A Novel Technique to Improve Anastomotic Perfusion Prior to Esophageal Surgery: Hybrid Ischemic Preconditioning of the Stomach. Preclinical Efficacy Proof in a Porcine Survival Model

Barberio, Manuel; Felli, Eric; Pop, Raoul; Pizzicannella, Margherita; Gény, Bernard; Lindner, Véronique; Baiocchini, Andrea; Jansen-Winkeln, Boris; Moulla, Yusef; Agnus, Vincent; Marescaux, Jacques; Gockel, Ines; Diana, Michele

doi:10.3390/cancers12102977

Cited by 15 publications

(13 citation statements)

References 48 publications

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“…Nevertheless, FLER, HYPER and CLE provide surrogate blood flow parameters and do not measure the red blood cells velocity (perfusion) itself. However, the accuracy of those three imaging modalities to precisely quantify ischemia within the gastrointestinal tract has been previously validated with in vivo experiments using robust biomarkers [ 8 , 9 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. On the other hand, another optical imaging modality, the laser speckle contrast imaging (LSCI), is able to detect the real-time perfusion.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative Perfusion Assessment in Enhanced Reality Using Quantitative Optical Imaging: An Experimental Study in a Pancreatic Partial Ischemia Model

et al. 2021

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To reduce the risk of pancreatic fistula after pancreatectomy, a satisfactory blood flow at the pancreatic stump is considered crucial. Our group has developed and validated a real-time computational imaging analysis of tissue perfusion, using fluorescence imaging, the fluorescence-based enhanced reality (FLER). Hyperspectral imaging (HSI) is another emerging technology, which provides tissue-specific spectral signatures, allowing for perfusion quantification. Both imaging modalities were employed to estimate perfusion in a porcine model of partial pancreatic ischemia. Perfusion quantification was assessed using the metrics of both imaging modalities (slope of the time to reach maximum fluorescence intensity and tissue oxygen saturation (StO2), for FLER and HSI, respectively). We found that the HSI-StO2 and the FLER slope were statistically correlated using the Spearman analysis (R = 0.697; p = 0.013). Local capillary lactate values were statistically correlated to the HSI-StO2 and to the FLER slope (R = −0.88; p < 0.001 and R = −0.608; p = 0.0074). HSI-based and FLER-based lactate prediction models had statistically similar predictive abilities (p = 0.112). Both modalities are promising to assess real-time pancreatic perfusion. Clinical translation in human pancreatic surgery is currently underway.

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Section: Discussionmentioning

confidence: 99%

“…Recently, confocal laser endomicroscopy (CLE), a probe-based optical imaging technology has been successfully employed to assess intestinal [ 22 , 23 ] and gastric ischemia [ 24 , 25 ]. However, differently from FLER and HYPER, CLE provides only limited and punctual spatial information.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Perfusion Assessment in Enhanced Reality Using Quantitative Optical Imaging: An Experimental Study in a Pancreatic Partial Ischemia Model

et al. 2021

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“…Interestingly, both techniques could precisely measure gastric perfusion, correlating well with one another and with the ischemia biomarker. In a second experimental study, an innovative ischemic preconditioning technique, aimed to improve gastric circulation following gastric conduit formation, was successfully tested using a multimodal optical imaging approach (CLE, HSI, quantitative FA), which once again showed the good correlation of HSI with other optical imaging modalities and ischemia biomarkers [43].…”

Section: Perfusion Assessment In Upper Gastrointestinal Surgerymentioning

confidence: 99%

Intraoperative Guidance Using Hyperspectral Imaging: A Review for Surgeons

Barberio

Benedicenti²,

Pizzicannella³

et al. 2021

Diagnostics

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Hyperspectral imaging (HSI) is a novel optical imaging modality, which has recently found diverse applications in the medical field. HSI is a hybrid imaging modality, combining a digital photographic camera with a spectrographic unit, and it allows for a contactless and non-destructive biochemical analysis of living tissue. HSI provides quantitative and qualitative information of the tissue composition at molecular level in a contrast-free manner, hence making it possible to objectively discriminate between different tissue types and between healthy and pathological tissue. Over the last two decades, HSI has been increasingly used in the medical field, and only recently it has found an application in the operating room. In the last few years, several research groups have used this imaging modality as an intraoperative guidance tool within different surgical disciplines. Despite its great potential, HSI still remains far from being routinely used in the daily surgical practice, since it is still largely unknown to most of the surgical community. The aim of this study is to provide clinical surgeons with an overview of the capabilities, current limitations, and future directions of HSI for intraoperative guidance.

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“…A new technique proposing a hybrid endovascular and surgical preconditioning of the stomach has shown interesting results in a porcine model [ 26 ]. Indeed, anastomotic complications are supposed to be related to insufficient perfusion of the gastric transplant.…”

Section: Surgical Trendsmentioning

confidence: 99%