Barbara Seeliger1,2, Vincent Agnus1, Pietro Mascagni1, Manuel Barberio1, Fabio Longo1, Alfonso Lapergola1, Didier Mutter1,2,3, Andrey S Klymchenko4, Manish Chand5, Jacques Marescaux1,2, Michele Diana6,7,8. 1. IHU-Strasbourg Institute of Image-Guided Surgery, Strasbourg, France. 2. Institute for Research Against Cancer of the Digestive System (IRCAD), Strasbourg, France. 3. Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France. 4. Faculty of Pharmacy, Nanochemistry and Bioimaging Laboratory, UMR 7021, CNRS, University of Strasbourg, Strasbourg, France. 5. Division of Surgery and Interventional Sciences, University College London, London, UK. 6. IHU-Strasbourg Institute of Image-Guided Surgery, Strasbourg, France. michele.diana@ihu-strasbourg.eu. 7. Institute for Research Against Cancer of the Digestive System (IRCAD), Strasbourg, France. michele.diana@ihu-strasbourg.eu. 8. Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France. michele.diana@ihu-strasbourg.eu.
Abstract
BACKGROUND: Fluorescence-based enhanced reality (FLER) enables the quantification of fluorescence signal dynamics, which can be superimposed onto real-time laparoscopic images by using a virtual perfusion cartogram. The current practice of perfusion assessment relies on visualizing the bowel serosa. The aim of this experimental study was to quantify potential differences in mucosal and serosal perfusion levels in an ischemic colon segment. METHODS: An ischemic colon segment was created in 12 pigs. Simultaneous quantitative mucosal and serosal fluorescence imaging was obtained via intravenous indocyanine green injection (0.2 mg/kg), using two near-infrared camera systems, and computer-assisted FLER analysis. Lactate levels were measured in capillary blood of the colonic wall at seven regions of interest (ROIs) as determined with FLER perfusion cartography: the ischemic zone (I), the proximal and distal vascularized areas (PV, DV), and the 50% perfusion threshold proximally and distally at the mucosal and serosal side (P50M, P50S, D50M, D50S). RESULTS: The mean ischemic zone as measured (mm) for the mucosal side was significantly larger than the serosal one (56.3 ± 21.3 vs. 40.8 ± 14.9, p = 0.001) with significantly lower lactate values at the mucosal ROIs. There was a significant weak inverse correlation between lactate and slope values for the defined ROIs (r = - 0.2452, p = 0.0246). CONCLUSIONS: Mucosal ischemic zones were larger than serosal zones. These results suggest that an assessment of bowel perfusion from the serosal side only can underestimate the extent of ischemia. Further studies are required to predict the optimal resection margin and anastomotic site.
BACKGROUND: Fluorescence-based enhanced reality (FLER) enables the quantification of fluorescence signal dynamics, which can be superimposed onto real-time laparoscopic images by using a virtual perfusion cartogram. The current practice of perfusion assessment relies on visualizing the bowel serosa. The aim of this experimental study was to quantify potential differences in mucosal and serosal perfusion levels in an ischemic colon segment. METHODS: An ischemic colon segment was created in 12 pigs. Simultaneous quantitative mucosal and serosal fluorescence imaging was obtained via intravenous indocyanine green injection (0.2 mg/kg), using two near-infrared camera systems, and computer-assisted FLER analysis. Lactate levels were measured in capillary blood of the colonic wall at seven regions of interest (ROIs) as determined with FLER perfusion cartography: the ischemic zone (I), the proximal and distal vascularized areas (PV, DV), and the 50% perfusion threshold proximally and distally at the mucosal and serosal side (P50M, P50S, D50M, D50S). RESULTS: The mean ischemic zone as measured (mm) for the mucosal side was significantly larger than the serosal one (56.3 ± 21.3 vs. 40.8 ± 14.9, p = 0.001) with significantly lower lactate values at the mucosal ROIs. There was a significant weak inverse correlation between lactate and slope values for the defined ROIs (r = - 0.2452, p = 0.0246). CONCLUSIONS:Mucosal ischemic zones were larger than serosal zones. These results suggest that an assessment of bowel perfusion from the serosal side only can underestimate the extent of ischemia. Further studies are required to predict the optimal resection margin and anastomotic site.
Authors: Antonio D'Urso; Vincent Agnus; Manuel Barberio; Barbara Seeliger; Francesco Marchegiani; Anne-Laure Charles; Bernard Geny; Jacques Marescaux; Didier Mutter; Michele Diana Journal: Surg Endosc Date: 2020-08-27 Impact factor: 4.584
Authors: Jonathan T Elliott; Rocco R Addante; Gerard-Paul Slobegean; Shudong Jiang; Eric R Henderson; Brian W Pogue; Ida Leah Gitajn Journal: J Biomed Opt Date: 2020-06 Impact factor: 3.170