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Barberio M, Pizzicannella M, Spota A, Ashoka AH, Agnus V, Al Taher M, Jansen-Winkeln B, Gockel I, Marescaux J, Swanström L, Kong SH, Felli E, Klymchenko A, Diana M. Preoperative endoscopic marking of the gastrointestinal tract using fluorescence imaging: submucosal indocyanine green tattooing versus a novel fluorescent over-the-scope clip in a survival experimental study. Surg Endosc 2020; 35:5115-5123. [PMID: 32989536 PMCID: PMC8346416 DOI: 10.1007/s00464-020-07999-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intraoperative localization of endoluminal lesions is can be difficult during laparoscopy. Preoperative endoscopic marking is therefore necessary. Current methods include submucosal tattooing using visible dyes, which in case of transmural injection can impair surgical dissection. Tattooing using indocyanine green (ICG) coupled to intraoperative near-infrared (NIR) laparoscopy has been described. ICG is only visible under NIR-light, therefore, it doesn't impair the surgical workflow under white light even if there is spillage. However, ICG tattoos have rapid diffusion and short longevity. We propose fluorescent over-the-scope clips (FOSC), using a novel biocompatible fluorescent paint, as durable lesion marking. METHODS In six pigs, gastric and colonic endoscopic tattoos using 0.05 mg/mL of ICG and markings using the fluorescent OSC were performed (T0). Simultaneously, NIR laparoscopy was executed. Follow-up laparoscopies were conducted at postoperative day (POD) 4-6 (T1) and POD 11-12 (T2). During laparoscopy, fluorescence intensity was assessed. In one human cadaver, FOSC was used to mark a site on the stomach and on the sigmoid colon, respectively. Intraoperative detection during NIR laparoscopy was assessed. RESULTS Gastric and colonic ICG tattooing and OSC markings were easily visible using NIR laparoscopy on T0. All FOSC were visible at T1 and T2 in both stomach and colon, whereas the ICG tattooing at T1 was only visible in the stomach of 2 animals and in the colon of 3 animals. At T2, tattoos were not visible in any animal. FOSC were still visible in both stomach and colon of the human cadaver at 10 days. CONCLUSION Endoscopic marking using FOSC can be an efficient and durable alternative to standard methods.
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Affiliation(s)
- Manuel Barberio
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France.
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany.
| | - Margherita Pizzicannella
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Andrea Spota
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Anila Hoskere Ashoka
- Laboratoire de Bio-Imagerie et Pathologies, UMR 7021 CNRS, Université de Strasbourg, Strasbourg, France
| | - Vincent Agnus
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Mahdi Al Taher
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Jacques Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Lee Swanström
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Seong-Ho Kong
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
- Department of Surgery, Seoul National University, Seoul, South Korea
| | - Eric Felli
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
| | - Andrey Klymchenko
- Laboratoire de Bio-Imagerie et Pathologies, UMR 7021 CNRS, Université de Strasbourg, Strasbourg, France
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
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