Impact of standardising indocyanine green fluorescence angiography technique for visual and quantitative interpretation on interuser variability in colorectal surgery.
Colorectal cancer
ICG
Indocyanine green
Near infrared
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
18 Dec 2023
18 Dec 2023
Historique:
received:
08
07
2023
accepted:
24
10
2023
medline:
19
12
2023
pubmed:
19
12
2023
entrez:
19
12
2023
Statut:
aheadofprint
Résumé
Intra-operative colonic perfusion assessment via indocyanine green fluorescence angiography (ICGFA) aims to address malperfusion-related anastomotic complications; however, its interpretation suffers interuser variability (IUV), especially early in ICGFA experience. This work assesses the impact of a protocol developed for both operator-based judgement and computational development on interpretation consistency, focusing on senior surgeons yet to start using ICGFA. Experienced and junior gastrointestinal surgeons were invited to complete an ICGFA-experience questionnaire. They subsequently interpreted nine operative ICGFA videos regarding perfusion sufficiency of a surgically prepared distal colon during laparoscopic anterior resection by indicating their preferred site of proximal transection using an online annotation platform (mindstamp.com). Six ICGFA videos had been prepared with a clinical standardisation protocol controlling camera and patient positioning of which three each had monochrome near infrared (NIR) and overlay display. Three others were non-standardised controls with synchronous NIR and overlay picture-in-picture display. Differences in transection level between different cohorts were assessed for intraclass correlation coefficient (ICC) via ImageJ and IBM SPSS. 58 clinicians (12 ICGFA experts, 46 ICGFA inexperienced of whom 23 were either finished or within one year of finishing training and 23 were junior trainees) participated as per power calculations. 63% felt that ICGFA should be routinely deployed with 57% believing interpretative competence requires 11-50 cases. Transection level concordance was generally good (ICC = 0.869) across all videos and levels of expertise (0.833-0.915). However, poor agreement was evident with the standardised protocol videos for overlay presentation (0.208-0.345). Similarly, poor agreement was seen for the monochrome display (0.392-0.517), except for those who were trained but ICG inexperienced (0.877) although even here agreement was less than with unstandardised videos (0.943). Colorectal ICGFA acquisition and display standardisation impacts IUV with this specific protocol tending to diminish surgeon interpretation consistency. ICGFA video recording for computational development may require dedicated protocols.
Sections du résumé
AIM/BACKGROUND
OBJECTIVE
Intra-operative colonic perfusion assessment via indocyanine green fluorescence angiography (ICGFA) aims to address malperfusion-related anastomotic complications; however, its interpretation suffers interuser variability (IUV), especially early in ICGFA experience. This work assesses the impact of a protocol developed for both operator-based judgement and computational development on interpretation consistency, focusing on senior surgeons yet to start using ICGFA.
METHODS
METHODS
Experienced and junior gastrointestinal surgeons were invited to complete an ICGFA-experience questionnaire. They subsequently interpreted nine operative ICGFA videos regarding perfusion sufficiency of a surgically prepared distal colon during laparoscopic anterior resection by indicating their preferred site of proximal transection using an online annotation platform (mindstamp.com). Six ICGFA videos had been prepared with a clinical standardisation protocol controlling camera and patient positioning of which three each had monochrome near infrared (NIR) and overlay display. Three others were non-standardised controls with synchronous NIR and overlay picture-in-picture display. Differences in transection level between different cohorts were assessed for intraclass correlation coefficient (ICC) via ImageJ and IBM SPSS.
RESULTS
RESULTS
58 clinicians (12 ICGFA experts, 46 ICGFA inexperienced of whom 23 were either finished or within one year of finishing training and 23 were junior trainees) participated as per power calculations. 63% felt that ICGFA should be routinely deployed with 57% believing interpretative competence requires 11-50 cases. Transection level concordance was generally good (ICC = 0.869) across all videos and levels of expertise (0.833-0.915). However, poor agreement was evident with the standardised protocol videos for overlay presentation (0.208-0.345). Similarly, poor agreement was seen for the monochrome display (0.392-0.517), except for those who were trained but ICG inexperienced (0.877) although even here agreement was less than with unstandardised videos (0.943).
CONCLUSION
CONCLUSIONS
Colorectal ICGFA acquisition and display standardisation impacts IUV with this specific protocol tending to diminish surgeon interpretation consistency. ICGFA video recording for computational development may require dedicated protocols.
