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van Dam MA, Bijlstra OD, Faber RA, Warmerdam MI, Achiam MP, Boni L, Cahill RA, Chand M, Diana M, Gioux S, Kruijff S, Van der Vorst JR, Rosenthal RJ, Polom K, Vahrmeijer AL, Mieog JSD. Consensus conference statement on fluorescence-guided surgery (FGS) ESSO course on fluorescence-guided surgery. Eur J Surg Oncol 2024; 50:107317. [PMID: 38104355 DOI: 10.1016/j.ejso.2023.107317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/09/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Fluorescence-guided surgery (FGS) has emerged as an innovative technique with promising applications in various surgical specialties. However, clinical implementation is hampered by limited availability of evidence-based reference work supporting the translation towards standard-of-care use in surgical practice. Therefore, we developed a consensus statement on current applications of FGS. METHODS During an international FGS course, participants anonymously voted on 36 statements. Consensus was defined as agreement ≥70% with participation grade of ≥80%. All participants of the questionnaire were stratified for user and handling experience within five domains of applicability (lymphatics & lymph node imaging; tissue perfusion; biliary anatomy and urinary tracts; tumor imaging in colorectal, HPB, and endocrine surgery, and quantification and (tumor-) targeted imaging). Results were pooled to determine consensus for each statement within the respective sections based on the degree of agreement. RESULTS In total 43/52 (81%) course participants were eligible as voting members for consensus, comprising the expert panel (n = 12) and trained users (n = 31). Consensus was achieved in 17 out of 36 (45%) statements with highest level of agreement for application of FGS in tissue perfusion and biliary/urinary tract visualization (71% and 67%, respectively) and lowest within the tumor imaging section (0%). CONCLUSIONS FGS is currently established for tissue perfusion and vital structure imaging. Lymphatics & lymph node imaging in breast cancer and melanoma are evolving, and tumor tissue imaging holds promise in early-phase trials. Quantification and (tumor-)targeted imaging are advancing toward clinical validation. Additional research is needed for tumor imaging due to a lack of consensus.
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Affiliation(s)
- M A van Dam
- Department of Surgery, Leiden University Medical Center, the Netherlands
| | - O D Bijlstra
- Department of Surgery, Leiden University Medical Center, the Netherlands; Department of Surgery, Amsterdam University Medical Centers, the Netherlands
| | - R A Faber
- Department of Surgery, Leiden University Medical Center, the Netherlands
| | - M I Warmerdam
- Department of Surgery, Leiden University Medical Center, the Netherlands
| | - M P Achiam
- Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Denmark
| | - L Boni
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Italy
| | - R A Cahill
- Department of Surgery, UCD Centre for Precision Surgery, University College Dublin, Ireland
| | - M Chand
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - M Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - S Gioux
- Intuitive Surgical, Aubonne, Switzerland
| | - S Kruijff
- Department of Surgical Oncology, University Medical Center Groningen, the Netherlands; Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
| | - J R Van der Vorst
- Department of Surgery, Leiden University Medical Center, the Netherlands
| | | | - K Polom
- The Academy of Applied Medical and Social Sciences, Lotnicza 2, Elblag, Poland; Gastrointestinal Surgical Oncology Department, Greater Poland Cancer Centre, Garbary 15, Poznan, Poland
| | - A L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, the Netherlands
| | - J S D Mieog
- Department of Surgery, Leiden University Medical Center, the Netherlands.
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2
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Felli E, Felli E, Muttillo EM, Urade T, Laracca GG, Giannelli V, Famularo S, Geny B, Ettorre GM, Rombouts K, Pinzani M, Diana M, Gracia-Sancho J. Liver ischemia-reperfusion injury: From trigger loading to shot firing. Liver Transpl 2023; 29:1226-1233. [PMID: 37728488 DOI: 10.1097/lvt.0000000000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/15/2023] [Indexed: 09/21/2023]
Abstract
An ischemia-reperfusion injury (IRI) results from a prolonged ischemic insult followed by the restoration of blood perfusion, being a common cause of morbidity and mortality, especially in liver transplantation. At the maximum of the potential damage, IRI is characterized by 2 main phases. The first is the ischemic phase, where the hypoxia and vascular stasis induces cell damage and the accumulation of damage-associated molecular patterns and cytokines. The second is the reperfusion phase, where the local sterile inflammatory response driven by innate immunity leads to a massive cell death and impaired liver functionality. The ischemic time becomes crucial in patients with underlying pathophysiological conditions. It is possible to compare this process to a shooting gun, where the loading trigger is the ischemia period and the firing shot is the reperfusion phase. In this optic, this article aims at reviewing the main ischemic events following the phases of the surgical timeline, considering the consequent reperfusion damage.
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Affiliation(s)
- Eric Felli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department for BioMedical Research, Visceral Surgery and Medicine, University of Bern, Switzerland
| | - Emanuele Felli
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Tours, France
| | - Edoardo M Muttillo
- Department of Medical Surgical Science and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Takeshi Urade
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Japan
| | - Giovanni G Laracca
- Department of Medical Surgical Science and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Valerio Giannelli
- Department of Transplantation and General Surgery, San Camillo Hospital, Italy
| | - Simone Famularo
- Department of Biomedical Science, Humanitas University Pieve Emanuele, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Research Institute Against Cancer of the Digestive System (IRCAD), France
| | - Bernard Geny
- Institute of Physiology, EA3072 Mitochondria Respiration and Oxidative Stress, University of Strasbourg, France
| | - Giuseppe M Ettorre
- Department of Transplantation and General Surgery, San Camillo Hospital, Italy
| | - Krista Rombouts
- University College London - Institute for Liver and Digestive Health, Royal Free Hospital, NW3 2PF London, United Kingdom
| | - Massimo Pinzani
- University College London - Institute for Liver and Digestive Health, Royal Free Hospital, NW3 2PF London, United Kingdom
| | - Michele Diana
- Research Institute Against Cancer of the Digestive System (IRCAD), France
| | - Jordi Gracia-Sancho
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department for BioMedical Research, Visceral Surgery and Medicine, University of Bern, Switzerland
- Liver Vascular Biology Research Group, IDIBAPS Biomedical Research Institute, Hospital Clínic Barcelona, CIBEREHD, Barcelona, Spain
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3
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de'Angelis N, Schena CA, Marchegiani F, Reitano E, De Simone B, Wong GYM, Martínez-Pérez A, Abu-Zidan FM, Agnoletti V, Aisoni F, Ammendola M, Ansaloni L, Bala M, Biffl W, Ceccarelli G, Ceresoli M, Chiara O, Chiarugi M, Cimbanassi S, Coccolini F, Coimbra R, Di Saverio S, Diana M, Dioguardi Burgio M, Fraga G, Gavriilidis P, Gurrado A, Inchingolo R, Ingels A, Ivatury R, Kashuk JL, Khan J, Kirkpatrick AW, Kim FJ, Kluger Y, Lakkis Z, Leppäniemi A, Maier RV, Memeo R, Moore EE, Ordoñez CA, Peitzman AB, Pellino G, Picetti E, Pikoulis M, Pisano M, Podda M, Romeo O, Rosa F, Tan E, Ten Broek RP, Testini M, Tian Wei Cheng BA, Weber D, Sacco E, Sartelli M, Tonsi A, Dal Moro F, Catena F. 2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery. World J Emerg Surg 2023; 18:45. [PMID: 37689688 PMCID: PMC10492308 DOI: 10.1186/s13017-023-00513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023] Open
Abstract
Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
- Faculty of Medicine, University of Paris Cité, Paris, France
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France.
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
| | - Elisa Reitano
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Guastalla Hospital, AUSL-IRCCS Reggio, Emilia, Italy
| | - Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Aleix Martínez-Pérez
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Filippo Aisoni
- Department of Morphology, Surgery and Experimental Medicine, Università Degli Studi Di Ferrara, Ferrara, Italy
| | - Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Luca Ansaloni
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Miklosh Bala
- Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Graziano Ceccarelli
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Italy
| | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Riverside, CA, USA
| | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | - Michele Diana
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | | | - Gustavo Fraga
- Department of Trauma and Acute Care Surgery, University of Campinas, Campinas, Brazil
| | - Paschalis Gavriilidis
- Department of HBP Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, F. Miulli Hospital, 70021, Acquaviva Delle Fonti, Italy
| | - Alexandre Ingels
- Department of Urology, Henri Mondor Hospital, University of Paris Est Créteil (UPEC), 94000, Créteil, France
| | - Rao Ivatury
- Professor Emeritus, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeffry L Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, University of Portsmouth, Southwick Hill Road, Cosham, Portsmouth, UK
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, EG23T2N 2T9, Canada
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology - Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ronald V Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Bari, Italy
| | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Carlos A Ordoñez
- Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gianluca Pellino
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Manos Pikoulis
- 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Michele Pisano
- 1st General Surgery Unit, Department of Emergency, ASST Papa Giovanni Hospital Bergamo, Bergamo, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | | | - Fausto Rosa
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | | | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Emilio Sacco
- Department of Urology, Università Cattolica del Sacro Cuore Di Roma, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Alfredo Tonsi
- Digestive Diseases Department, Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy.
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4
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Heuvelings DJI, Al-Difaie Z, Scheepers MHMC, Okamoto N, Diana M, Stassen LPS, Bouvy ND, Al-Taher M. Simultaneous fluorescence imaging of bowel perfusion and ureter delineation using methylene blue: a demonstration in a porcine model. Surg Endosc 2023; 37:6779-6790. [PMID: 37253870 PMCID: PMC10462514 DOI: 10.1007/s00464-023-10142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Intraoperative near-infrared fluorescence imaging (NIRF) with preoperative optical dye administration is a promising technique for quick and easy intraoperative visualization of the ureter and for an improved, real-time assessment of intestinal perfusion. During colorectal surgery, there is a need for simultaneous non-invasive ureteral imaging and bowel perfusion assessment, using one single camera system. The purpose of this study is to investigate the feasibility of simultaneous intestinal perfusion and ureteral imaging using a single commercially available NIRF imaging system. METHODS Six Landrace pigs underwent laparotomy under general anesthesia in this experiment. An intravenous (IV) dose of 0.2 mg/kg indocyanine green (ICG) was given to assess bowel perfusion. Two pairs received a methylene blue (MB) iv injection of 0.75, 0.50 or 0.25 mg/kg respectively to investigate ureteral visualization. Quest Spectrum Fluorescence Camera (Quest Medical Imaging, Middenmeer, The Netherlands) was used for NIRF imaging. RESULTS Ureter visualization and bowel perfusion under NIRF imaging was achieved in all animals. All ureters were visible after five to ten minutes and remained clearly visible until the end of every experiment (120-420 min). A mixed model analysis did not show any significant differences neither between the three groups nor over time. Importantly, we demonstrated that bowel perfusion could be visualized with methylene blue (MB) as well. We observed no interference between ICG and MB and a faster washout of MB. CONCLUSION We successfully demonstrated simultaneous fluorescence angiography with ICG and ureteral imaging with MB in the same surgical procedure, with the same commercially available NIRF imaging equipment. More importantly, we showed that the use MB is adequate for bowel perfusion assessment and ureter visualization with this NIRF imaging system. Besides, MB showed an earlier washout time, which can be clinical beneficial as a repeated dye injection may be necessary during a surgical procedure.
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Affiliation(s)
- Danique J I Heuvelings
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Max H M C Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nariaki Okamoto
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Laurents P S Stassen
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nicole D Bouvy
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mahdi Al-Taher
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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5
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Milana F, Famularo S, Diana M, Mishima K, Reitano E, Cho HD, Kim KH, Marescaux J, Donadon M, Torzilli G. How Much Is Enough? A Surgical Perspective on Imaging Modalities to Estimate Function and Volume of the Future Liver Remnant before Hepatic Resection. Diagnostics (Basel) 2023; 13:2726. [PMID: 37685264 PMCID: PMC10486462 DOI: 10.3390/diagnostics13172726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/19/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
Liver resection is the first curative option for most hepatic primary and secondary malignancies. However, post-hepatectomy liver failure (PHLF) still represents a non-negligible postoperative complication, embodying the most frequent cause of hepatic-related mortality. In the absence of a specific treatment, the most effective way to deal with PHLF is its prevention through a careful preoperative assessment of future liver remnant (FLR) volume and function. Apart from the clinical score and classical criteria to define the safe limit of resectability, new imaging modalities have shown their ability to assist surgeons in planning the best operative strategy with a precise estimation of the FLR amount. New technologies leading to liver and tumor 3D reconstruction may guide the surgeon along the best resection planes combining the least liver parenchymal sacrifice with oncological appropriateness. Integration with imaging modalities, such as hepatobiliary scintigraphy, capable of estimating total and regional liver function, may bring about a decrease in postoperative complications. Magnetic resonance imaging with hepatobiliary contrast seems to be predominant since it simultaneously integrates hepatic function and volume information along with a precise characterization of the target malignancy.
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Affiliation(s)
- Flavio Milana
- Department of Biomedical Sciences, Humanitas University, Via Montalcini 4, 20090 Pieve Emanuele, MI, Italy
- Division of Hepatobiliary and General Surgery, Department of Hepatobiliary and General Surgery, Humanitas Research Hospital-IRCCS, Humanitas University, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Simone Famularo
- Department of Biomedical Sciences, Humanitas University, Via Montalcini 4, 20090 Pieve Emanuele, MI, Italy
- Division of Hepatobiliary and General Surgery, Department of Hepatobiliary and General Surgery, Humanitas Research Hospital-IRCCS, Humanitas University, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Michele Diana
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- Photonics Instrumentation for Health, iCube Laboratory, University of Strasbourg, 67000 Strasbourg, France
- Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, 67200 Strasbourg, France
| | - Kohei Mishima
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Elisa Reitano
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Hwui-Dong Cho
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jacques Marescaux
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Matteo Donadon
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, NO, Italy
- Department of General Surgery, University Maggiore Hospital, 28100 Novara, NO, Italy
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, Via Montalcini 4, 20090 Pieve Emanuele, MI, Italy
- Division of Hepatobiliary and General Surgery, Department of Hepatobiliary and General Surgery, Humanitas Research Hospital-IRCCS, Humanitas University, Via Manzoni 56, 20089 Rozzano, MI, Italy
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6
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Tzeng WJ, Lin YH, Hou TY, Yin SM, Lin YC, Liu YW, Liu YY, Li WF, Wang CC, Marescaux J, Diana M. Near-infrared cholangiography can increase the chance of success in laparoscopic approaches to common bile duct stones, even with previous abdominal surgery. BMC Surg 2023; 23:203. [PMID: 37454060 DOI: 10.1186/s12893-023-02103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The treatment of common bile duct (CBD) stones with minimally invasive surgery (MIS) is more technical demanding than laparoscopic cholecystectomy (LC), especially in patients with history of previous abdominal surgery, cholangitis or cholecystitis. Near-infrared (NIR) cholangiography via systemic or biliary tree administration of indocyanine green (ICG), which enhances the visualization of the biliary tree anatomy, may increase the reassurance of CBD localization. The aim of this study was to identify the benefit of near-infrared cholangiography for laparoscopic common bile duct exploration (LCBDE). METHODS Three groups of CBD stone patients were included in this retrospective study depending on the surgical methods: 1) open choledocholithotomy (OCC), 2) laparoscopic choledocholithotomy (LCC), and 3) near-infrared cholangiography-assisted laparoscopic choledocholithotomy (NIR-CC). For the NIR-CC group, either 3 ml (concentration: 2.5 mg/mL) of ICG were intravenously administered or 10 ml (concentration: 0.125 mg/mL) of ICG were injected directly into the biliary tree. The enhancement rate of the cystic duct (CD), CBD, the upper and lower margin of the CBD were compared using white light image. RESULTS A total of 187 patients with a mean age of 68.3 years were included (OCC, n = 56; LCC, n = 110; NIR-CC, n = 21). The rate of previous abdominal surgery was significantly lower in the LCC group. The conversion rate was similar between the LCC and the NIR CC groups (p = 0.746). The postoperative hospital stay was significantly longer in the OCC group. No differences in morbidity and mortality were found between the three groups. In the NIR-CC group, the localization of CBD was as high as 85% compared to 24% with white light imaging. CONCLUSIONS Near-infrared cholangiography helps increase the chance of success in minimally invasive approaches to CBD stones even in patients with previous abdominal surgeries, without increasing the rate of conversion.
