Computer-assisted quantification and visualization of bowel perfusion using fluorescence-based enhanced reality in left-sided colonic resections.
Anastomotic perfusion
Capillary lactates
Fluorescence angiography
Fluorescence quantification
Fluorescence-based enhanced reality
Indocyanine green
Mitochondria respiration
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
11
05
2020
accepted:
17
08
2020
pubmed:
29
8
2020
medline:
21
10
2021
entrez:
29
8
2020
Statut:
ppublish
Résumé
Fluorescence-based enhanced reality (FLER) is a computer-based quantification method of fluorescence angiographies to evaluate bowel perfusion. The aim of this prospective trial was to assess the clinical feasibility and to correlate FLER with metabolic markers of perfusion, during colorectal resections. FLER analysis and visualization was performed in 22 patients (diverticulitis n = 17; colorectal cancer n = 5) intra- and extra-abdominally during distal and proximal resection, respectively. The fluorescence signal of indocyanine green (0.2 mg/kg) was captured using a near-infrared camera and computed to create a virtual color-coded cartography. This was overlaid onto the bowel (enhanced reality). It helped to identify regions of interest (ROIs) where samples were subsequently obtained. Resections were performed strictly guided according to clinical decision. On the surgical specimen, samplings were made at different ROIs to measure intestinal lactates (mmol/L) and mitochondria efficiency as acceptor control ratio (ACR). The native (unquantified) fluorescent signal diffused to obvious ischemic areas during the distal appreciation. Proximally, a lower diffusion of ICG was observed. Five anastomotic complications occurred. The expected values of local capillary lactates were correlated with the measured values both proximally (3.62 ± 2.48 expected vs. 3.17 ± 2.8 actual; rho 0.89; p = 0.0006) and distally (4.5 ± 3 expected vs. 4 ± 2.5 actual; rho 0.73; p = 0.0021). FLER values correlated with ACR at the proximal site (rho 0.76; p = 0.04) and at the ischemic zone (rho 0.71; p = 0.01). In complicated cases, lactates at the proximal resection site were higher (5.8 ± 4.5) as opposed to uncomplicated cases (2.45 ± 1.5; p = 0.008). ACR was reduced proximally in complicated (1.3 ± 0.18) vs. uncomplicated cases (1.68 ± 0.3; p = 0.023). FLER allows to image the quantified fluorescence signal in augmented reality and provides a reproducible estimation of bowel perfusion (NCT02626091).
Sections du résumé
BACKGROUND
Fluorescence-based enhanced reality (FLER) is a computer-based quantification method of fluorescence angiographies to evaluate bowel perfusion. The aim of this prospective trial was to assess the clinical feasibility and to correlate FLER with metabolic markers of perfusion, during colorectal resections.
METHODS
FLER analysis and visualization was performed in 22 patients (diverticulitis n = 17; colorectal cancer n = 5) intra- and extra-abdominally during distal and proximal resection, respectively. The fluorescence signal of indocyanine green (0.2 mg/kg) was captured using a near-infrared camera and computed to create a virtual color-coded cartography. This was overlaid onto the bowel (enhanced reality). It helped to identify regions of interest (ROIs) where samples were subsequently obtained. Resections were performed strictly guided according to clinical decision. On the surgical specimen, samplings were made at different ROIs to measure intestinal lactates (mmol/L) and mitochondria efficiency as acceptor control ratio (ACR).
RESULTS
The native (unquantified) fluorescent signal diffused to obvious ischemic areas during the distal appreciation. Proximally, a lower diffusion of ICG was observed. Five anastomotic complications occurred. The expected values of local capillary lactates were correlated with the measured values both proximally (3.62 ± 2.48 expected vs. 3.17 ± 2.8 actual; rho 0.89; p = 0.0006) and distally (4.5 ± 3 expected vs. 4 ± 2.5 actual; rho 0.73; p = 0.0021). FLER values correlated with ACR at the proximal site (rho 0.76; p = 0.04) and at the ischemic zone (rho 0.71; p = 0.01). In complicated cases, lactates at the proximal resection site were higher (5.8 ± 4.5) as opposed to uncomplicated cases (2.45 ± 1.5; p = 0.008). ACR was reduced proximally in complicated (1.3 ± 0.18) vs. uncomplicated cases (1.68 ± 0.3; p = 0.023).