Identifiants
pubmed: 38110792
doi: 10.1007/s00464-023-10564-2
pii: 10.1007/s00464-023-10564-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Department of Enterprise, Trade and Employment (IE)
ID : Disruptive Technologies Innovation Fund
Organisme : The Ministry for Education, Sport, Youth, Research and Innovation (MT)
ID : Tertiary Education Scholarship Scheme (TESS)
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Argilés G, Tabernero J, Labianca R, Hochhauser D, Salazar R, Iveson T, Laurent-Puig P, Quirke P, Yoshino T, Taieb J, Martinelli E, Arnold D (2020) Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 31:1291–1305
doi: 10.1016/j.annonc.2020.06.022
pubmed: 32702383
Noh GT, Ann YS, Cheong C, Han J, Cho MS, Hur H, Min BS, Lee KY, Kim NK (2016) Impact of anastomotic leakage on long-term oncologic outcome and its related factors in rectal cancer. Medicine (Baltimore) 95:e4367–e4367
doi: 10.1097/MD.0000000000004367
pubmed: 27472726
La Regina D, Di Giuseppe M, Lucchelli M, Saporito A, Boni L, Efthymiou C, Cafarotti S, Marengo M, Mongelli F (2019) Financial impact of anastomotic leakage in colorectal surgery. J Gastrointest Surg 23:580–586
doi: 10.1007/s11605-018-3954-z
pubmed: 30215201
Tang G, Du D, Tao J, Wei Z (2022) Effect of indocyanine green fluorescence angiography on anastomotic leakage in patients undergoing colorectal surgery: a meta-analysis of randomized controlled trials and propensity-score-matched studies. Front Surg 9:815753
doi: 10.3389/fsurg.2022.815753
pubmed: 35372484
pmcid: 8964518
Liu RQ, Elnahas A, Tang E, Alkhamesi NA, Hawel J, Alnumay A, Schlachta CM (2022) Cost analysis of indocyanine green fluorescence angiography for prevention of anastomotic leakage in colorectal surgery. Surg Endosc 36(12):9281–9287
doi: 10.1007/s00464-022-09166-1
pubmed: 35290507
Hardy NP, Dalli J, Khan MF, Andrejevic P, Neary PM, Cahill RA (2021) Inter-user variation in the interpretation of near infrared perfusion imaging using indocyanine green in colorectal surgery. Surg Endosc 4:1–8
Kim GY, Bae KS, Noh GJ, Min WK (2009) Estimation of indocyanine green elimination rate constant k and retention rate at 15 min using patient age, weight, bilirubin, and albumin. J Hepatobiliary Pancreat Surg 16:521
doi: 10.1007/s00534-009-0097-3
pubmed: 19365598
Vos JJ, Scheeren TWL, Wietasch GJK (2010) Pulse dye densitometry and indocyanine green plasma disappearance: the issue of “Normal” values. Anesth Analg 111:1075–1076
doi: 10.1213/ANE.0b013e3181ef35ba
pubmed: 20870988
Boerma EC, Ince C (2010) The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients. Intensive Care Med 36:2004–2018
doi: 10.1007/s00134-010-1970-x
pubmed: 20811874
pmcid: 2981743
Harper D, Chandler B (2015) Splanchnic circulation. BJA. Education 16:66–71
Tapar H, Karaman S, Dogru S, Karaman T, Sahin A, Tapar GG, Altiparmak F, Suren M (2018) The effect of patient positions on perfusion index. BMC Anesthesiol 18:1–4
doi: 10.1186/s12871-018-0571-z
Yoneda G, Katagiri S, Yamamoto M (2015) Reverse Trendelenburg position is a safer technique for lowering central venous pressure without decreasing blood pressure than clamping of the inferior vena cava below the liver. J Hepatobiliary Pancreat Sci 22:463–466
doi: 10.1002/jhbp.229
pubmed: 25763776
Dalli J, Jindal A, Gallagher G, Epperlein JP, Hardy NP, Re M, O’Donoghue K, Cantillon-Murphy P, Mac Aonghusa PG, Cahill RA (2023) Evaluating clinical near-infrared surgical camera systems with a view to optimizing operator and computational signal analysis. J Biomed Opt 28:035002–035002
doi: 10.1117/1.JBO.28.3.035002
pubmed: 37009578
pmcid: 10050972
Dalli J, Hardy N, Mac Aonghusa PG, Epperlein JP, Cantillon-Murphy P, Cahill RA (2021) Challenges in the interpretation of colorectal indocyanine green fluorescence angiography: video vignette. Colorectal Dis 23:1289–1290
doi: 10.1111/codi.15592
pubmed: 33599372
Bujang MA (2017) A simplified guide to determination of sample size requirements for estimating the value of intraclass correlation coefficient: a review. Arch Orofac Sci 12:1–11