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Affiliation(s)
- Wei-Juo Tzeng
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Yu-Hung Lin
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Teng-Yuan Hou
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Shih-Min Yin
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Yu-Cheng Lin
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Yueh-Wei Liu
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Yu-Yin Liu
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan.
| | - Wei-Feng Li
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Chih-Chi Wang
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Jacques Marescaux
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Lab, Photonics for Health, University of Strasbourg, Strasbourg, France
- Department of Surgery, University Hospital of Strasbourg, Strasbourg, France
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7
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Saadi A, Fellrath JM, Bec-Moussally J, Papastathi-Boureau C, Blanc C, Courtine V, Vanini L, Marechal M, Authier F, Curty B, Fournier P, Diana M, Saillant S. Using patient-reported outcome measures to assess the effectiveness of social media networking programs for people living with overweight and obesity to adopt a healthier lifestyle. Front Public Health 2023; 11:1161851. [PMID: 37377557 PMCID: PMC10291679 DOI: 10.3389/fpubh.2023.1161851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Overweight, obesity, and their associated health complications have become a major public health issue. Online approaches have been rarely attempted to address the problem. The aim of this study was to evaluate the effectiveness of using social media networking for people living with overweight and obesity to adopt a healthier lifestyle with a three-month multidisciplinary healthcare program. Effectiveness was assessed through questionnaires on patient-related outcome measures (PROMs). Materials and methods Two non-profit associations designed the program delivered to people living with overweight and obesity in a closed group via Facebook, the popular social network. The three-month program had three main axes, namely nutrition, psychology, and physical activity. Anthropomorphic data and sociodemographic profiles were collected. Quality of life (QoL) was assessed at the beginning and at the end of the intervention using PROM questionnaires for six different domains, i.e., body image, eating behavior, physical, sexual, social, and psychological functioning. Results Six hundred and twenty persons participated in the program; 567 persons consented for the study, and 145 completed the questionnaires entirely. QoL was significantly improved in five out of six domains, i.e., body image, eating behavior, as well as physical, sexual, and psychological functioning. The improvement was valid regardless of age, gender, initial body mass index, person with or without children, educational level (primary versus secondary versus high school), and occupation (employment compared to unemployment or any kind of social assistance). In multivariate analysis, living as a couple was an independent factor correlated to a positive progression in four domains, i.e., body image, eating behavior, as well as physical, and psychological functioning. Conclusion This study showed that an online lifestyle intervention might be a promising way of improving the quality of life of people living with overweight or obesity.
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Affiliation(s)
- Alend Saadi
- Department of Surgery, Neuchâtel Hospital, Neuchâtel, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jean-Marc Fellrath
- Department of Surgery, Neuchâtel Hospital, Neuchâtel, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | | | - Céline Blanc
- Ligue Pulmonaire Neuchateloise, Neuchâtel, Switzerland
| | | | - Léo Vanini
- Ligue Pulmonaire Neuchateloise, Neuchâtel, Switzerland
| | - Marc Marechal
- Ligue Pulmonaire Neuchateloise, Neuchâtel, Switzerland
| | | | | | - Pierre Fournier
- Service de Chirurgie, Hôpital de Nyon, Nyon, Switzerland
- Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- Department of Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Stéphane Saillant
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Département de Psychiatrie Générale et de Liaison, Centre Neuchâtelois de Psychiatrie, Neuchâtel, Switzerland
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8
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Famularo S, Bannone E, Collins T, Reitano E, Okamoto N, Mishima K, Riva P, Tsai YC, Nkusi R, Hostettler A, Marescaux J, Felli E, Diana M. Partial Hepatic Vein Occlusion and Venous Congestion in Liver Exploration Using a Hyperspectral Camera: A Proposal for Monitoring Intraoperative Liver Perfusion. Cancers (Basel) 2023; 15:cancers15082397. [PMID: 37190325 DOI: 10.3390/cancers15082397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION The changes occurring in the liver in cases of outflow deprivation have rarely been investigated, and no measurements of this phenomenon are available. This investigation explored outflow occlusion in a pig model using a hyperspectral camera. METHODS Six pigs were enrolled. The right hepatic vein was clamped for 30 min. The oxygen saturation (StO2%), deoxygenated hemoglobin level (de-Hb), near-infrared perfusion (NIR), and total hemoglobin index (THI) were investigated at different time points in four perfused lobes using a hyperspectral camera measuring light absorbance between 500 nm and 995 nm. Differences among lobes at different time points were estimated by mixed-effect linear regression. RESULTS StO2% decreased over time in the right lateral lobe (RLL, totally occluded) when compared to the left lateral (LLL, outflow preserved) and the right medial (RML, partially occluded) lobes (p < 0.05). De-Hb significantly increased after clamping in RLL when compared to RML and LLL (p < 0.05). RML was further analyzed considering the right portion (totally occluded) and the left portion of the lobe (with an autonomous draining vein). StO2% decreased and de-Hb increased more smoothly when compared to the totally occluded RLL (p < 0.05). CONCLUSIONS The variations of StO2% and deoxy-Hb could be considered good markers of venous liver congestion.
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Affiliation(s)
- Simone Famularo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20133 Milan, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
| | - Elisa Bannone
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Department of General Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
| | - Toby Collins
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
| | - Elisa Reitano
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
| | - Nariaki Okamoto
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Photonics Instrumentation for Health, iCube Laboratory, University of Strasbourg, 67000 Strasbourg, France
| | - Kohei Mishima
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
| | - Pietro Riva
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Yu-Chieh Tsai
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
| | - Richard Nkusi
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
| | | | - Jacques Marescaux
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Eric Felli
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Michele Diana
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Photonics Instrumentation for Health, iCube Laboratory, University of Strasbourg, 67000 Strasbourg, France
- Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, 67000 Strasbourg, France
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9
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Okamoto N, Al-Difaie Z, Scheepers MHMC, Heuvelings DJI, Rodríguez-Luna MR, Marescaux J, Diana M, Stassen LPS, Bouvy ND, Al-Taher M. Simultaneous, Multi-Channel, Near-Infrared Fluorescence Visualization of Mesenteric Lymph Nodes Using Indocyanine Green and Methylene Blue: A Demonstration in a Porcine Model. Diagnostics (Basel) 2023; 13:diagnostics13081469. [PMID: 37189570 DOI: 10.3390/diagnostics13081469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Near-infrared fluorescence (NIRF) image-guided surgery is a useful tool that can help reduce perioperative complications and improve tissue recognition. Indocyanine green (ICG) dye is the most frequently used in clinical studies. ICG NIRF imaging has been used for lymph node identification. However, there are still many challenges in lymph node identification by ICG. There is increasing evidence that methylene blue (MB), another clinically applicable fluorescent dye, can also be useful in the intraoperative fluorescence-guided identification of structures and tissues. We hypothesized that MB NIRF imaging could be used for lymph node identification. The aim of this study was to evaluate the feasibility of intraoperative lymph node fluorescence detection using intravenously (IV) administered MB and compare it to ICG via a camera that has two dedicated near-infrared (NIR) channels. Three pigs were used in this study. ICG (0.2 mg/kg) was administered via a peripheral venous catheter followed by immediate administration of MB (0.25 mg/kg). NIRF images were acquired as video recordings at different time points (every 10 min) over an hour using the QUEST SPECTRUM® 3 system (Quest Medical Imaging, Middenmeer, The Netherlands), which has two dedicated NIR channels for simultaneous intraoperative fluorescence guidance. The 800 nm channel was used to capture ICG fluorescence and the 700 nm channel was used for MB. The target (lymph nodes and small bowel) and the background (vessels-free field of the mesentery) were highlighted as the regions of interest (ROIs), and corresponding fluorescence intensities (FI) from these ROIs were measured. The target-to-background ratio (TBR) was then computed as the mean FI of the target minus the mean FI of the background divided by the mean FI of the background. In all included animals, a clear identification of lymph nodes was achieved at all time points. The mean TBR of ICG in lymph nodes and small bowel was 4.57 ± 1.00 and 4.37 ± 1.70, respectively for the overall experimental time. Regarding MB, the mean TBR in lymph nodes and small bowel was 4.60 ± 0.92 and 3.27 ± 0.62, respectively. The Mann-Whitney U test of the lymph node TBR/small bowel TBR showed that the TBR ratio of MB was statistically significantly higher than ICG. The fluorescence optical imaging technology used allows for double-wavelength assessment. This feasibility study proves that lymph nodes can be discriminated using two different fluorophores (MB and ICG) with different wavelengths. The results suggest that MB has a promising potential to be used to detect lymphatic tissue during image-guided surgery. Further preclinical trials are needed before clinical translation.
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Affiliation(s)
- Nariaki Okamoto
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Max H M C Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Danique J I Heuvelings
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - María Rita Rodríguez-Luna
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Jacques Marescaux
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Mahdi Al-Taher
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
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10
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Picchetto A, Cinelli L, Bannone E, Baiocchi GL, Morales-Conde S, Casali L, Spinoglio G, Franzini C, Santi C, D'Ambrosio G, Copaescu C, Rollo A, Balla A, Lepiane P, Paganini AM, Detullio P, Quaresima S, Pesce A, Luciano T, Bianchi G, Marescaux J, Diana M. Fluorescence-based sentinel lymph node mapping and lymphography evaluation: results from the IHU-IRCAD-EAES EURO-FIGS registry. Surg Endosc 2023:10.1007/s00464-023-10043-8. [PMID: 37043006 DOI: 10.1007/s00464-023-10043-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/25/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND The identification of metastatic lymph nodes is one of the most important prognostic factors in gastrointestinal (GI) cancers. Near-infrared fluorescence (NIRF) imaging has been successfully used in GI tumors to detect the lymphatic pathway and the sentinel lymph node (SLN), facilitating fluorescence image-guided surgery (FIGS) with the purpose to achieve a correct nodal staging. The aim of this study was to analyze the current results of NIRF SLN navigation and lymphography through data collected in the EURO-FIGS registry. METHODS Prospectively collected data regarding patients and ICG-guided lymphadenectomies were analyzed. Additional analyses were performed to identify predictors of metastatic SLN and determinants of fluorescence positivity and nodal metastases outside the boundaries of standard lymphadenectomies. RESULTS Overall, 188 patients were included by 18 surgeons from 10 different centers. Colorectal cancer was the most reported pathology (77.7%), followed by gastric (19.1%) and esophageal tumors (3.2%). ICG was injected with higher doses (p < 0.001) via extraparietal side (63.3%), and with higher volumes (p < 0.001) via endoluminal side (36.7%). Overall, NIRF SLN navigation was positive in 75.5% of all cases and 95.5% of positive SLNs were retrieved, with a metastatic rate of 14.7%. NIRF identification of lymph nodes outside standard lymphatic stations occurred in 52.1% of all cases, 43.8% of which were positive for metastatic involvement. Positive NIRF SLN identification was an independent predictor of metastasis outside standard lymphatic stations (OR = 4.392, p = 0.029), while BMI independently predicted metastasis in retrieved SLNs (OR = 1.187, p = 0.013). Lower doses of ICG were protective against NIRF identification outside standard of care lymphadenectomy (OR = 0.596, p = 0.006), while higher volumes of ICG were predictive of metastatic involvement outside standard of care lymphadenectomy (OR = 1.597, p = 0.001). CONCLUSIONS SLN mapping helps identifying potentially metastatic lymph nodes outside the boundaries of standard lymphadenectomies. The EURO-FIGS registry is a valuable tool to share and analyze European surgeons' practices.
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Affiliation(s)
- Andrea Picchetto
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Lorenzo Cinelli
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Bannone
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy
- Department of Pancreatic Surgery, Verona University, Verona, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
- General and Digestive Unit, Hospital Quironsalud Sagrado Corazon, Seville, Spain
| | | | | | | | | | - Giancarlo D'Ambrosio
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | | | | | - Andrea Balla
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, 00053, Rome, Civitavecchia, Italy
| | - Pasquale Lepiane
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, 00053, Rome, Civitavecchia, Italy
| | - Alessandro M Paganini
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | | | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | | | | | | | - Jacques Marescaux
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Michele Diana
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- University of Strasbourg, Strasbourg, France
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
- ICube Laboratory, Photonics for Health, University of Strasbourg, Strasbourg, France
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11
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Cassinotti E, Al-Taher M, Antoniou SA, Arezzo A, Baldari L, Boni L, Bonino MA, Bouvy ND, Brodie R, Carus T, Chand M, Diana M, Eussen MMM, Francis N, Guida A, Gontero P, Haney CM, Jansen M, Mintz Y, Morales-Conde S, Muller-Stich BP, Nakajima K, Nickel F, Oderda M, Parise P, Rosati R, Schijven MP, Silecchia G, Soares AS, Urakawa S, Vettoretto N. European Association for Endoscopic Surgery (EAES) consensus on Indocyanine Green (ICG) fluorescence-guided surgery. Surg Endosc 2023; 37:1629-1648. [PMID: 36781468 PMCID: PMC10017637 DOI: 10.1007/s00464-023-09928-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/28/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND In recent years, the use of Indocyanine Green (ICG) fluorescence-guided surgery during open and laparoscopic procedures has exponentially expanded across various clinical settings. The European Association of Endoscopic Surgery (EAES) initiated a consensus development conference on this topic with the aim of creating evidence-based statements and recommendations for the surgical community. METHODS An expert panel of surgeons has been selected and invited to participate to this project. Systematic reviews of the PubMed, Embase and Cochrane libraries were performed to identify evidence on potential benefits of ICG fluorescence-guided surgery on clinical practice and patient outcomes. Statements and recommendations were prepared and unanimously agreed by the panel; they were then submitted to all EAES members through a two-rounds online survey and results presented at the EAES annual congress, Barcelona, November 2021. RESULTS A total of 18,273 abstracts were screened with 117 articles included. 22 statements and 16 recommendations were generated and approved. In some areas, such as the use of ICG fluorescence-guided surgery during laparoscopic cholecystectomy, the perfusion assessment in colorectal surgery and the search for the sentinel lymph nodes in gynaecological malignancies, the large number of evidences in literature has allowed us to strongly recommend the use of ICG for a better anatomical definition and a reduction in post-operative complications. CONCLUSIONS Overall, from the systematic literature review performed by the experts panel and the survey extended to all EAES members, ICG fluorescence-guided surgery could be considered a safe and effective technology. Future robust clinical research is required to specifically validate multiple organ-specific applications and the potential benefits of this technique on clinical outcomes.
