improving surgical outcomes for patients.
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Affiliation(s)
- Sanne M Jansen
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
- Department of Plastic, Reconstructive & Hand Surgery, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Mitra Almasian
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Leah S Wilk
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Daniel M de Bruin
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Mark I van Berge Henegouwen
- Department of Surgery, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Simon D Strackee
- Department of Plastic, Reconstructive & Hand Surgery, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Paul R Bloemen
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Sybren L Meijer
- Department of Pathology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Suzanne S Gisbertz
- Department of Surgery, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Ton G van Leeuwen
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
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10
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Jansen SM, de Bruin DM, van Berge Henegouwen MI, Strackee SD, Veelo DP, van Leeuwen TG, Gisbertz SS. Can we predict necrosis intra-operatively? Real-time optical quantitative perfusion imaging in surgery: study protocol for a prospective, observational, in vivo pilot study. Pilot Feasibility Stud 2017; 3:65. [PMID: 29209513 PMCID: PMC5702143 DOI: 10.1186/s40814-017-0204-1] [Citation(s) in RCA: 9] [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: 12/13/2016] [Accepted: 10/31/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Compromised perfusion as a result of surgical intervention causes a reduction of oxygen and nutrients in tissue and therefore decreased tissue vitality. Quantitative imaging of tissue perfusion during reconstructive surgery, therefore, may reduce the incidence of complications. Non-invasive optical techniques allow real-time tissue imaging, with high resolution and high contrast. The objectives of this study are, first, to assess the feasibility and accuracy of optical coherence tomography (OCT), sidestream darkfield microscopy (SDF), laser speckle contrast imaging (LSCI), and fluorescence imaging (FI) for quantitative perfusion imaging and, second, to identify/search for criteria that enable risk prediction of necrosis during gastric tube and free flap reconstruction. METHODS This prospective, multicenter, observational in vivo pilot study will assess tissue perfusion using four optical technologies: OCT, SDF, LSCI, and FI in 40 patients: 20 patients who will undergo gastric tube reconstruction after esophagectomy and 20 patients who will undergo free flap surgery. Intra-operative images of gastric perfusion will be obtained directly after reconstruction at four perfusion areas. Feasibility of perfusion imaging will be analyzed per technique. Quantitative parameters directly related to perfusion will be scored per perfusion area, and differences between biologically good versus reduced perfusion will be tested statistically. Patient outcome will be correlated to images and perfusion parameters. Differences in perfusion parameters before and after a bolus of ephedrine will be tested for significance. DISCUSSION This study will identify quantitative perfusion-related parameters for an objective assessment of tissue perfusion during surgery. This will likely allow early risk stratification of necrosis development, which will aid in achieving a reduction of complications in gastric tube reconstruction and free flap transplantation. TRIAL REGISTRATION Clinicaltrials.gov registration number NCT02902549. Dutch Central Committee on Research Involving Human Subjects registration number NL52377.018.15.
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Affiliation(s)
- Sanne M. Jansen
- Academic Medical Center, University of Amsterdam, Dep. of Biomedical Engineering & Physics, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Daniel M. de Bruin
- Academic Medical Center, University of Amsterdam, Dep. of Biomedical Engineering & Physics, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Mark I. van Berge Henegouwen
- Academic Medical Center, University of Amsterdam, Dep. of Gastrointestinal Surgery, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Simon D. Strackee
- Academic Medical Center, University of Amsterdam, Dep. of Plastic, Reconstructive and Handsurgery, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Denise P. Veelo
- Academic Medical Center, University of Amsterdam, Dep. of Anesthesiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ton G. van Leeuwen
- Academic Medical Center, University of Amsterdam, Dep. of Biomedical Engineering & Physics, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Suzanne S. Gisbertz
- Academic Medical Center, University of Amsterdam, Dep. of Gastrointestinal Surgery, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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