Joosten JJ, Longchamp G, Khan MF, Lameris W, van Berge Henegouwen MI, Bemelman WA, Cahill RA, Hompes R, Ris F (2022) The use of fluorescence angiography to assess bowel viability in the acute setting: an international, multicentre case series. Surg Endosc 36(10):7369–7375. https://doi.org/10.1007/s00464-022-09136-7
doi: 10.1007/s00464-022-09136-7
pubmed: 35199204
pmcid: 9485089
Dip F, Boni L, Bouvet M, Carus T, Diana M, Falco J, Gurtner GC, Ishizawa T, Kokudo N, Lo Menzo E, Low PS, Masia J, Muehrcke D, Papay FA, Pulitano C, Schneider-Koraith S, Sherwinter D, Spinoglio G, Stassen L, Urano Y, Vahrmeijer A, Vibert E, Warram J, Wexner SD, White K, Rosenthal RJ (2022) Consensus conference statement on the general use of near-infrared fluorescence imaging and indocyanine green guided surgery: results of a modified delphi study. Ann Surg 275:685–691
doi: 10.1097/SLA.0000000000004412
pubmed: 33214476
Dalli J, Shanahan S, Hardy NP, Chand M, Hompes R, Jayne D, Ris F, Spinelli A, Wexner S, Cahill RA (2022) Deconstructing mastery in colorectal fluorescence angiography interpretation. Surg Endosc 36(12):8764–8773
doi: 10.1007/s00464-022-09299-3
pubmed: 35543771
pmcid: 9652172
Joosten JJ, Bloemen PR, Van Den Elzen RM, Dalli J, Cahill RA, Van Berge Henegouwen MI, Hompes R, De Bruin DM (2023) Investigating and compensating for periphery-center effect among commercial near infrared imaging systems using an indocyanine green phantom. Appl Sci 13:2042
doi: 10.3390/app13042042
Pardo Aranda F, Gené Škrabec C, López-Sánchez J, Zarate Pinedo A, Espin Álvarez F, Cremades Pérez M, Navinés López J, Herrero Vicente C, Vidal Piñeiro L, Cugat Andorrà E (2023) Indocyanine green (ICG) fluorescent cholangiography in laparoscopic cholecystectomy: Simplifying time and dose. Dig Liver Dis 55:249–253
doi: 10.1016/j.dld.2022.10.023
pubmed: 36404235
Ahn HM, Son GM, Lee IY, Park SH, Kim NS, Baek KR (2021) Optimization of indocyanine green angiography for colon perfusion during laparoscopic colorectal surgery. Colorectal Dis 23(7):1848–1859
doi: 10.1111/codi.15684
pubmed: 33894016
pmcid: 8359947
Vincent BT, Baddeley R, Correani A, Troscianko T, Leonards U (2009) Do we look at lights? Using mixture modelling to distinguish between low- and high-level factors in natural image viewing. Vis Cogn 17:856–879
doi: 10.1080/13506280902916691
Chiti LE, Park B, d’Orchymont F, Holland JP, Nolff MC (2023) Impact of surgical lights on the performance of fluorescence-guided surgery systems: a pilot study. Animals 13:2363
doi: 10.3390/ani13142363
pubmed: 37508142
pmcid: 10376740
Son GM, Kwon MS, Kim Y, Kim J, Kim SH, Lee JW (2019) Quantitative analysis of colon perfusion pattern using indocyanine green (ICG) angiography in laparoscopic colorectal surgery. Surg Endosc 33:1640–1649
doi: 10.1007/s00464-018-6439-y
pubmed: 30203201
Wada T, Kawada K, Takahashi R, Yoshitomi M, Hida K, Hasegawa S, Sakai Y (2017) ICG fluorescence imaging for quantitative evaluation of colonic perfusion in laparoscopic colorectal surgery. Surg Endosc 31:4184–4193
doi: 10.1007/s00464-017-5475-3
pubmed: 28281123
Park SH, Park HM, Baek KR, Ahn HM, Lee IY, Son GM (2020) Artificial intelligence based real-time microcirculation analysis system for laparoscopic colorectal surgery. World J Gastroenterol 26:6945–6962
doi: 10.3748/wjg.v26.i44.6945
pubmed: 33311942
pmcid: 7701947
Van Den Hoven P, Osterkamp J, Nerup N, Svendsen MBS, Vahrmeijer A, Van Der Vorst JR, Achiam MP (2023) Quantitative perfusion assessment using indocyanine green during surgery: current applications and recommendations for future use. Langenbecks Arch Surg 408:67
doi: 10.1007/s00423-023-02780-0
pubmed: 36700999
Larsen PO, Nerup N, Andersen J, Dohrn N, Klein MF, Brisling S, Salomon S, Andersen PV, Möller S, Svendsen MBS, Rahr HB, Iversen LH, Gögenur I, Qvist N, Ellebaek MB (2023) Anastomotic perfusion assessment with indocyanine green in robot-assisted low-anterior resection, a multicenter study of interobserver variation. Surg Endosc 37(5):3602–3609
doi: 10.1007/s00464-022-09819-1
pubmed: 36624218
pmcid: 10156761
Soares AS, Clancy NT, Bano S, Raza I, Diana M, Lovat LB, Stoyanov D, Chand M (2023) Interobserver variability in the assessment of fluorescence angiography in the colon. Surg Innov 30(1):45–49. https://doi.org/10.1177/15533506221132681
doi: 10.1177/15533506221132681
pubmed: 36377296