CONCLUSIONS
FLER allows to image the quantified fluorescence signal in augmented reality and provides a reproducible estimation of bowel perfusion (NCT02626091).
Identifiants
pubmed: 32856153
doi: 10.1007/s00464-020-07922-9
pii: 10.1007/s00464-020-07922-9
doi:
Substances chimiques
Indocyanine Green
IX6J1063HV
Banques de données
ClinicalTrials.gov
['NCT02626091']
Types de publication
Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
4321-4331Références
Blanco-Colino R, Espin-Basany E (2018) Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol 22(1):15–23
doi: 10.1007/s10151-017-1731-8
Baiocchi GL, Diana M, Boni L (2018) Indocyanine green-based fluorescence imaging in visceral and hepatobiliary and pancreatic surgery: state of the art and future directions. World J Gastroenterol 24(27):2921–2930
doi: 10.3748/wjg.v24.i27.2921
van Manen L, Handgraaf HJM, Diana M et al (2018) A practical guide for the use of indocyanine green and methylene blue in fluorescence-guided abdominal surgery. J Surg Oncol 118(2):283–300
doi: 10.1002/jso.25105
Jafari MD, Wexner SD, Martz JE et al (2015) Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 220(1):82–92
doi: 10.1016/j.jamcollsurg.2014.09.015
Ris F, Liot E, Buchs NC et al (2018) Multicentre phase II trial of near-infrared imaging in elective colorectal surgery. Br J Surg 105(10):1359–1367
doi: 10.1002/bjs.10844
Kudszus S, Roesel C, Schachtrupp A et al (2010) Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbecks Arch Surg 395(8):1025–1030
doi: 10.1007/s00423-010-0699-x
Kim JC, Lee JL, Yoon YS et al (2016) Utility of indocyanine-green fluorescent imaging during robot-assisted sphincter-saving surgery on rectal cancer patients. Int J Med Robot 12(4):710–717
doi: 10.1002/rcs.1710
Kin C, Vo H, Welton L et al (2015) Equivocal effect of intraoperative fluorescence angiography on colorectal anastomotic leaks. Dis Colon Rectum 58(6):582–587
doi: 10.1097/DCR.0000000000000320
Jafari MD, Lee KH, Halabi WJ et al (2013) The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc 27(8):3003–3008
doi: 10.1007/s00464-013-2832-8
Boni L, Fingerhut A, Marzorati A et al (2017) Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc 31(4):1836–1840
doi: 10.1007/s00464-016-5181-6
De Nardi P, Elmore U, Maggi G et al (2019) Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: results of a multicenter randomized controlled trial. Surg Endosc 34(1):53–60
doi: 10.1007/s00464-019-06730-0
van den Bos J, Al-Taher M, Schols RM et al (2018) Near-infrared fluorescence imaging for real-time intraoperative guidance in anastomotic colorectal surgery: a systematic review of literature. J Laparoendosc Adv Surg Tech A 28(2):157–167
doi: 10.1089/lap.2017.0231
Wada T, Kawada K, Takahashi R et al (2017) ICG fluorescence imaging for quantitative evaluation of colonic perfusion in laparoscopic colorectal surgery. Surg Endosc 31(10):4184–4193
doi: 10.1007/s00464-017-5475-3
Son GM, Kwon MS, Kim Y et al (2019) Quantitative analysis of colon perfusion pattern using indocyanine green (ICG) angiography in laparoscopic colorectal surgery. Surg Endosc 33(5):1640–1649
doi: 10.1007/s00464-018-6439-y
Nerup N, Andersen HS, Ambrus R et al (2017) Quantification of fluorescence angiography in a porcine model. Langenbecks Arch Surg 402(4):655–662
doi: 10.1007/s00423-016-1531-z
Diana M, Noll E, Agnus V et al (2017) Reply to letter: "Enhanced reality fluorescence videography to assess bowel perfusion: the cybernetic eye". Ann Surg 265(4):e49–e52
doi: 10.1097/SLA.0000000000001257
