B Jansen-Winkeln1, M Maktabi2, J P Takoh1, S M Rabe1, M Barberio1,3, H Köhler2, T Neumuth2, A Melzer2, C Chalopin2, I Gockel4. 1. Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland. 2. Innovation Center Computer Assisted Surgery (ICCAS), Universität Leipzig, Leipzig, Deutschland. 3. Institut de Recherche contre les Cancers de l'Appareil Digestive (IRCAD), Straßburg, Frankreich. 4. Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland. ines.gockel@medizin.uni-leipzig.de.
Abstract
INTRODUCTION: Anastomotic insufficiency (AI) remains the most feared surgical complication in gastrointestinal surgery, which is closely associated with a prolonged inpatient hospital stay and significant postoperative mortality. Hyperspectral imaging (HSI) is a relatively new medical imaging procedure which has proven to be promising in tissue identification as well as in the analysis of tissue oxygenation and water content. Until now, no data exist on the in vivo HSI analysis of gastrointestinal anastomoses. METHODS: Intraoperative images were obtained using the TIVITA™ tissue system HSI camera from Diaspective Vision GmbH (Pepelow, Germany). In 47 patients who underwent gastrointestinal surgery with esophageal, gastric, pancreatic, small bowel or colorectal anastomoses, 97 assessable recordings were generated. Parameters obtained at the sites of the anastomoses included tissue oxygenation (StO2), the tissue hemoglobin index (THI), near-infrared (NIR) perfusion index, and tissue water index (TWI). RESULTS: Obtaining and analyzing the intraoperative images with this non-invasive imaging system proved practicable and delivered good results on a consistent basis. A NIR gradient along and across the anastomosis was observed and, furthermore, analysis of the tissue water and oxygenation content showed specific changes at the site of anastomosis. CONCLUSION: The HSI method provides a non-contact, non-invasive, intraoperative imaging procedure without the use of a contrast medium, which enables a real-time analysis of physiological anastomotic parameters, which may contribute to determine the "ideal" anastomotic region. In light of this, the establishment of this methodology in the field of visceral surgery, enabling the generation of normal or cut off values for different gastrointestinal anastomotic types, is an obvious necessity.
INTRODUCTION:Anastomotic insufficiency (AI) remains the most feared surgical complication in gastrointestinal surgery, which is closely associated with a prolonged inpatient hospital stay and significant postoperative mortality. Hyperspectral imaging (HSI) is a relatively new medical imaging procedure which has proven to be promising in tissue identification as well as in the analysis of tissue oxygenation and water content. Until now, no data exist on the in vivo HSI analysis of gastrointestinal anastomoses. METHODS: Intraoperative images were obtained using the TIVITA™ tissue system HSI camera from Diaspective Vision GmbH (Pepelow, Germany). In 47 patients who underwent gastrointestinal surgery with esophageal, gastric, pancreatic, small bowel or colorectal anastomoses, 97 assessable recordings were generated. Parameters obtained at the sites of the anastomoses included tissue oxygenation (StO2), the tissue hemoglobin index (THI), near-infrared (NIR) perfusion index, and tissue water index (TWI). RESULTS: Obtaining and analyzing the intraoperative images with this non-invasive imaging system proved practicable and delivered good results on a consistent basis. A NIR gradient along and across the anastomosis was observed and, furthermore, analysis of the tissue water and oxygenation content showed specific changes at the site of anastomosis. CONCLUSION: The HSI method provides a non-contact, non-invasive, intraoperative imaging procedure without the use of a contrast medium, which enables a real-time analysis of physiological anastomotic parameters, which may contribute to determine the "ideal" anastomotic region. In light of this, the establishment of this methodology in the field of visceral surgery, enabling the generation of normal or cut off values for different gastrointestinal anastomotic types, is an obvious necessity.
Authors: Mehraneh D Jafari; Steven D Wexner; Joseph E Martz; Elisabeth C McLemore; David A Margolin; Danny A Sherwinter; Sang W Lee; Anthony J Senagore; Michael J Phelan; Michael J Stamos Journal: J Am Coll Surg Date: 2014-09-28 Impact factor: 6.113
Authors: I Gockel; B Jansen-Winkeln; N Holfert; N Rayes; R Thieme; M Maktabi; R Sucher; D Seehofer; M Barberio; M Diana; S M Rabe; M Mehdorn; Y Moulla; S Niebisch; D Branzan; K Rehmet; J P Takoh; T-O Petersen; T Neumuth; A Melzer; C Chalopin; H Köhler Journal: Chirurg Date: 2020-02 Impact factor: 0.955
Authors: Boris Jansen-Winkeln; N Holfert; H Köhler; Y Moulla; J P Takoh; S M Rabe; M Mehdorn; M Barberio; C Chalopin; T Neumuth; I Gockel Journal: Int J Colorectal Dis Date: 2019-02-02 Impact factor: 2.571
Authors: Hannes Köhler; Boris Jansen-Winkeln; Marianne Maktabi; Manuel Barberio; Jonathan Takoh; Nico Holfert; Yusef Moulla; Stefan Niebisch; Michele Diana; Thomas Neumuth; Sebastian M Rabe; Claire Chalopin; Andreas Melzer; Ines Gockel Journal: Surg Endosc Date: 2019-01-23 Impact factor: 4.584
Authors: Jonathan Shapey; Yijing Xie; Eli Nabavi; Robert Bradford; Shakeel R Saeed; Sebastien Ourselin; Tom Vercauteren Journal: J Biophotonics Date: 2019-04-29 Impact factor: 3.207
Authors: Boris Jansen-Winkeln; Jonathan P Takoh; Claire Chalopin; Marianne Maktabi; Orestis Lyros; Robert Sucher; Albrecht Hoffmeister; Niels Teich; Hannes Köhler; Ines Gockel Journal: Visc Med Date: 2021-04-13