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Affiliation(s)
- E Cassinotti
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy.
| | - M Al-Taher
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - S A Antoniou
- Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - A Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - L Baldari
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - L Boni
- Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 35, 20121, Milan, Italy
| | - M A Bonino
- Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Brodie
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - T Carus
- Niels-Stensen-Kliniken, Elisabeth-Hospital, Thuine, Germany
| | - M Chand
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - M Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - M M M Eussen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - A Guida
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - P Gontero
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - C M Haney
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Y Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
| | - B P Muller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - K Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - F Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Oderda
- Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - P Parise
- U.O.C. Chirurgia Generale, Policlinico di Abano Terme, Abano Terme, PD, Italy
| | - R Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - M P Schijven
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, North Holland, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam UMC, Amsterdam, North Holland, The Netherlands
| | - G Silecchia
- Department of Medico-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - A S Soares
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - S Urakawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - N Vettoretto
- U.O.C. Chirurgia Generale, ASST Spedali Civili di Brescia P.O. Montichiari, Ospedale di Montichiari, Montichiari, Italy
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Garzelli L, Felli E, Al-Taher M, Barberio M, Agnus V, Plaforet V, Bonvalet F, Baiocchini A, Nuzzo A, Paulatto L, Vilgrain V, Gallix B, Diana M, Ronot M. MRI for the Detection of Small Bowel Ischemic Injury in Arterial Acute Mesenteric Ischemia: Preclinical Study in a Porcine Model. J Magn Reson Imaging 2023; 57:918-927. [PMID: 35852296 DOI: 10.1002/jmri.28344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND MRI is the reference for the diagnosis of arterial cerebral ischemia, but its role in acute mesenteric ischemia (AMI) is poorly known. PURPOSE To assess MRI detection of early ischemic bowel lesions in a porcine model of arterial AMI. STUDY TYPE Prospective/cohort. ANIMAL MODEL Porcine model of arterial AMI obtained by embolization of the superior mesenteric artery (seven pigs). FIELD STRENGTH/SEQUENCE A 5-T. T1 gradient-echo-weighted-imaging (WI), half-Fourier-acquisition-single-shot-turbo-spin-echo, T2 turbo-spin-echo, true-fast-imaging-with-steady-precession (True-FISP), diffusion-weighted-echo-planar (DWI). ASSESSMENT T1-WI, T2-WI, and DWI were performed before and continuously after embolization for 6 hours. The signal intensity (SI) of the ischemic bowel was assessed visually and quantitatively on all sequences. The apparent diffusion coefficient (ADC) was assessed. STATISTICAL TESTS Paired Student's t-test or Mann-Whitney U-test, significance at P < 0.05. RESULTS One pig died from non-AMI-related causes. The remaining pigs underwent a median 5 h53 (range 1 h24-6 h01) of ischemia. Visually, the ischemic bowel showed signal hyperintensity on DWI-b800 after a median 85 (57-276) minutes compared to the nonischemic bowel. DWI-b800 SI significantly increased after 2 hours (+19%) and the ADC significant decrease within the first hour (-31%). The ischemic bowel was hyperintense on precontrast T1-WI after a median 87 (70-171) minutes with no significant quantitative changes over time (P = 0.46-0.93). The ischemic bowel was hyperintense on T2-WI in three pigs with a significant SI increase on True-FISP after 1 and 2 hours. DATA CONCLUSION Changes in SI and ADC can be seen early after the onset of arterial AMI with DWI. The value of T2-WI appears to be limited. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Lorenzo Garzelli
- Université Paris Cité, Paris, France & Department of Radiology, Beaujon Hospital, APHP.Nord, Clichy, France.,IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France
| | - Eric Felli
- IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France.,Hepatology, Department of Biomedical Research, Inselspital, University of Bern, Bern, Switzerland
| | - Mahdi Al-Taher
- IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France
| | - Manuel Barberio
- IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France
| | - Vincent Agnus
- IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France
| | - Vincent Plaforet
- Université Paris Cité, Paris, France & Department of Radiology, Beaujon Hospital, APHP.Nord, Clichy, France
| | - Fanny Bonvalet
- Université Paris Cité, Paris, France & Department of Radiology, Beaujon Hospital, APHP.Nord, Clichy, France
| | - Andrea Baiocchini
- Department of Pathology, San Camillo Forlanini Hospital, Rome, Italy
| | - Alexandre Nuzzo
- Université Paris Cité, Paris, France & Structure d'Urgence Vasculaire Intestinales (SURVI), Nutritional support, Gastroenterology, Beaujon Hospital, APHP.Nord, Clichy, France
| | - Luisa Paulatto
- Université Paris Cité, Paris, France & Department of Radiology, Beaujon Hospital, APHP.Nord, Clichy, France
| | - Valérie Vilgrain
- Université Paris Cité, Paris, France & Department of Radiology, Beaujon Hospital, APHP.Nord, Clichy, France
| | - Benoit Gallix
- IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France
| | - Michele Diana
- IHU Strasbourg - Image Guided Surgery, Strasbourg University, Strasbourg, France.,IRCAD, Research Institute against Digestive Cancer, Strasbourg, France.,Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, France.,ICube Lab, Photonics for Health, Strasbourg, France
| | - Maxime Ronot
- Université Paris Cité, Paris, France & Department of Radiology, Beaujon Hospital, APHP.Nord, Clichy, France
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13
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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14
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de’Angelis N, Marchegiani F, Schena CA, Khan J, Agnoletti V, Ansaloni L, Barría Rodríguez AG, Bianchi PP, Biffl W, Bravi F, Ceccarelli G, Ceresoli M, Chiara O, Chirica M, Cobianchi L, Coccolini F, Coimbra R, Cotsoglou C, D’Hondt M, Damaskos D, De Simone B, Di Saverio S, Diana M, Espin‐Basany E, Fichtner‐Feigl S, Fugazzola P, Gavriilidis P, Gronnier C, Kashuk J, Kirkpatrick AW, Ammendola M, Kouwenhoven EA, Laurent A, Leppaniemi A, Lesurtel M, Memeo R, Milone M, Moore E, Pararas N, Peitzmann A, Pessaux P, Picetti E, Pikoulis M, Pisano M, Ris F, Robison T, Sartelli M, Shelat VG, Spinoglio G, Sugrue M, Tan E, Van Eetvelde E, Kluger Y, Weber D, Catena F. Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper. World J Emerg Surg 2023; 18:11. [PMID: 36707879 PMCID: PMC9883976 DOI: 10.1186/s13017-023-00476-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS. METHODS This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements. RESULTS Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20-107) depending on the initial surgeon's experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon's proficiency. CONCLUSIONS Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.
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Affiliation(s)
- Nicola de’Angelis
- grid.508487.60000 0004 7885 7602Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, Paris, France ,grid.410511.00000 0001 2149 7878Faculty of Medicine, University of Paris Est, UPEC, Créteil, France
| | - Francesco Marchegiani
- grid.508487.60000 0004 7885 7602Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, Paris, France
| | - Carlo Alberto Schena
- grid.508487.60000 0004 7885 7602Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, Paris, France
| | - Jim Khan
- grid.4701.20000 0001 0728 6636Department of Colorectal Surgery, Queen Alexandra Hospital, University of Portsmouth, Southwick Hill Road, Cosham, Portsmouth, UK
| | - Vanni Agnoletti
- grid.414682.d0000 0004 1758 8744Intensive Care Unit, Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- grid.419425.f0000 0004 1760 3027Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Paolo Pietro Bianchi
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Walter Biffl
- grid.415402.60000 0004 0449 3295Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA USA
| | - Francesca Bravi
- grid.415207.50000 0004 1760 3756Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Graziano Ceccarelli
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Italy
| | - Marco Ceresoli
- grid.7563.70000 0001 2174 1754General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Osvaldo Chiara
- grid.4708.b0000 0004 1757 2822General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Mircea Chirica
- grid.450307.50000 0001 0944 2786Department of Digestive Surgery and Liver Transplantation, Michallon Hospital, Grenoble University, Grenoble, France
| | - Lorenzo Cobianchi
- grid.419425.f0000 0004 1760 3027Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy ,grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Federico Coccolini
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- grid.488519.90000 0004 5946 0028Riverside University Health System Medical Center, Riverside, CA USA
| | | | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Dimitris Damaskos
- grid.418716.d0000 0001 0709 1919Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Belinda De Simone
- Department of General and Metabolic Surgery, Poissy and Saint‐Germain‐en‐Laye Hospitals, Poissy, France
| | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | - Michele Diana
- grid.11843.3f0000 0001 2157 9291Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France ,grid.420397.b0000 0000 9635 7370IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Eloy Espin‐Basany
- grid.7080.f0000 0001 2296 0625Department of General Surgery, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Stefan Fichtner‐Feigl
- grid.7708.80000 0000 9428 7911Department of General and Visceral Surgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Paola Fugazzola
- grid.419425.f0000 0004 1760 3027Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Paschalis Gavriilidis
- grid.15628.380000 0004 0393 1193Department of HBP Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX UK
| | - Caroline Gronnier
- grid.42399.350000 0004 0593 7118Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Jeffry Kashuk
- grid.12136.370000 0004 1937 0546Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew W. Kirkpatrick
- grid.414959.40000 0004 0469 2139Department of General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB Canada
| | - Michele Ammendola
- grid.411489.10000 0001 2168 2547Digestive Surgery Unit, Health of Science Department, “Magna Graecia” University Medical School, “Mater Domini” Hospital, Catanzaro, Italy
| | - Ewout A. Kouwenhoven
- grid.417370.60000 0004 0502 0983Department of Surgery, Hospital Group Twente ZGT, Almelo, Netherlands
| | - Alexis Laurent
- grid.410511.00000 0001 2149 7878Faculty of Medicine, University of Paris Est, UPEC, Créteil, France ,grid.412116.10000 0004 1799 3934Unit of HPB and Service of General Surgery, Henri Mondor University Hospital, Creteil, France
| | - Ari Leppaniemi
- grid.7737.40000 0004 0410 2071Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mickaël Lesurtel
- grid.508487.60000 0004 7885 7602Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris Cité, Clichy, France
| | - Riccardo Memeo
- grid.415844.80000 0004 1759 7181Unit of Hepato‐Pancreato‐Biliary Surgery, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, Bari, Italy
| | - Marco Milone
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Federico II” University of Naples, Naples, Italy
| | - Ernest Moore
- grid.241116.10000000107903411Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO USA
| | - Nikolaos Pararas
- grid.5216.00000 0001 2155 08003Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Andrew Peitzmann
- grid.21925.3d0000 0004 1936 9000University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Patrick Pessaux
- grid.11843.3f0000 0001 2157 9291Visceral and Digestive Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France ,grid.480511.9Institute for Image‐Guided Surgery, IHU Strasbourg, Strasbourg, France ,Institute of Viral and Liver Disease, INSERM U1110, Strasbourg, France
| | - Edoardo Picetti
- grid.411482.aDepartment of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | - Manos Pikoulis
- grid.5216.00000 0001 2155 08003Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Michele Pisano
- 1St General Surgery Unit, Department of Emergency, ASST Papa Giovanni Hospital Bergamo, Bergamo, Italy
| | - Frederic Ris
- grid.150338.c0000 0001 0721 9812Division of Digestive Surgery, University Hospitals of Geneva and Medical School, Geneva, Switzerland
| | - Tyler Robison
- grid.5288.70000 0000 9758 5690Minimally Invasive Surgery Fellow, Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR USA
| | | | - Vishal G. Shelat
- grid.240988.f0000 0001 0298 8161Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Giuseppe Spinoglio
- grid.420397.b0000 0000 9635 7370IRCAD Faculty Member Robotic and Colorectal Surgery‐ IRCAD, Strasbourg, France
| | - Michael Sugrue
- grid.415900.90000 0004 0617 6488Department of Surgery, Letterkenny University Hospital, Donegal, Ireland
| | - Edward Tan
- grid.10417.330000 0004 0444 9382Department of Surgery, Trauma Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ellen Van Eetvelde
- grid.411326.30000 0004 0626 3362Department of Digestive Surgery, UZ, Brussels, Belgium
| | - Yoram Kluger
- Department of General Surgery, Rambam Healthcare Campus, Haifa, Israel
| | - Dieter Weber
- grid.416195.e0000 0004 0453 3875Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744Department of General and Emergency Surgery, Bufalini Hospital‐Level 1 Trauma Center, Cesena, Italy
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15
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Dip F, Aleman J, DeBoer E, Boni L, Bouvet M, Buchs N, Carus T, Diana M, Elli EF, Hutteman M, Ishizawa T, Kokudo N, Lo Menzo E, Ludwig K, Phillips E, Regimbeau JM, Rodriguez-Zentner H, Roy MD, Schneider-Koriath S, Schols RM, Sherwinter D, Simpfendorfer C, Stassen L, Szomstein S, Vahrmeijer A, Verbeek FPR, Walsh M, White KP, Rosenthal RJ. Use of fluorescence imaging and indocyanine green during laparoscopic cholecystectomy: Results of an international Delphi survey. Surgery 2022; 172:S21-S28. [PMID: 36427926 DOI: 10.1016/j.surg.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/25/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Published empirical data have increasingly suggested that using near-infrared fluorescence cholangiography during laparoscopic cholecystectomy markedly increases biliary anatomy visualization. The technology is rapidly evolving, and different equipment and doses may be used. We aimed to identify areas of consensus and nonconsensus in the use of incisionless near-infrared fluorescent cholangiography during laparoscopic cholecystectomy. METHODS A 2-round Delphi survey was conducted among 28 international experts in minimally invasive surgery and near-infrared fluorescent cholangiography in 2020, during which respondents voted on 62 statements on patient preparation and contraindications (n = 12); on indocyanine green administration (n = 14); on potential advantages and uses of near-infrared fluorescent cholangiography (n = 18); comparing near-infrared fluorescent cholangiography with intraoperative x-ray cholangiography (n = 7); and on potential disadvantages of and required training for near-infrared fluorescent cholangiography (n = 11). RESULTS Expert consensus strongly supports near-infrared fluorescent cholangiography superiority over white light for the visualization of biliary structures and reduction of laparoscopic cholecystectomy risks. It also offers other advantages like enhancing anatomic visualization in obese patients and those with moderate to severe inflammation. Regarding indocyanine green administration, consensus was reached that dosing should be on a milligrams/kilogram basis, rather than as an absolute dose, and that doses >0.05 mg/kg are necessary. Although there is no consensus on the optimum preoperative timing of indocyanine green injections, the majority of participants consider it important to administer indocyanine green at least 45 minutes before the procedure to decrease the light intensity of the liver. CONCLUSION Near-infrared fluorescent cholangiography experts strongly agree on its effectiveness and safety during laparoscopic cholecystectomy and that it should be used routinely, but further research is necessary to establish optimum timing and doses for indocyanine green.