Diana M, Noll E, Diemunsch P et al (2014) Enhanced-reality video fluorescence: a real-time assessment of intestinal viability. Ann Surg 259(4):700–707
doi: 10.1097/SLA.0b013e31828d4ab3
Watanabe J, Ishibe A, Suwa Y et al (2019) Indocyanine green fluorescence imaging to reduce the risk of anastomotic leakage in laparoscopic low anterior resection for rectal cancer: a propensity score-matched cohort study. Surg Endosc 34(1):202–208
doi: 10.1007/s00464-019-06751-9
Diana M (2017) Enabling precision digestive surgery with fluorescence imaging. Transl Gastroenterol Hepatol 2:97
doi: 10.21037/tgh.2017.11.06
Mascagni P, Longo F, Barberio M et al (2018) New intraoperative imaging technologies: innovating the surgeon's eye toward surgical precision. J Surg Oncol 118(2):265–282
doi: 10.1002/jso.25148
Diana M, Halvax P, Dallemagne B et al (2014) Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery. Surg Endosc 28(11):3108–3118
doi: 10.1007/s00464-014-3592-9
Diana M, Dallemagne B, Chung H et al (2014) Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia. Surg Endosc 28(11):3224–3233
doi: 10.1007/s00464-014-3595-6
Diana M, Agnus V, Halvax P et al (2015) Intraoperative fluorescence-based enhanced reality laparoscopic real-time imaging to assess bowel perfusion at the anastomotic site in an experimental model. Br J Surg 102(2):e169–e176
doi: 10.1002/bjs.9725
Quero G, Lapergola A, Barberio M et al (2019) Discrimination between arterial and venous bowel ischemia by computer-assisted analysis of the fluorescent signal. Surg Endosc 33(6):1988–1997
doi: 10.1007/s00464-018-6512-6
Gosvig K, Jensen SS, Qvist N et al (2019) Remote computer-assisted analysis of ICG fluorescence signal for evaluation of small intestinal anastomotic perfusion: a blinded, randomized, experimental trial. Surg Endosc 34(5):2095–2102
doi: 10.1007/s00464-019-06990-w
Seeliger B, Agnus V, Mascagni P et al (2019) Simultaneous computer-assisted assessment of mucosal and serosal perfusion in a model of segmental colonic ischemia. Surg Endosc. https://doi.org/10.1007/s00464-019-07258-z.pdf
doi: 10.1007/s00464-019-07258-z.pdf
pubmed: 31741157
pmcid: 6795913
Barberio M, Longo F, Fiorillo C et al (2020) HYPerspectral enhanced reality (HYPER): a physiology-based surgical guidance tool. Surg Endosc 34(4):1736–1744
doi: 10.1007/s00464-019-06959-9
Barberio M, Felli E, Seyller E et al (2020) Quantitative fluorescence angiography versus hyperspectral imaging to assess bowel ischemia: A comparative study in enhanced reality. Surgery. https://doi.org/10.1016/j.surg.2020.02.008
doi: 10.1016/j.surg.2020.02.008
pubmed: 32223983
Schlagowski AI, Singh F, Charles AL et al (2014) Mitochondrial uncoupling reduces exercise capacity despite several skeletal muscle metabolic adaptations. J Appl Physiol 116(4):364–375
doi: 10.1152/japplphysiol.01177.2013
Diana M, Noll E, Diemunsch P et al (2015) Metabolism-guided bowel resection: potential role and accuracy of instant capillary lactates to identify the optimal resection site. Surg Innov 22(5):453–461
doi: 10.1177/1553350615598620
Hayami S, Matsuda K, Iwamoto H et al (2019) Visualization and quantification of anastomotic perfusion in colorectal surgery using near-infrared fluorescence. Tech Coloproctol 23(10):973–980
doi: 10.1007/s10151-019-02089-5
Agnus V, Pesce A, Boni L et al (2019) Fluorescence-based cholangiography: preliminary results from the IHU-IRCAD-EAES EURO-FIGS registry. Surg Endosc. https://doi.org/10.1007/s00464-019-07157-3
doi: 10.1007/s00464-019-07157-3
pubmed: 31741157