Boris Jansen-Winkeln1, Jonathan P Takoh1, Claire Chalopin2, Marianne Maktabi2, Orestis Lyros1, Robert Sucher1, Albrecht Hoffmeister3, Niels Teich4, Hannes Köhler2, Ines Gockel1. 1. Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany. 2. Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany. 3. Department of Gastroenterology, University Hospital of Leipzig, Leipzig, Germany. 4. Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten (IGVS), Leipzig and Schkeuditz, Leipzig, Germany.
Abstract
INTRODUCTION: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a challenging operation. Especially the mobilization of the pouch into the pelvis can be complex. Adequate perfusion of the pouch is required for optimal healing and functioning. METHODS: With hyperspectral imaging (HSI) wavelengths between 500 and 1,000 nm can be analyzed in addition to visible light and by reflecting patterns. This intraoperative procedure is non-invasive, contact-free, and no contrast medium is needed. Fifteen patients undergoing IPAA were examined prospectively, and the pouch was evaluated by HSI intraoperatively. HSI was measured in standardized fashion at 4 defined locations of the J-pouch. Each measurement took about 10 s. The clinical postoperative course was assessed in all patients and correlated to the intraoperative HSI findings. RESULTS: Mean near-infrared perfusion and oxygenation of patients showed values ≥74% for all defined pouch areas, revealing good blood supply. Three minor anastomotic leaks were detected by standard pouchoscopy in the postoperative course, which could be treated conservatively with endosponge therapy. CONCLUSION: HSI values of perfusion and oxygenation of the IPAA were high. The leak rate is associated with redo procedures. This is reflected by the current literature and most likely related to the higher complexity of the revisional pouch operation. HSI has proved itself as a quick and effective new intraoperative tool to evaluate pouch perfusion objectively and quantitatively.
INTRODUCTION: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a challenging operation. Especially the mobilization of the pouch into the pelvis can be complex. Adequate perfusion of the pouch is required for optimal healing and functioning. METHODS: With hyperspectral imaging (HSI) wavelengths between 500 and 1,000 nm can be analyzed in addition to visible light and by reflecting patterns. This intraoperative procedure is non-invasive, contact-free, and no contrast medium is needed. Fifteen patients undergoing IPAA were examined prospectively, and the pouch was evaluated by HSI intraoperatively. HSI was measured in standardized fashion at 4 defined locations of the J-pouch. Each measurement took about 10 s. The clinical postoperative course was assessed in all patients and correlated to the intraoperative HSI findings. RESULTS: Mean near-infrared perfusion and oxygenation of patients showed values ≥74% for all defined pouch areas, revealing good blood supply. Three minor anastomotic leaks were detected by standard pouchoscopy in the postoperative course, which could be treated conservatively with endosponge therapy. CONCLUSION: HSI values of perfusion and oxygenation of the IPAA were high. The leak rate is associated with redo procedures. This is reflected by the current literature and most likely related to the higher complexity of the revisional pouch operation. HSI has proved itself as a quick and effective new intraoperative tool to evaluate pouch perfusion objectively and quantitatively.
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: 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: B Jansen-Winkeln; M Maktabi; J P Takoh; S M Rabe; M Barberio; H Köhler; T Neumuth; A Melzer; C Chalopin; I Gockel Journal: Chirurg Date: 2018-09 Impact factor: 0.955
Authors: Willem E Hueting; Erik Buskens; Ingeborg van der Tweel; Hein G Gooszen; Cees J H M van Laarhoven Journal: Dig Surg Date: 2005-04-14 Impact factor: 2.588
Authors: Feza H Remzi; Erman Aytac; Jean Ashburn; Jinyu Gu; Tracy L Hull; David W Dietz; Luca Stocchi; James M Church; Bo Shen Journal: Ann Surg Date: 2015-10 Impact factor: 12.969