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Affiliation(s)
- Fernando Dip
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Julio Aleman
- Hospital Centro Médico, Laparoscopic surgery, Guatemala
| | - Esther DeBoer
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Luigi Boni
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | | | | | - Thomas Carus
- Niels-Stensen-Kliniken, Elisabeth-Hospital, Thuine, Germany
| | - Michele Diana
- Research Institute against Digestive Cancer (IRCAD), Strasbourg, France
| | | | | | | | - Norihiro Kokudo
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Kaja Ludwig
- Klinikum Suedstadt Rostock, Rostock, Germany
| | | | - Jean Marc Regimbeau
- CHU Amiens-Picardie, Site Sud, Service de Chirurgie Digestive, Amiens, France
| | | | | | | | - Rutger M Schols
- Maastricht University Medical Center, Maastricht, Netherlands
| | | | | | - Laurent Stassen
- Maastricht University Medical Center, Maastricht, Netherlands
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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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:
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Muttillo EM, Mazzarella G, Picardi B, Rossi S, Cinelli L, Diana M, Baiocchini A, Felli E, Pessaux P, Felli E, Muttillo IA. Treatment strategies for neuroendocrine liver metastases: a systematic review. HPB (Oxford) 2022; 24:1832-1843. [PMID: 35794053 DOI: 10.1016/j.hpb.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/19/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastroenteropancreatic neuroendocrine tumors are often diagnosed when metastatic. The liver is the main site of metastases. Unfortunately, optimal management of neuroendocrine liver metastases remains a topic of debate. The aim of this study was to make a systematic review of the current literature about the results of the different treatments of neuroendocrine liver metastases. METHODS A systematic review was conducted for English language publications from 1995 to 2021. Outcomes were analyzed according to survival, disease-free survival, and in the case of systemic therapies, progression-free survival. RESULTS 5509 patients were analyzed in the review. 67% of patients underwent surgery achieving 5 years overall survival despite only 30% percent without a recurrence. 60% of patients that had received a transplant reached 5 years survival with a low disease-free survival rate (20%). Five-year survival rate was 36.2% for patients undergoing loco-regional therapies. CONCLUSION Surgical resection is the best treatment when metastases are resectable, with the highest rate of survival, although liver transplantation shows good results for patients not eligible for surgery. Loco-regional therapies may be useful when surgical resection is contraindicated, or selectively used as a bridge to surgery or transplantation. Systemic therapies are indicated in patients for whom curative treatment cannot be obtained.
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Affiliation(s)
- Edoardo M Muttillo
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy; Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Gennaro Mazzarella
- Department of General and Emergency Surgery, Ospedale San Filippo Neri, Rome, Italy
| | - Biagio Picardi
- Department of General and Emergency Surgery, Ospedale San Filippo Neri, Rome, Italy
| | - Stefano Rossi
- Department of General and Emergency Surgery, Ospedale San Filippo Neri, Rome, Italy
| | | | - Michele Diana
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | | | - Eric Felli
- Hepatology, Department of Biomedical Research, Inselspital, University of Bern, Bern, Switzerland
| | - Patrick Pessaux
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France; HPB Unit, Digestive Surgery Department, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France
| | - Emanuele Felli
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France; Service Chirurgie Digestive et Transplantation Hépatique Hopital Trousseau CHU Tours, France
| | - Irnerio A Muttillo
- Department of General and Emergency Surgery, Ospedale San Filippo Neri, Rome, Italy.
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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19
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Collins T, Bencteux V, Benedicenti S, Moretti V, Mita MT, Barbieri V, Rubichi F, Altamura A, Giaracuni G, Marescaux J, Hostettler A, Diana M, Viola MG, Barberio M. Automatic optical biopsy for colorectal cancer using hyperspectral imaging and artificial neural networks. Surg Endosc 2022; 36:8549-8559. [PMID: 36008640 DOI: 10.1007/s00464-022-09524-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/31/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intraoperative identification of cancerous tissue is fundamental during oncological surgical or endoscopic procedures. This relies on visual assessment supported by histopathological evaluation, implying a longer operative time. Hyperspectral imaging (HSI), a contrast-free and contactless imaging technology, provides spatially resolved spectroscopic analysis, with the potential to differentiate tissue at a cellular level. However, HSI produces "big data", which is impossible to directly interpret by clinicians. We hypothesize that advanced machine learning algorithms (convolutional neural networks-CNNs) can accurately detect colorectal cancer in HSI data. METHODS In 34 patients undergoing colorectal resections for cancer, immediately after extraction, the specimen was opened, the tumor-bearing section was exposed and imaged using HSI. Cancer and normal mucosa were categorized from histopathology. A state-of-the-art CNN was developed to automatically detect regions of colorectal cancer in a hyperspectral image. Accuracy was validated with three levels of cross-validation (twofold, fivefold, and 15-fold). RESULTS 32 patients had colorectal adenocarcinomas confirmed by histopathology (9 left, 11 right, 4 transverse colon, and 9 rectum). 6 patients had a local initial stage (T1-2) and 26 had a local advanced stage (T3-4). The cancer detection performance of the CNN using 15-fold cross-validation showed high sensitivity and specificity (87% and 90%, respectively) and a ROC-AUC score of 0.95 (considered outstanding). In the T1-2 group, the sensitivity and specificity were 89% and 90%, respectively, and in the T3-4 group, the sensitivity and specificity were 81% and 93%, respectively. CONCLUSIONS Automatic colorectal cancer detection on fresh specimens using HSI, using a properly trained CNN is feasible and accurate, even with small datasets, regardless of the local tumor extension. In the near future, this approach may become a useful intraoperative tool during oncological endoscopic and surgical procedures, and may result in precise and non-destructive optical biopsies to support objective and consistent tumor-free resection margins.
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Affiliation(s)
- Toby Collins
- Research Institute Against Digestive Cancer (IRCAD France), Strasbourg, France.
- Research Institute Against Digestive Cancer (IRCAD Africa), Kigali, Rwanda.
| | - Valentin Bencteux
- Research Institute Against Digestive Cancer (IRCAD France), Strasbourg, France
- ICUBE Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | | | | | | | | | | | - Amedeo Altamura
- Department of Surgery, Ospedale Card. G. Panico, Tricase, Italy
| | | | - Jacques Marescaux
- Research Institute Against Digestive Cancer (IRCAD France), Strasbourg, France
- Research Institute Against Digestive Cancer (IRCAD Africa), Kigali, Rwanda
| | - Alex Hostettler
- Research Institute Against Digestive Cancer (IRCAD France), Strasbourg, France
- Research Institute Against Digestive Cancer (IRCAD Africa), Kigali, Rwanda
| | - Michele Diana
- Research Institute Against Digestive Cancer (IRCAD France), Strasbourg, France
- ICUBE Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | | | - Manuel Barberio
- Research Institute Against Digestive Cancer (IRCAD France), Strasbourg, France
- Department of Surgery, Ospedale Card. G. Panico, Tricase, Italy
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Ishizawa T, McCulloch P, Stassen L, van den Bos J, Regimbeau JM, Dembinski J, Schneider-Koriath S, Boni L, Aoki T, Nishino H, Hasegawa K, Sekine Y, Chen-Yoshikawa T, Yeung T, Berber E, Kahramangil B, Bouvet M, Diana M, Kokudo N, Dip F, White K, Rosenthal RJ. Assessing the development status of intraoperative fluorescence imaging for anatomy visualisation, using the IDEAL framework. BMJ Surg Interv Health Technologies 2022; 4:e000156. [DOI: 10.1136/bmjsit-2022-000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
Abstract
ObjectivesIntraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: visualising anatomy, assessing tissue perfusion, identifying/localising cancer and mapping lymphatic systems. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging used to visualise anatomical structures using the IDEAL framework, a framework designed to describe the stages of innovation in surgery and other interventional procedures.DesignIDEAL staging based on a thorough literature review.SettingAll publications on intraoperative fluorescence imaging for visualising anatomical structures reported in PubMed through 2020 were identified for five surgical procedures: cholangiography, hepatic segmentation, lung segmentation, ureterography and parathyroid identification.Main outcome measuresThe IDEAL stage of research evidence was determined for each of the five procedures using a previously described approach.Results225 articles (8427 cases) were selected for analysis. Current status of research evidence on fluorescence imaging was rated IDEAL stage 2a for ureterography and lung segmentation, IDEAL 2b for hepatic segmentation and IDEAL stage 3 for cholangiography and parathyroid identification. Enhanced tissue identification rates using fluorescence imaging relative to conventional white-light imaging have been documented for all five procedures by comparative studies including randomised controlled trials for cholangiography and parathyroid identification. Advantages of anatomy visualisation with fluorescence imaging for improving short-term and long-term postoperative outcomes also were demonstrated, especially for hepatobiliary surgery and (para)thyroidectomy. No adverse reactions associated with fluorescent agents were reported.ConclusionsIntraoperative fluorescence imaging can be used safely to enhance the identification of anatomical structures, which may lead to improved postoperative outcomes. Overviewing current research knowledge using the IDEAL framework aids in designing further studies to develop fluorescence imaging techniques into an essential intraoperative navigation tool in each surgical field.
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Okamoto N, Rodríguez-Luna MR, Bencteux V, Al-Taher M, Cinelli L, Felli E, Urade T, Nkusi R, Mutter D, Marescaux J, Hostettler A, Collins T, Diana M. Computer-Assisted Differentiation between Colon-Mesocolon and Retroperitoneum Using Hyperspectral Imaging (HSI) Technology. Diagnostics (Basel) 2022; 12:diagnostics12092225. [PMID: 36140626 PMCID: PMC9497769 DOI: 10.3390/diagnostics12092225] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 12/01/2022] Open
Abstract
Complete mesocolic excision (CME), which involves the adequate resection of the tumor-bearing colonic segment with “en bloc” removal of its mesocolon along embryological fascial planes is associated with superior oncological outcomes. However, CME presents a higher complication rate compared to non-CME resections due to a higher risk of vascular injury. Hyperspectral imaging (HSI) is a contrast-free optical imaging technology, which facilitates the quantitative imaging of physiological tissue parameters and the visualization of anatomical structures. This study evaluates the accuracy of HSI combined with deep learning (DL) to differentiate the colon and its mesenteric tissue from retroperitoneal tissue. In an animal study including 20 pig models, intraoperative hyperspectral images of the sigmoid colon, sigmoid mesentery, and retroperitoneum were recorded. A convolutional neural network (CNN) was trained to distinguish the two tissue classes using HSI data, validated with a leave-one-out cross-validation process. The overall recognition sensitivity of the tissues to be preserved (retroperitoneum) and the tissues to be resected (colon and mesentery) was 79.0 ± 21.0% and 86.0 ± 16.0%, respectively. Automatic classification based on HSI and CNNs is a promising tool to automatically, non-invasively, and objectively differentiate the colon and its mesentery from retroperitoneal tissue.
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Affiliation(s)
- Nariaki Okamoto
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
- Correspondence:
| | - María Rita Rodríguez-Luna
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Valentin Bencteux
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Mahdi Al-Taher
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Lorenzo Cinelli
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, 20132 Milan, Italy
| | - Eric Felli
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
| | - Takeshi Urade
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe 6500017, Japan
| | - Richard Nkusi
- Research Institute against Digestive Cancer (IRCAD), Kigali, Rwanda
| | - Didier Mutter
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, 67091 Strasbourg, France
- IHU-Strasbourg—Institut de Chirurgie Guidée par L’image, 67091 Strasbourg, France
| | - Jacques Marescaux
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
| | - Alexandre Hostettler
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Research Institute against Digestive Cancer (IRCAD), Kigali, Rwanda
| | - Toby Collins
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Research Institute against Digestive Cancer (IRCAD), Kigali, Rwanda
| | - Michele Diana
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
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22
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Poget M, Chautems R, Kohler R, Diana M, Saadi A. Impact of the COVID-19 pandemic on the severity and management of acute appendicitis. Front Surg 2022; 9:981885. [PMID: 36117810 PMCID: PMC9474729 DOI: 10.3389/fsurg.2022.981885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background The literature seems to indicate that the number of appendectomies dropped at the beginning of the coronavirus disease in 2019 (COVID-19 pandemic), while the number of complicated appendicitis increased due to late presentation. In addition, a longer delay before surgical treatment resulted in a higher morbidity. This study aims to compare the number of appendectomies, the severity, and the management of acute appendicitis during the first two pandemic peaks of COVID-19 with those observed during the same seasonal periods in the previous 2 years in a regional hospital in Switzerland. Methods We retrospectively reviewed and compared the number of appendectomies, rate of complicated appendicitis, delay to consultation and to surgery, distribution of appendectomies over a 24-h schedule, postoperative outcomes, and rates of overall complications in 177 patients, that is, 66 during the COVID-19 pandemic and 111 before the pandemic. Results No statistical difference was found in the number of appendectomies, duration of symptoms before consultation, median time to surgery, number of appendectomies performed outside the usual scheduled time for non-urgent surgery, length of postoperative stay, or the rates of overall complications. However, there was a trend in the rate of complicated appendicitis (p = .05). Conclusion In spite of a high incidence rate of COVID-19 in our canton, the impact of COVID-19 on our population did not follow the pattern observed elsewhere. The reasons for this might be that people would still present to the emergency department due to less strict social distancing measures. Great availability of emergency operating room may also account for the unchanged delay preceding surgical treatment and complication rates.
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Affiliation(s)
- Marion Poget
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland
| | - Roland Chautems
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Rémy Kohler
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland
- Surgery Department, Geneva University Hospitals, Geneva, Switzerland
| | - Michele Diana
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
- Surgery Department, University Hospital of Strasbourg, Strasbourg, France
| | - Alend Saadi
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland
- Obesity and Metabolic Diseases Center, Neuchâtel Hospital, Neuchâtel, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Correspondence: Alend Saadi
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Rodríguez-Luna MR, Okamoto N, Al-Taher M, Keller DS, Cinelli L, Hoskere Ashoka A, Klymchenko AS, Marescaux J, Diana M. In Vivo Imaging Evaluation of Fluorescence Intensity at Tail Emission of Near-Infrared-I (NIR-I) Fluorophores in a Porcine Model. Life (Basel) 2022; 12:life12081123. [PMID: 35892925 PMCID: PMC9332805 DOI: 10.3390/life12081123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022]
Abstract
Over the last decade fluorescence-guided surgery has been primarily focused on the NIR-I window. However, the NIR-I window has constraints, such as limited penetration and scattering. Consequently, exploring the performance of NIR-I dyes at longer wavelengths (i.e., the NIR-II window) is crucial to expanding its application. Two fluorophores were used in three pigs to identify the mean fluorescence intensity (MFI) using two commercially available NIR-I and NIR-II cameras. The near-infrared coating of equipment (NICE) was used to identify endoluminal surgical catheters and indocyanine green (ICG) for common bile duct (CBD) characterization. The NIR-II window evaluation showed an MFI of 0.4 arbitrary units (a.u.) ± 0.106 a.u. in small bowel NICE-coated catheters and an MFI of 0.09 a.u. ± 0.039 a.u. in gastric ones. In CBD characterization, the ICG MFI was 0.12 a.u. ± 0.027 a.u., 0.18 a.u. ± 0.100 a.u., and 0.22 a.u. ± 0.041 a.u. at 5, 35, and 65 min, respectively. This in vivo imaging evaluation of NIR-I dyes confirms its application in the NIR-II domain. To the best of our knowledge, this is the first study assessing the MIF of NICE in the NIR-II window using a commercially available system. Further comparative trials are necessary to determine the superiority of NIR-II imaging systems.
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Affiliation(s)
- María Rita Rodríguez-Luna
- Research Institute against Digestive Cancer (IRCAD), 1 Place de l’Hôpital, 67000 Strasbourg, France; (N.O.); (M.A.-T.); (J.M.); (M.D.)
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
- Correspondence:
| | - Nariaki Okamoto
- Research Institute against Digestive Cancer (IRCAD), 1 Place de l’Hôpital, 67000 Strasbourg, France; (N.O.); (M.A.-T.); (J.M.); (M.D.)
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Mahdi Al-Taher
- Research Institute against Digestive Cancer (IRCAD), 1 Place de l’Hôpital, 67000 Strasbourg, France; (N.O.); (M.A.-T.); (J.M.); (M.D.)
- Maastricht University Medical Center, 6229 Maastricht, The Netherlands
| | - Deborah S. Keller
- Marks Colorectal Surgical Associates, Lankenau Medical Center, Main Line Health, Wynnewood, PA 19096, USA;
| | - Lorenzo Cinelli
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, 20132 Milan, Italy;
| | - Anila Hoskere Ashoka
- Laboratoire de Bioimagerie et Pathologies, UMR 7021 CNRS, Université de Strasbourg, 74 Route du Rhin, 67401 Illkirch, France; (A.H.A.); (A.S.K.)
| | - Andrey S. Klymchenko
- Laboratoire de Bioimagerie et Pathologies, UMR 7021 CNRS, Université de Strasbourg, 74 Route du Rhin, 67401 Illkirch, France; (A.H.A.); (A.S.K.)
| | - Jacques Marescaux
- Research Institute against Digestive Cancer (IRCAD), 1 Place de l’Hôpital, 67000 Strasbourg, France; (N.O.); (M.A.-T.); (J.M.); (M.D.)
| | - Michele Diana
- Research Institute against Digestive Cancer (IRCAD), 1 Place de l’Hôpital, 67000 Strasbourg, France; (N.O.); (M.A.-T.); (J.M.); (M.D.)
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
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24
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Richard V, Stähli C, Giudicelli G, Worreth MD, Krähenbühl N, Greiner E, Papastathi C, Diana M, Saadi A. Does the socio-demographic profile of patients limit access to bariatric surgery? Eat Weight Disord 2022; 27:1457-1466. [PMID: 34426952 PMCID: PMC9079012 DOI: 10.1007/s40519-021-01285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/03/2021] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Surgery remains the only treatment allowing for a significant and sustainable weight loss in case of severe obesity. Patients undergo a specific multidisciplinary preparation and selection before the operation. This study aims to correlate the psychosocial profile with the likelihood of undergoing bariatric surgery in patients enrolled in the preparation program of a Swiss reference center. METHODS All patients referred to an obesity center between January 1, 2016, and June 30, 2017, seeking a first bariatric procedure were included. Socio-demographic data, BMI, preoperative psychological and dietary evaluations were collected. Usually, the preoperative process lasts 1 year. Patients who left the preparation or who had not undergone surgery after more than 2 years of follow-up were considered withdrawers. Surgery completion predictors were reviewed with bivariate analysis and socio-demographic clusters established using the K-means method. RESULTS Out of a total of 221 patients, 99 (45%) patients had not undergone bariatric surgery 2 years after their first consultation. The patients were divided into four distinct socio-demographic clusters, among which a particularly deprived one. Criteria such as unfavorable psychological (p < 0.001) and dietary (p < 0.001) evaluations, and male gender (p < 0.05) were significantly associated with non-operation, unlike socio-demographic indicators and clusters (p > 0.1). CONCLUSION Almost half of the patients starting a bariatric program are not operated on, which is related to an unfavorable psychological or dietary evaluation and to the male gender. This study also demonstrates that a significant share of patients combines several factors of social deprivation, without influencing the likelihood of surgery completion. LEVEL OF EVIDENCE Level V: Descriptive study.
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Affiliation(s)
- Viviane Richard
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland. .,Service of Populational Epidemiology, Geneva University Hospital, Geneva, Switzerland.
| | - Christof Stähli
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland
| | - Guillaume Giudicelli
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland.,Visceral Surgery Service, Geneva University Hospital, Geneva, Switzerland
| | - Marc Daniel Worreth
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland.,Obesity and Metabolic Diseases Centre, Neuchâtel Hospital, Neuchâtel, Switzerland
| | - Nicole Krähenbühl
- Obesity and Metabolic Diseases Centre, Neuchâtel Hospital, Neuchâtel, Switzerland
| | - Emilie Greiner
- Obesity and Metabolic Diseases Centre, Neuchâtel Hospital, Neuchâtel, Switzerland
| | - Chrysoula Papastathi
- Obesity and Metabolic Diseases Centre, Neuchâtel Hospital, Neuchâtel, Switzerland
| | - Michele Diana
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland.,IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France.,Surgery Department, Strasbourg University Hospital, Strasbourg, France
| | - Alend Saadi
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland.,Obesity and Metabolic Diseases Centre, Neuchâtel Hospital, Neuchâtel, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Dip F, Boni L, Bouvet M, Carus T, Diana M, Falco J, Gurtner GC, Ishizawa T, Kokudo N, Lo Menzo E, Low PS, Masia J, Muehrcke D, Papay FA, Pulitano C, Schneider-Koraith S, Sherwinter D, Spinoglio G, Stassen L, Urano Y, Vahrmeijer A, Vibert E, Warram J, Wexner SD, White K, Rosenthal RJ. Consensus Conference Statement on the General Use of Near-infrared Fluorescence Imaging and Indocyanine Green Guided Surgery: Results of a Modified Delphi Study. Ann Surg 2022; 275:685-691. [PMID: 33214476 PMCID: PMC8906245 DOI: 10.1097/sla.0000000000004412] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In recent decades, the use of near-infrared light and fluorescence-guidance during open and laparoscopic surgery has exponentially expanded across various clinical settings. However, tremendous variability exists in how it is performed. OBJECTIVE In this first published survey of international experts on fluorescence-guided surgery, we sought to identify areas of consensus and nonconsensus across 4 areas of practice: fundamentals; patient selection/preparation; technical aspects; and effectiveness and safety. METHODS A Delphi survey was conducted among 19 international experts in fluorescence-guided surgery attending a 1-day consensus meeting in Frankfurt, Germany on September 8th, 2019. Using mobile phones, experts were asked to anonymously vote over 2 rounds of voting, with 70% and 80% set as a priori thresholds for consensus and vote robustness, respectively. RESULTS Experts from 5 continents reached consensus on 41 of 44 statements, including strong consensus that near-infrared fluorescence-guided surgery is both effective and safe across a broad variety of clinical settings, including the localization of critical anatomical structures like vessels, detection of tumors and sentinel nodes, assessment of tissue perfusion and anastomotic leaks, delineation of segmented organs, and localization of parathyroid glands. Although the minimum and maximum safe effective dose of ICG were felt to be 1 to 2 mg and >10 mg, respectively, there was strong consensus that determining the optimum dose, concentration, route and timing of ICG administration should be an ongoing research focus. CONCLUSIONS Although fluorescence imaging was almost unanimously perceived to be both effective and safe across a broad range of clinical settings, considerable further research remains necessary to optimize its use.
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Affiliation(s)
- Fernando Dip
- Hospital de Clinicas Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina
- Cleveland Clinic Florida, Weston, FL
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico University of Milan, Milan, Italy
| | | | | | - Michele Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France
| | - Jorge Falco
- University Hospital Das Clinicas, Buenos Aires, Argentina
| | | | | | - Norihiro Kokudo
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | | | | | - Francis A Papay
- Cleveland Clinic, Lerner College of Medicine at Case Western Reserve University, Cleveland, OH
| | | | | | | | - Giuseppe Spinoglio
- FPO Candolo Institute for Cancer Research and Treatment I.R.C.C.S, Turin, Italy
| | - Laurents Stassen
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Eric Vibert
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France
| | - Jason Warram
- University of Alabama at Birmingham, Birmingham, AL
| | | | - Kevin White
- ScienceRight Research Consulting London, Ontario, Canada
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Ekman M, Girnyi S, Marano L, Roviello F, Chand M, Diana M, Polom K. Near-Infrared Fluorescence Image-Guided Surgery in Esophageal and Gastric Cancer Operations. Surg Innov 2022; 29:540-549. [DOI: 10.1177/15533506211073417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Near-infrared fluorescence image-guided surgery helps surgeons to see beyond the classical eye vision. Over the last few years, we have witnessed a revolution which has begun in the field of image-guided surgery. Purpose, and Research design Fluorescence technology using indocyanine green (ICG) has shown promising results in many organs, and in this review article, we wanted to discuss the 6 main domains where fluorescence image-guided surgery is currently used for esophageal and gastric cancer surgery. Study sample and data collection Visualization of lymphatic vessels, tumor localization, fluorescence angiography for anastomotic evaluation, thoracic duct visualization, tracheal blood flow analysis, and sentinel node biopsy are discussed. Conclusions It seems that this technology has already found its place in surgery. However, new possibilities and research avenues in this area will probably make it even more important in the near future.
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Affiliation(s)
- Marcin Ekman
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Sergii Girnyi
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Manish Chand
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London
| | - Michele Diana
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
- Wellcome EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London
| | - Karol Polom
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
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Abstract
Fluorescence imaging in colorectal surgery is considered a novel predominantly intraoperative method of ensuring a greater surgical success. The use of fluorescence is linked to advanced tumor visualization and projection of its lymphatics, both vessels and nodes, which results in a higher chance of achieving a total excision. Additionally, iatrogenic complications prove to be reduced using fluorescence during the surgical excision. The combination of fluorescence and artificial intelligence to better facilitate oncological surgery will soon become an established approach in operating rooms worldwide.
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Affiliation(s)
- Paulina Daniluk
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Natalia Mazur
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Maciej Swierblewski
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Manish Chand
- Department of Surgery and Interventional Sciences, GENIE Centre, 4919University College London, University College London Hospitals, NHS Trust, London, UK
| | - Michele Diana
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Karol Polom
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
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Piccolo G, Barabino M, Pesce A, Diana M, Lecchi F, Santambrogio R, Opocher E, Bianchi PP, Piozzi GN. Role of Indocyanine Green Fluorescence Imaging in Minimally Invasive Resection of Colorectal Liver Metastases. Surg Laparosc Endosc Percutan Tech 2022; 32:259-265. [PMID: 35180735 DOI: 10.1097/sle.0000000000001037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/15/2021] [Indexed: 02/07/2023]
Abstract
Indocyanine green (ICG) fluorescence imaging is an easy and reproducible method to detect hepatic lesions, both primary and metastatic. This review reports the potential benefits of this technique as a tactile mimicking visual tool and a navigator guide in minimally invasive liver resection of colorectal liver metastases (CRLM). PubMed and MEDLINE databases were searched for studies reporting the use of intravenous injection of ICG before minimally invasive surgery for CLRM. The search was performed for publications reported from the first study in 2014 to April 2021. The final review included 13 articles: 6 prospective cohort studies, 1 retrospective cohort study, 3 case series, 1 case report, 1 case-matched study, and 1 clinical trial registry. The administered dose ranged between 0.3 and 0.5 mg/kg, while timing ranged between 1 and 14 days before surgery. CRLM detection rate ranged between 30.3% and 100% with preoperative imaging (abdominal computed tomography/magnetic resonance imaging), between 93.3 and 100% with laparoscopic ultrasound, between 57.6% and 100% with ICG fluorescence, and was 100% with combined modalities (ICG and laparoscopic ultrasound) with weighted averages of 77.42%, 95.97%, 79.03%, and 100%, respectively. ICG fusion imaging also allowed to detect occult small-sized lesions, not diagnosed preoperatively. In addition, ICG is effective in real-time assessment of surgical margins by evaluating the integrity of the fluorescent rim around the CRLM.
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Affiliation(s)
- Gaetano Piccolo
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences
| | - Matteo Barabino
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences
| | - Antonio Pesce
- Unit of General Surgery, University of Ferrara, Azienda USL di Ferrara, Lagosanto (FE), Italy
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer
- Department of General, Digestive, Endocrine Surgery, University Hospital of Strasbourg
- ICube Laboratory, Photonics for Health, University of Strasbourg, Strasbourg, France
| | | | - Roberto Santambrogio
- Unit of General Surgery, ASST Fatebenefratelli Sacco: Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Milan
| | - Enrico Opocher
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences
| | - Paolo P Bianchi
- Division of General and Robotic Surgery, Department of Health Sciences, University of Milan, San Paolo Hospital
| | - Guglielmo N Piozzi
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Knospe L, Gockel I, Jansen-Winkeln B, Thieme R, Niebisch S, Moulla Y, Stelzner S, Lyros O, Diana M, Marescaux J, Chalopin C, Köhler H, Pfahl A, Maktabi M, Park JH, Yang HK. New Intraoperative Imaging Tools and Image-Guided Surgery in Gastric Cancer Surgery. Diagnostics (Basel) 2022; 12:diagnostics12020507. [PMID: 35204597 PMCID: PMC8871069 DOI: 10.3390/diagnostics12020507] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 02/05/2023] Open
Abstract
Innovations and new advancements in intraoperative real-time imaging have gained significant importance in the field of gastric cancer surgery in the recent past. Currently, the most promising procedures include indocyanine green fluorescence imaging (ICG-FI) and hyperspectral imaging or multispectral imaging (HSI, MSI). ICG-FI is utilized in a broad range of clinical applications, e.g., assessment of perfusion or lymphatic drainage, and additional implementations are currently investigated. HSI is still in the experimental phase and its value and clinical relevance require further evaluation, but initial studies have shown a successful application in perfusion assessment, and prospects concerning non-invasive tissue and tumor classification are promising. The application of machine learning and artificial intelligence technologies might enable an automatic evaluation of the acquired image data in the future. Both methods facilitate the accurate visualization of tissue characteristics that are initially indistinguishable for the human eye. By aiding surgeons in optimizing the surgical procedure, image-guided surgery can contribute to the oncologic safety and reduction of complications in gastric cancer surgery and recent advances hold promise for the application of HSI in intraoperative tissue diagnostics.
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Affiliation(s)
- Luise Knospe
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
- Correspondence:
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
- Department of General, Visceral and Oncological Surgery, St. Georg Hospital, 04129 Leipzig, Germany
| | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Stefan Niebisch
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Sigmar Stelzner
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Orestis Lyros
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Michele Diana
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.D.); (J.M.)
- ICUBE Laboratory, Photonics Instrumentation for Health, University of Strasbourg, 67400 Strasbourg, France
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, 67091 Strasbourg, France
| | - Jacques Marescaux
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.D.); (J.M.)
| | - Claire Chalopin
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, 04103 Leipzig, Germany; (C.C.); (H.K.); (A.P.); (M.M.)
| | - Hannes Köhler
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, 04103 Leipzig, Germany; (C.C.); (H.K.); (A.P.); (M.M.)
| | - Annekatrin Pfahl
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, 04103 Leipzig, Germany; (C.C.); (H.K.); (A.P.); (M.M.)
| | - Marianne Maktabi
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, 04103 Leipzig, Germany; (C.C.); (H.K.); (A.P.); (M.M.)
| | - Ji-Hyeon Park
- Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea; (J.-H.P.); (H.-K.Y.)
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea; (J.-H.P.); (H.-K.Y.)
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Al-Taher M, Okamoto N, Mutter D, Stassen LPS, Marescaux J, Diana M, Dallemagne B. International survey among surgeons on laparoscopic right hemicolectomy: the gap between guidelines and reality. Surg Endosc 2022; 36:5840-5853. [PMID: 35064320 PMCID: PMC8782220 DOI: 10.1007/s00464-022-09044-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/08/2022] [Indexed: 12/14/2022]
Abstract
Introduction To assess the current approaches and perioperative treatments of laparoscopic right hemicolectomy (LRHC) and to highlight similarities and differences with international guidelines and scientific evidence, we conducted a survey for surgeons across the globe. Methods All digestive and colorectal surgeons registered with the database of the Research Institute against Digestive Cancer (IRCAD) were invited to take part in the survey via email and through the social media networks of IRCAD. Results There were a total of 440 respondents from 78 countries. Most surgeons worked in the European region (38.6%) followed by the Americas (34.1%), the Eastern Mediterranean region (13.0%), the South-East Asian region (5.9%), the Western Pacific region (4.8%), and Africa (3.2%) respectively. Over half of the respondents performed less than 25% of right hemicolectomies laparoscopically where 4 ports are usually used by 68% of the surgeons. The medial-to-lateral, vessel-first approach is the approach most commonly used (74.1%). The most common extraction site was through a midline incision (53%) and an abdominal drain tube is routinely used by 52% of the surgeons after surgery. A total of 68.6% of the responding surgeons perform the majority of the anastomoses extracorporeally. Finally, we found that the majority of responders (60.7%) routinely used mechanical bowel preparations prior to LRHC. Conclusion Regarding several topics related to LRHC care, a discrepancy was observed between the current medical practice and the recommendations from RCTs and international guidelines and significant regional differences were observed. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09044-w.
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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] [What about the content of this article? (0)] [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.
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Pruimboom T, Lindelauf AAMA, Felli E, Sawor JH, Deliaert AEK, van der Hulst RRWJ, Al-Taher M, Diana M, Schols RM. Perioperative Hyperspectral Imaging to Assess Mastectomy Skin Flap and DIEP Flap Perfusion in Immediate Autologous Breast Reconstruction: A Pilot Study. Diagnostics (Basel) 2022; 12:diagnostics12010184. [PMID: 35054352 PMCID: PMC8774932 DOI: 10.3390/diagnostics12010184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 12/10/2022] Open
Abstract
Mastectomy skin flap necrosis (MSFN) and partial DIEP (deep inferior epigastric artery perforator) flap loss represent two frequently reported complications in immediate autologous breast reconstruction. These complications could be prevented when areas of insufficient tissue perfusion are detected intraoperatively. Hyperspectral imaging (HSI) is a relatively novel, non-invasive imaging technique, which could be used to objectively assess tissue perfusion through analysis of tissue oxygenation patterns (StO2%), near-infrared (NIR%), tissue hemoglobin (THI%), and tissue water (TWI%) perfusion indices. This prospective clinical pilot study aimed to evaluate the efficacy of HSI for tissue perfusion assessment and to identify a cut-off value for flap necrosis. Ten patients with a mean age of 55.4 years underwent immediate unilateral autologous breast reconstruction. Prior, during and up to 72 h after surgery, a total of 19 hyperspectral images per patient were acquired. MSFN was observed in 3 out of 10 patients. No DIEP flap necrosis was observed. In all MSFN cases, an increased THI% and decreased StO2%, NIR%, and TWI% were observed when compared to the vital group. StO2% was found to be the most sensitive parameter to detect MSFN with a statistically significant lower mean StO2% (51% in the vital group versus 32% in the necrosis group, p < 0.0001) and a cut-off value of 36.29% for flap necrosis. HSI has the potential to accurately assess mastectomy skin flap perfusion and discriminate between vital and necrotic skin flap during the early postoperative period prior to clinical observation. Although the results should be confirmed in future studies, including DIEP flap necrosis specifically, these findings suggest that HSI can aid clinicians in postoperative mastectomy skin flap and DIEP flap monitoring.
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Affiliation(s)
- Tim Pruimboom
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands;
- Correspondence: (T.P.); (R.M.S.); Tel.: +31-(0)43-3877481 (T.P. & R.M.S.)
| | - Anouk A. M. A. Lindelauf
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
| | - Eric Felli
- Department of Visceral Surgery and Medicine, University of Bern, 3010 Bern, Switzerland;
- Department of Biomedical Research, Hepatology, University of Bern, 3012 Bern, Switzerland
| | - John H. Sawor
- Department of Plastic, Reconstructive, and Hand Surgery, VieCuri Medical Center, 5912 BL Venlo, The Netherlands; (J.H.S.); (A.E.K.D.)
| | - An E. K. Deliaert
- Department of Plastic, Reconstructive, and Hand Surgery, VieCuri Medical Center, 5912 BL Venlo, The Netherlands; (J.H.S.); (A.E.K.D.)
| | - René R. W. J. van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands;
| | - Mahdi Al-Taher
- Department of Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France;
| | - Michele Diana
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France;
- Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, 67200 Strasbourg, France
- ICube Lab, Photonics for Health, University of Strasbourg, 67400 Strasbourg, France
| | - Rutger M. Schols
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands;
- Correspondence: (T.P.); (R.M.S.); Tel.: +31-(0)43-3877481 (T.P. & R.M.S.)
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Jansen-Winkeln B, Germann I, Köhler H, Mehdorn M, Maktabi M, Sucher R, Barberio M, Chalopin C, Diana M, Moulla Y, Gockel I. Correction to: Comparison of hyperspectral imaging and fluorescence angiography for the determination of the transection margin in colorectal resections-a comparative study. Int J Colorectal Dis 2022; 37:1921. [PMID: 35916906 PMCID: PMC9388422 DOI: 10.1007/s00384-022-04227-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Boris Jansen-Winkeln
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, TransplantLeipzig, Germany.
| | - Isabell Germann
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, TransplantLeipzig, Germany
| | - Hannes Köhler
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
| | - Matthias Mehdorn
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, TransplantLeipzig, Germany
| | - Marianne Maktabi
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
| | - Robert Sucher
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, TransplantLeipzig, Germany
| | - Manuel Barberio
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, TransplantLeipzig, Germany
| | - Claire Chalopin
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
| | - Michele Diana
- Institute of Image-Guided Surgery (IHU), IRCAD, Strasbourg, France
| | - Yusef Moulla
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, TransplantLeipzig, Germany
| | - Ines Gockel
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, TransplantLeipzig, Germany
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Schmidt MW, Haney CM, Kowalewski KF, Bintintan VV, Abu Hilal M, Arezzo A, Bahra M, Besselink MG, Biebl M, Boni L, Diana M, Egberts JH, Fischer L, Francis N, Hashimoto DA, Perez D, Schijven M, Schmelzle M, Soltes M, Swanstrom L, Welsch T, Müller-Stich BP, Nickel F. Development and validity evidence of an objective structured assessment of technical skills score for minimally invasive linear-stapled, hand-sewn intestinal anastomoses: the A-OSATS score. Surg Endosc 2022; 36:4529-4541. [PMID: 34755235 PMCID: PMC9085690 DOI: 10.1007/s00464-021-08806-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The aim of this study was to develop a reliable objective structured assessment of technical skills (OSATS) score for linear-stapled, hand-sewn closure of enterotomy intestinal anastomoses (A-OSATS). MATERIALS AND METHODS The Delphi methodology was used to create a traditional and weighted A-OSATS score highlighting the more important steps for patient outcomes according to an international expert consensus. Minimally invasive novices, intermediates, and experts were asked to perform a minimally invasive linear-stapled intestinal anastomosis with hand-sewn closure of the enterotomy in a live animal model either laparoscopically or robot-assisted. Video recordings were scored by two blinded raters assessing intrarater and interrater reliability and discriminative abilities between novices (n = 8), intermediates (n = 24), and experts (n = 8). RESULTS The Delphi process included 18 international experts and was successfully completed after 4 rounds. A total of 4 relevant main steps as well as 15 substeps were identified and a definition of each substep was provided. A maximum of 75 points could be reached in the unweighted A-OSATS score and 170 points in the weighted A-OSATS score respectively. A total of 41 anastomoses were evaluated. Excellent intrarater (r = 0.807-0.988, p < 0.001) and interrater (intraclass correlation coefficient = 0.923-0.924, p < 0.001) reliability was demonstrated. Both versions of the A-OSATS correlated well with the general OSATS and discriminated between novices, intermediates, and experts defined by their OSATS global rating scale. CONCLUSION With the weighted and unweighted A-OSATS score, we propose a new reliable standard to assess the creation of minimally invasive linear-stapled, hand-sewn anastomoses based on an international expert consensus. Validity evidence in live animal models is provided in this study. Future research should focus on assessing whether the weighted A-OSATS exceeds the predictive capabilities of patient outcomes of the unweighted A-OSATS and provide further validity evidence on using the score on different anastomotic techniques in humans.
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Affiliation(s)
- Mona W. Schmidt
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,Department of Gynecology and Obstetrics, University Medical Centre Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Caelan M. Haney
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,Department of Urology, University Hospital Leipzig, Liebigstraße 20, Haus 4, 04103 Leipzig, Germany
| | - Karl-Friedrich Kowalewski
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany ,Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Vasile V. Bintintan
- Department of Surgery, 1st Surgical Clinic, University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Mohammed Abu Hilal
- Department of Surgery, Hepatobiliary Pancreatic and Minimally Invasive Unit, Poliambulanza Foundation Hospital, Brescia, Italy ,Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Marcus Bahra
- Department of Surgical Oncology and Robotics, Waldfriede Hospital, Berlin, Germany
| | - Marc G. Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Matthias Biebl
- Department of Surgery, Charité—Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow Klinikum, Berlin, Germany
| | - Luigi Boni
- Fondazione IRCCS-Ca`Granda - Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | - Michele Diana
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France ,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France ,Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France ,ICube Lab, Photonics for Health, University of Strasbourg, Strasbourg, France
| | - Jan H. Egberts
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, Kurt Semm Center for Minimally Invasive and Robotic Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Lars Fischer
- Department of Surgery, Hospital Mittelbaden, Baden-Baden, Germany
| | - Nader Francis
- Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Yeovil, UK
| | | | - Daniel Perez
- Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlies Schijven
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Moritz Schmelzle
- Department of Surgery, Charité—Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow Klinikum, Berlin, Germany
| | - Marek Soltes
- 1St Department of Surgery, University of Pavol Jozef Safarik, Košice, Slovakia
| | - Lee Swanstrom
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Thilo Welsch
- Department of Visceral, Thoracic, and Vascular Surgery, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Beat P. Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Spota A, Al-Taher M, Felli E, Morales Conde S, Dal Dosso I, Moretto G, Spinoglio G, Baiocchi G, Vilallonga R, Impellizzeri H, Martin-Martin GP, Casali L, Franzini C, Silvestri M, de Manzini N, Castagnola M, Filauro M, Cosola D, Copaescu C, Garbarino GM, Pesce A, Calabrò M, de Nardi P, Anania G, Carus T, Boni L, Patané A, Santi C, Saadi A, Rollo A, Chautems R, Noguera J, Grosek J, D'Ambrosio G, Ferreira CM, Norcic G, Navarra G, Riva P, Quaresima S, Paganini A, Rosso N, De Paolis P, Balla A, Sauvain MO, Gialamas E, Bianchi G, La Greca G, Castoro C, Picchetto A, Franchello A, Tartamella L, Juvan R, Ioannidis O, Kosir JA, Bertani E, Stassen L, Marescaux J, Diana M. Fluorescence-based bowel anastomosis perfusion evaluation: results from the IHU-IRCAD-EAES EURO-FIGS registry. Surg Endosc 2021; 35:7142-7153. [PMID: 33492508 DOI: 10.1007/s00464-020-08234-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Near-infrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry. METHODS Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications. RESULTS A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013-0.89 mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not. CONCLUSION The EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery.
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Affiliation(s)
- Andrea Spota
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France
- Scuola di Specializzazione in Chirurgia Generale, Università Degli Studi di Milano, Milano, Italy
| | - Mahdi Al-Taher
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Eric Felli
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Salvador Morales Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Sevilla, Spain
- General and Digestive Unit, Hospital Quironsalud Sagrado Corazon, Sevilla, Spain
| | | | | | | | - Gianluca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | | | | | | | | | | | | | | | | | - Davide Cosola
- Clinica Chirurgica, University of Trieste, Trieste, Italy
| | | | - Giovanni Maria Garbarino
- San Pietro Fatebenefratelli Hospital, Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Roma, Italy
| | | | | | | | | | | | - Luigi Boni
- Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico di Milano, University of Milan, Milano, Italy
| | | | | | - Alend Saadi
- Réseau Hospitalier Neuchâtelois, Neuchatel, Switzerland
| | | | | | | | - Jan Grosek
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Giancarlo D'Ambrosio
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | | | - Gregor Norcic
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Pietro Riva
- Unit of Foregut Surgery, IRCCS Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Alessandro Paganini
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | | | | | - Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | | | | | | | | | - Carlo Castoro
- Unit of Foregut Surgery, IRCCS Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | - Andrea Picchetto
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | | | | | - Robert Juvan
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | | | | | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jacques Marescaux
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France
| | - Michele Diana
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France.
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.
- Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.
- ICube Lab, Photonics for Health, University of Strasbourg, Strasbourg, France.
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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: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Okamoto N, Al-Taher M, Mascagni P, Vazquez AG, Takeuchi M, Marescaux J, Diana M, Dallemagne B. Robotic endoscopic cooperative surgery for colorectal tumors: a feasibility study (with video). Surg Endosc 2021; 36:826-832. [PMID: 34741202 DOI: 10.1007/s00464-021-08786-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Laparoscopic endoscopic cooperative colorectal surgery (LECS-CR) is a promising technique to achieve full-thickness resection of colorectal tumors. This approach has shown good rates of complete resection and low local recurrence, especially for large laterally spreading tumors, which are difficult to remove via endoscopy alone. However, it is often difficult to prevent peritoneal leakage of intestinal content, causing infections and risks of cancer spreading. It was hypothesized that a robotic assistance could make the procedure easier and decrease intestinal fluid leakage. This preclinical trial aims to assess the feasibility of robotic and endoscopic cooperative colorectal surgery (RECS-CR). METHODS LECS-CR was performed in five female pigs and RECS-CR was also performed in five female pigs. With the animal under general anesthesia, pseudotumors were created on the colonic mucosa at a distance comprised between 20 and 25 cm from the anal verge. Desired resection margins were marked endoscopically and two stay sutures were placed either robotically or laparoscopically. A mucosa-to-submucosa dissection was performed endoscopically along the markings. Complete full-thickness dissection was performed cooperatively. The specimen was withdrawn endoscopically. The colon was closed using a self-fixating running suture. Abdominal contaminations, operating times, complications, and complete resections were evaluated and compared between LECS-CR and RECS-CR. RESULTS The mean number of colonies of Escherichia coli in the RECS group was significantly lower than in the LECS group (36.7 ± 30.2 vs. 142.2 ± 78.4, respectively, p < 0.05). Operating time was comparable (118 ± 11.2 vs. 98.6 ± 25.7, respectively, p = 0.22). Two stenoses occurred in the LECS group. R0 resection was achieved in all cases. CONCLUSION This study suggests that RECS-CR is feasible and has the potential to reduce intestinal content leakage, potentially preventing postoperative infections.
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Affiliation(s)
- Nariaki Okamoto
- IRCAD, Research Institute Against Digestive Cancer, 1, place de l'Hôpital, 67091, Strasbourg, France.
| | - Mahdi Al-Taher
- IRCAD, Research Institute Against Digestive Cancer, 1, place de l'Hôpital, 67091, Strasbourg, France.,Department of Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Pietro Mascagni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | | | - Masashi Takeuchi
- IRCAD, Research Institute Against Digestive Cancer, 1, place de l'Hôpital, 67091, Strasbourg, France.,Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Jacques Marescaux
- IRCAD, Research Institute Against Digestive Cancer, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, 1, place de l'Hôpital, 67091, Strasbourg, France.,Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Bernard Dallemagne
- IRCAD, Research Institute Against Digestive Cancer, 1, place de l'Hôpital, 67091, Strasbourg, France.,Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
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Felli E, Ishizawa T, Cherkaoui Z, Diana M, Tripon S, Baumert TF, Schuster C, Pessaux P. Laparoscopic anatomical liver resection for malignancies using positive or negative staining technique with intraoperative indocyanine green-fluorescence imaging. HPB (Oxford) 2021; 23:1647-1655. [PMID: 34289953 DOI: 10.1016/j.hpb.2021.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Indications for a minimally invasive resections are increasing worldwide, but respecting anatomical planes during intraparenchymal transection is demanding. Intraoperative ICG fluorescence staining of liver parenchyma has been introduced as a tool for real-time intraoperative guidance. The aim of this study is to make a systematic review of the current relevant literature on indications, techniques, and results of laparoscopic anatomical liver resection (LALR) using intraoperative indocyanine green (ICG) fluorescence for positive and negative staining of liver segments in patients affected by liver malignancies. METHODS Electronic bibliographical databases (MEDLINE and PubMed) were searched according to the PRISMA criteria. English language articles meeting the selection criteria and published until June 2020 were retrieved and reviewed. RESULTS a total of 86 articles were initially found and 11 articles were finally included in the analysis with a total of 83 patients treated. Sixty-two patients (74.6%) underwent mono-segmentectomies. Thirty-five patients (42.1%) underwent the positive staining technique, and forty-eight patients (57.8%) the negative staining technique. CONCLUSIONS The positive or negative indocyanine green staining technique with real-time fluorescence guidance is an emerging and promising approach. However, the technique has to be standardized and advantages in terms of oncologic results still need validation in further studies.
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Affiliation(s)
- Emanuele Felli
- Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France; IHU Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France; IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France; Institute of Viral and Liver Disease, INSERM U1110, Strasbourg, France
| | - Takeaki Ishizawa
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Japan; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Zineb Cherkaoui
- Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France; IHU Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France
| | - Michele Diana
- Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France; IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Simona Tripon
- Hepatology and Gastroenterology Department, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France; Institute of Viral and Liver Disease, INSERM U1110, Strasbourg, France
| | - Thomas F Baumert
- Hepatology and Gastroenterology Department, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France; Institute of Viral and Liver Disease, INSERM U1110, Strasbourg, France
| | | | - Patrick Pessaux
- Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France; IHU Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France; IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France; Institute of Viral and Liver Disease, INSERM U1110, Strasbourg, France.
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Ishizawa T, McCulloch P, Muehrcke D, Carus T, Wiesel O, Dapri G, Schneider-Koriath S, Wexner SD, Abu-Gazala M, Boni L, Cassinotti E, Sabbagh C, Cahill R, Ris F, Carvello M, Spinelli A, Vibert E, Terasawa M, Takao M, Hasegawa K, Schols RM, Pruimboom T, Murai Y, Matano F, Bouvet M, Diana M, Kokudo N, Dip F, White K, Rosenthal RJ. Assessing the development status of intraoperative fluorescence imaging for perfusion assessments, using the IDEAL framework. BMJ Surg Interv Health Technologies 2021; 3:e000088. [PMID: 35047805 PMCID: PMC8749280 DOI: 10.1136/bmjsit-2021-000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives Intraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: assessing tissue perfusion; identifying/localizing cancer; mapping lymphatic systems; and visualizing anatomy. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging for perfusion assessments using the Idea, Development, Exploration, Assessment, Long Term Study (IDEAL) framework, which was designed for describing the stages of innovation in surgery and other interventional procedures. Design Narrative literature review with analysis of IDEAL stage of each field of study. Setting All publications on intraoperative fluorescence imaging for perfusion assessments reported in PubMed through 2019 were identified for six surgical procedures: coronary artery bypass grafting (CABG), upper gastrointestinal (GI) surgery, colorectal surgery, solid organ transplantation, reconstructive surgery, and cerebral aneurysm surgery. Main outcome measures The IDEAL stage of research evidence was determined for each specialty field using a previously described approach. Results 196 articles (15 003 cases) were selected for analysis. Current status of research evidence was determined to be IDEAL Stage 2a for upper GI and transplantation surgery, IDEAL 2b for CABG, colorectal and cerebral aneurysm surgery, and IDEAL Stage 3 for reconstructive surgery. Using the technique resulted in a high (up to 50%) rate of revisions among surgical procedures, but its efficacy improving postoperative outcomes has not yet been demonstrated by randomized controlled trials in any discipline. Only one possible adverse reaction to intravenous indocyanine green was reported. Conclusions Using fluorescence imaging intraoperatively to assess perfusion is feasible and appears useful for surgical decision making across a range of disciplines. Identifying the IDEAL stage of current research knowledge aids in planning further studies to establish the potential for patient benefit.
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Affiliation(s)
- Takeaki Ishizawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Peter McCulloch
- IDEAL Collaboration, Nuffield Department of Surgical Science, University of Oxford, John Radcliffe Hospital, Oxford, Oxfordshire, UK
| | | | | | - Ory Wiesel
- Maimonides Medical Center, Brooklyn, New York, USA
- Rabin Medical Center, Petah Tikva, Israel
| | - Giovanni Dapri
- Saint-Pierre University Hospital, Bruxelles, Bruxelles, Belgium
| | | | | | - Mahmoud Abu-Gazala
- General Surgery Department, Hadassah Medical Center Hebrew University Biotechnology Park, Jerusalem, Jerusalem, Israel
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Amiens, Hauts-de-France, France
- Simplication of Surgical Pateint Care Research Unit, University of Picardie Jules Verne, Amiens, France
| | - Ronan Cahill
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Frederic Ris
- Service of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Michele Carvello
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy
| | - Eric Vibert
- Centre Hépato-Biliaire, Hopital Universitaire Paul Brousse, Villejuif, France
| | - Muga Terasawa
- Centre Hépato-Biliaire, Hopital Universitaire Paul Brousse, Villejuif, France
| | - Mikiya Takao
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Rutger M Schols
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre+, Maastricht, Limburg, Netherlands
| | - Tim Pruimboom
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre+, Maastricht, Limburg, Netherlands
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Michael Bouvet
- University of California San Diego, La Jolla, California, USA
| | - Michele Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France
| | - Norihiro Kokudo
- National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Fernando Dip
- Cleveland Clinic Florida, Weston, Florida, USA
- Hospital de Clinicas Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina
| | - Kevin White
- Science Right Research Consulting London, Ontario, Canada
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Collins T, Maktabi M, Barberio M, Bencteux V, Jansen-Winkeln B, Chalopin C, Marescaux J, Hostettler A, Diana M, Gockel I. Automatic Recognition of Colon and Esophagogastric Cancer with Machine Learning and Hyperspectral Imaging. Diagnostics (Basel) 2021; 11:diagnostics11101810. [PMID: 34679508 PMCID: PMC8535008 DOI: 10.3390/diagnostics11101810] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/18/2021] [Accepted: 09/23/2021] [Indexed: 01/23/2023] Open
Abstract
There are approximately 1.8 million diagnoses of colorectal cancer, 1 million diagnoses of stomach cancer, and 0.6 million diagnoses of esophageal cancer each year globally. An automatic computer-assisted diagnostic (CAD) tool to rapidly detect colorectal and esophagogastric cancer tissue in optical images would be hugely valuable to a surgeon during an intervention. Based on a colon dataset with 12 patients and an esophagogastric dataset of 10 patients, several state-of-the-art machine learning methods have been trained to detect cancer tissue using hyperspectral imaging (HSI), including Support Vector Machines (SVM) with radial basis function kernels, Multi-Layer Perceptrons (MLP) and 3D Convolutional Neural Networks (3DCNN). A leave-one-patient-out cross-validation (LOPOCV) with and without combining these sets was performed. The ROC-AUC score of the 3DCNN was slightly higher than the MLP and SVM with a difference of 0.04 AUC. The best performance was achieved with the 3DCNN for colon cancer and esophagogastric cancer detection with a high ROC-AUC of 0.93. The 3DCNN also achieved the best DICE scores of 0.49 and 0.41 on the colon and esophagogastric datasets, respectively. These scores were significantly improved using a patient-specific decision threshold to 0.58 and 0.51, respectively. This indicates that, in practical use, an HSI-based CAD system using an interactive decision threshold is likely to be valuable. Experiments were also performed to measure the benefits of combining the colorectal and esophagogastric datasets (22 patients), and this yielded significantly better results with the MLP and SVM models.
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Affiliation(s)
- Toby Collins
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.B.); (J.M.); (A.H.); (M.D.)
- Correspondence:
| | - Marianne Maktabi
- Innovation Center Computer-Assisted Surgery (ICCAS), University of Leipzig, 04103 Leipzig, Germany; (M.M.); (C.C.)
| | - Manuel Barberio
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.B.); (J.M.); (A.H.); (M.D.)
- General Surgery Department, Card. G. Panico, 73039 Tricase, Italy
| | - Valentin Bencteux
- ICUBE Laboratory, Photonics Instrumentation for Health, University of Strasbourg, 67400 Strasbourg, France;
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (B.J.-W.); (I.G.)
| | - Claire Chalopin
- Innovation Center Computer-Assisted Surgery (ICCAS), University of Leipzig, 04103 Leipzig, Germany; (M.M.); (C.C.)
| | - Jacques Marescaux
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.B.); (J.M.); (A.H.); (M.D.)
| | - Alexandre Hostettler
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.B.); (J.M.); (A.H.); (M.D.)
| | - Michele Diana
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.B.); (J.M.); (A.H.); (M.D.)
- ICUBE Laboratory, Photonics Instrumentation for Health, University of Strasbourg, 67400 Strasbourg, France;
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, 67091 Strasbourg, France
- INSERM, Institute of Viral and Liver Disease, 67091 Strasbourg, France
- Mitochondrion, Oxidative Stress and Muscle Protection (MSP)-EA 3072, Institute of Physiology, Faculty of Medicine, University of Strasbourg, 67085 Strasbourg, France
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany; (B.J.-W.); (I.G.)
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Pesce A, Piccolo G, Lecchi F, Fabbri N, Diana M, Feo CV. Fluorescent cholangiography: An up-to-date overview twelve years after the first clinical application. World J Gastroenterol 2021; 27:5989-6003. [PMID: 34629815 PMCID: PMC8476339 DOI: 10.3748/wjg.v27.i36.5989] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/10/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic cholecystectomy (LC) is one of the most frequently performed gastrointestinal surgeries worldwide. Bile duct injury (BDI) represents the most serious complication of LC, with an incidence of 0.3%-0.7%, resulting in significant perioperative morbidity and mortality, impaired quality of life, and high rates of subsequent medico-legal litigation. In most cases, the primary cause of BDI is the misinterpretation of biliary anatomy, leading to unexpected biliary lesions. Near-infrared fluorescent cholangiography is widely spreading in clinical practice to delineate biliary anatomy during LC in elective and emergency settings. The primary aim of this article was to perform an up-to-date overview of the evolution of this method 12 years after the first clinical application in 2009 and to highlight all advantages and current limitations according to the available scientific evidence.
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Affiliation(s)
- Antonio Pesce
- Department of Surgery, Section of General Surgery, Ospedale del Delta, Azienda USL of Ferrara, University of Ferrara, Ferrara 44023, Italy
| | - Gaetano Piccolo
- Department of Health Sciences, University of Milan, Unit of Hepato-Bilio-Pancreatic and Digestive Surgery, San Paolo Hospital, Milano 20142, Italy
| | - Francesca Lecchi
- Department of Health Sciences, University of Milan, Unit of Hepato-Bilio-Pancreatic and Digestive Surgery, San Paolo Hospital, Milano 20142, Italy
| | - Nicolò Fabbri
- Department of Surgery, Section of General Surgery, Ospedale del Delta, Azienda USL of Ferrara, University of Ferrara, Ferrara 44023, Italy
| | - Michele Diana
- Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, IRCAD, Research Institute Against Digestive Cancer, ICUBE lab, PHOTONICS for Health, University of Strasbourg, Strasbourg Cedex F-67091, France
| | - Carlo Vittorio Feo
- Department of Surgery, Section of General Surgery, Ospedale del Delta, Azienda USL of Ferrara, University of Ferrara, Ferrara 44023, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Barberio M, Collins T, Bencteux V, Nkusi R, Felli E, Viola MG, Marescaux J, Hostettler A, Diana M. Deep Learning Analysis of In Vivo Hyperspectral Images for Automated Intraoperative Nerve Detection. Diagnostics (Basel) 2021; 11:1508. [PMID: 34441442 PMCID: PMC8391550 DOI: 10.3390/diagnostics11081508] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/27/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022] Open
Abstract
Nerves are critical structures that may be difficult to recognize during surgery. Inadvertent nerve injuries can have catastrophic consequences for the patient and lead to life-long pain and a reduced quality of life. Hyperspectral imaging (HSI) is a non-invasive technique combining photography with spectroscopy, allowing non-invasive intraoperative biological tissue property quantification. We show, for the first time, that HSI combined with deep learning allows nerves and other tissue types to be automatically recognized in in vivo hyperspectral images. An animal model was used, and eight anesthetized pigs underwent neck midline incisions, exposing several structures (nerve, artery, vein, muscle, fat, skin). State-of-the-art machine learning models were trained to recognize these tissue types in HSI data. The best model was a convolutional neural network (CNN), achieving an overall average sensitivity of 0.91 and a specificity of 1.0, validated with leave-one-patient-out cross-validation. For the nerve, the CNN achieved an average sensitivity of 0.76 and a specificity of 0.99. In conclusion, HSI combined with a CNN model is suitable for in vivo nerve recognition.
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Affiliation(s)
- Manuel Barberio
- Department of Research, Institute of Image-Guided Surgery, IHU-Strasbourg, 67091 Strasbourg, France; (V.B.); (E.F.)
- Department of Research, Research Institute against Digestive Cancer, IRCAD, 67091 Strasbourg, France; (T.C.); (J.M.); (A.H.); (M.D.)
- Department of Surgery, Ospedale Card. G. Panico, 73039 Tricase, Italy;
| | - Toby Collins
- Department of Research, Research Institute against Digestive Cancer, IRCAD, 67091 Strasbourg, France; (T.C.); (J.M.); (A.H.); (M.D.)
| | - Valentin Bencteux
- Department of Research, Institute of Image-Guided Surgery, IHU-Strasbourg, 67091 Strasbourg, France; (V.B.); (E.F.)
| | - Richard Nkusi
- Department of Research, Research Institute against Digestive Cancer, IRCAD Africa, Kigali 2 KN 30 ST, Rwanda;
| | - Eric Felli
- Department of Research, Institute of Image-Guided Surgery, IHU-Strasbourg, 67091 Strasbourg, France; (V.B.); (E.F.)
| | | | - Jacques Marescaux
- Department of Research, Research Institute against Digestive Cancer, IRCAD, 67091 Strasbourg, France; (T.C.); (J.M.); (A.H.); (M.D.)
| | - Alexandre Hostettler
- Department of Research, Research Institute against Digestive Cancer, IRCAD, 67091 Strasbourg, France; (T.C.); (J.M.); (A.H.); (M.D.)
| | - Michele Diana
- Department of Research, Research Institute against Digestive Cancer, IRCAD, 67091 Strasbourg, France; (T.C.); (J.M.); (A.H.); (M.D.)
- ICUBE Laboratory, Photonics Instrumentation for Health, 67412 Strasbourg, France
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Shlomovitz E, Patel NR, Diana M, Pescarus R, Swanström LL. Percutaneous Transgastric Duodenal Stenting and Gastrostomy Repair Using a Vascular Closure Device: Proof of Concept in a Porcine Model. Surg Innov 2021; 29:139-144. [PMID: 34243695 PMCID: PMC9016659 DOI: 10.1177/15533506211031070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. Gastroduodenal stenting is efficacious and safe in both benign and malignant foregut diseases. Transgastric duodenal stenting has been described and however requires a gastrostomy tube to remain in situ for 4 to 6 weeks post-procedure which can lead to complications. We present a technique for immediate gastric repair using a suture-mediated vascular closure device, without the need for a gastrostomy tube in porcine models. Methods. Percutaneous access into the stomach was achieved using fluoroscopy. Two or 3 Perclose Proglide devices were pre-deployed. The tract was dilated and a wire advanced into the distal duodenum. A 15.5 cm covered enteric stent was delivered through the gastrostomy, deployed and position confirmed. The gastrostomy was closed using Perclose Proglide sutures. Necropsy leak pressure measurement was performed to assess integrity of gastrostomy closure in the porcine models. Results. Two (n = 8) or 3 (n = 2) Perclose Proglide devices were deployed in ten porcine models, with 1 misfire (4.5%). Percutaneous transgastric access and stent delivery was successful in all porcine models. Mean leak pressure in the animals with adequately deployed devices was 219 mmHg (range 172 mmHg-270 mmHg). Conclusion. This study demonstrates percutaneous transgastric duodenal stenting with immediate gastric repair using suture-mediated vascular closure devices is a feasible procedure.
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Affiliation(s)
- Eran Shlomovitz
- Department of Interventional Radiology, 7989University Health Network, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Intitute Hospitalo-Universitaire Strasbourg, Strasbourg, France
| | - Neeral R Patel
- Department of Interventional Radiology, 7989University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michele Diana
- Department of Surgery, Intitute Hospitalo-Universitaire Strasbourg, Strasbourg, France
| | - Radu Pescarus
- Department of Surgery, 67120Hôspital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Lee L Swanström
- Department of Surgery, Intitute Hospitalo-Universitaire Strasbourg, Strasbourg, France
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Felli E, Felli E, Muttillo EM, Memeo R, Giannelli V, Colasanti M, Pellicelli A, Diana M, Ettorre GM. Liver transplantation for sickle cell disease: a systematic review. HPB (Oxford) 2021; 23:994-999. [PMID: 33431265 DOI: 10.1016/j.hpb.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sickle cell disease is a group of autosomal recessive disorders characterised by haemolytic anaemia. Liver is one of the most affected organs, ranging from liver tests alterations to acute liver failure for which liver transplantation is the only life-saving treatment. METHODS This study aims to make a systematic review of the current literature to evaluate indications, timing, and results of liver transplantation for patients affected by SCD. RESULTS Twenty-nine patients in total were reported worldwide until 2018, the average patient age is 28.7 (0.42-56), all patients have a pre-transplant diagnosis of SCD. Cirrhosis at transplantation was present in six-teen (n = 16, 55.1%) patients. In ten patients (n = 10, 34.5%), acute liver failure arises from healthy liver and presented sickle cell intrahepatic cholestasis. Eleven patients (n = 11, 39.2%) died, three (n = 3, 10.7%) in the first postoperative month, and seven (n = 7, 25%) in the first year. Mean follow-up was 27 months (range: 7-96), one-year overall survival was 48.7%. DISCUSSION Liver transplantation for SCD has been increasingly reported with encouraging results. Indications are presently reserved for acute liver failure arising both in healthy liver and end-stage liver disease.
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Affiliation(s)
- Emanuele Felli
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France; IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France; Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France; Institute of Viral and Liver Disease, Inserm U1110, Strasbourg, France.
| | - Eric Felli
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France; Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Edoardo M Muttillo
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France; Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Riccardo Memeo
- Division of Hepato-Pancreato-Biliary Surgery, "F. Miulli" General Hospital, Acquaviva Delle Fonti, Bari, Italy; Liver Transplant Unit, Policlinico di Bari, Bari, Italy
| | - Valerio Giannelli
- San Camillo Hospital, Department of Transplantation and General Surgery, Rome, Italy
| | - Marco Colasanti
- San Camillo Hospital, Department of Transplantation and General Surgery, Rome, Italy
| | - Adriano Pellicelli
- San Camillo Hospital, Department of Transplantation and General Surgery, Rome, Italy
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France; Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France; ICUBE Laboratory, Photonics Instrumentation for Health, University of Strasbourg, Strasbourg, France
| | - Giuseppe M Ettorre
- San Camillo Hospital, Department of Transplantation and General Surgery, Rome, Italy
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Giménez ME, Garcia Vazquez A, Davrieux CF, Verde JM, Serra E, Palermo M, Houghton EJ, Dallemagne B, Perretta S, Acquafresca PA, Diana M, Marescaux J. Image-Guided Surgical Training in Percutaneous Hepatobiliary Procedures: Development of a Realistic and Meaningful Bile Duct Dilatation Porcine Model. J Laparoendosc Adv Surg Tech A 2021; 31:790-795. [DOI: 10.1089/lap.2020.0680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Mariano Eduardo Giménez
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Alain Garcia Vazquez
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Carlos Federico Davrieux
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Juan M. Verde
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Edgardo Serra
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Mariano Palermo
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Eduardo Javier Houghton
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Bernard Dallemagne
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Silvana Perretta
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Pablo Agustín Acquafresca
- DAICIM Foundation, Teaching, Research, Assistance in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
| | - Jacques Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
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48
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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]. Z Gastroenterol 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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49
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Cinelli L, Felli E, Muttillo EM, Fiorentini G, Diana M, Pessaux P, Felli E. Prepancreatic common hepatic artery arising from superior mesenteric artery: an exceptional but important finding during pancreaticoduodenectomy. Surg Radiol Anat 2021; 43:1413-1420. [PMID: 34117902 DOI: 10.1007/s00276-021-02786-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The hepato-mesenteric trunk is an extremely rare condition in which the common hepatic artery (CHA) originates from the superior mesenteric artery (SMA). Usually, CHA passes behind the head of the pancreas. A systematic review was performed to provide guidelines for the perioperative management of patients with this anatomical variation who underwent a pancreaticoduodenectomy (PD). A case report was also included. METHODS A systematic search of the literature was conducted and the manuscript was structured following point-by-point the PRISMA guidelines. The risk of bias within individual studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist tools. Case report was structured according to the CARE guidelines. RESULTS After an initial selection of 141 titles, 9 articles were included in the study (n = 10 patients). A postoperative surgical complication which required a reintervention occurred only one time. In four patients, CHA had a posterior position relative to pancreas, while in three cases, it was anterior. The remaining three patients had an intrapancreatic course. The CHA was resected in two patients, with an end-to-end reconstruction or using the splenic artery stump. In only three patients, a preoperative multidisciplinary presentation was performed and in four cases, the CHA variation was not described by radiologists in formal CT-scan reports. CONCLUSION Although there are no definitive guidelines, improvements in the preoperative knowledge of such a rare anatomical variation may ensure better postoperative outcomes, avoiding intraoperative accidents and life-threatening postoperative complications.
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Affiliation(s)
- Lorenzo Cinelli
- IRCCS San Raffaele Scientific Institute, Milan, Italy.,Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Eric Felli
- Hepatology, Department of Biomedical Research, Inselspital, Bern University, Bern, Switzerland
| | | | - Guido Fiorentini
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michele Diana
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France.,University of Strasbourg, Strasbourg, France
| | - Patrick Pessaux
- HPB Unit, Digestive Surgery Department, Nouvel Hopital Civil, University of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg, France
| | - Emanuele Felli
- HPB Unit, Digestive Surgery Department, Nouvel Hopital Civil, University of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg, France.
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50
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Al-Taher M, Pruimboom T, Schols RM, Okamoto N, Bouvy ND, Stassen LPS, van der Hulst RRWJ, Kugler M, Hostettler A, Noll E, Marescaux J, Diemunsch S, Diana M. Influence of intraoperative vasopressor use on indocyanine green fluorescence angiography: first evaluation in an experimental model. Sci Rep 2021; 11:9650. [PMID: 33958693 PMCID: PMC8102475 DOI: 10.1038/s41598-021-89223-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/22/2021] [Indexed: 12/13/2022] Open
Abstract
Intraoperative indocyanine green (ICG) fluorescence angiography has gained popularity and acceptance in many surgical fields for the real-time assessment of tissue perfusion. Although vasopressors have the potential to preclude an accurate assessment of tissue perfusion, there is a lack of literature with regards to its effect on ICG fluorescence angiography. An experimental porcine model was used to expose the small bowel for quantitative tissue perfusion assessment. Three increasing doses of norepinephrine infusion (0.1, 0.5, and 1.0 µg/kg/min) were administered intravenously over a 25-min interval. Time-to-peak fluorescence intensity (TTP) was the primary outcome. Secondary outcomes included absolute fluorescence intensity and local capillary lactate (LCL) levels. Five large pigs (mean weight: 40.3 ± 4.24 kg) were included. There was no significant difference in mean TTP (in seconds) at baseline (4.23) as compared to the second (3.90), third (4.41), fourth (4.60), and fifth ICG assessment (5.99). As a result of ICG accumulation, the mean and the maximum absolute fluorescence intensity were significantly different as compared to the baseline assessment. There was no significant difference in LCL levels (in mmol/L) at baseline (0.74) as compared to the second (0.82), third (0.64), fourth (0.60), and fifth assessment (0.62). Increasing doses of norepinephrine infusion have no significant influence on bowel perfusion using ICG fluorescence angiography.
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Affiliation(s)
- Mahdi Al-Taher
- IRCAD, Research Institute Against Digestive Cancer, 1, Place de l'Hôpital, 67000, Strasbourg, France. .,Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Tim Pruimboom
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Rutger M Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Nariaki Okamoto
- IRCAD, Research Institute Against Digestive Cancer, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - René R W J van der Hulst
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Michael Kugler
- IRCAD, Research Institute Against Digestive Cancer, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - Alexandre Hostettler
- IRCAD, Research Institute Against Digestive Cancer, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - Eric Noll
- Department of Anesthesiology, Critical Care and Prehospital Emergency Medicine, University Hospital of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- IRCAD, Research Institute Against Digestive Cancer, 1, Place de l'Hôpital, 67000, Strasbourg, France
| | - Sophie Diemunsch
- Department of Anesthesiology, Critical Care and Prehospital Emergency Medicine, University Hospital of Strasbourg, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, 1, Place de l'Hôpital, 67000, Strasbourg, France.,Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.,ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
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