An ambient light-compatible, fluorescence-guided surgery imaging platform for real-time clinical assessment of vascular perfusion and flap viability in breast reconstruction

Seets, Trevor; Shaffrey, Ellen C.; Kawahara, Tisha; Singh, Sakshi; Seitz, Allison J.; Poore, Samuel O.; Uselmann, Adam J.; Lin, Christie

doi:10.1117/12.2649353

Cited by 3 publications

(3 citation statements)

References 26 publications

(25 reference statements)

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“…Furthermore, the Avata System provides a repeatable and reproducible fluorescence quantitation, as described by Seets et al, whereas the current SPY-Elite and SPY-PHI systems cannot. 8 9 Additionally, there are potential cost savings with implementation of the OnLume Avata System. Despite their limitations, use of previous generation fluorescence systems to assess vascular perfusion in autologous breast reconstruction operations has resulted in a decreased incidence of revision operations, ultimately saving patients an average of $1,400 to $9,550.…”

Section: Discussionmentioning

confidence: 99%

Predicting Nipple Necrosis with a “Lights-on” Indocyanine Green Imaging System: A Report of Two Patients

Shaffrey,

Moura,

Jupitz

et al. 2024

Arch Plast Surg

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Nipple–areolar complex (NAC) necrosis is a devastating complication in nipple-sparing mastectomies (NSMs) that significantly impacts patient's quality of life. The use of fluorescence angiography for intraoperative assessment of mastectomy skin flap perfusion in NSM has been successfully described and can be utilized to help guide surgical decision-making. Recently, a novel fluorescence-guided surgical imager was developed, OnLume Avata System (OnLume Surgical, Madison, WI), which provides intraoperative evaluation of vascular perfusion in ambient light. In this case report, we describe the use of OnLume fluorescence-guided surgery technology to help aid in clinical decision-making for two breast reconstruction cases with concern for intraoperative nipple hypoperfusion.

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Section: Discussionmentioning

confidence: 99%

Predicting Nipple Necrosis with a “Lights-on” Indocyanine Green Imaging System: A Report of Two Patients

Shaffrey,

Moura,

Jupitz

et al. 2024

Arch Plast Surg

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“… 16 Real time cystectomy has also been performed through fluorescence guidance by the SPY-PHI system. 17 Another important application is breast cancer removal and reconstruction surgeries in which FGS systems such as OnLume Avata 18 and VITOM-ICG 19 have improved surgery outcomes. In the case of the OnLume Avata FGS system, adaptations on its design have allowed for surgery under room light conditions.…”

Section: Overview Of Open-field Fgs Contrasts Components and Parametersmentioning

confidence: 99%

Assessment of open-field fluorescence guided surgery systems: implementing a standardized method for characterization and comparison

Ochoa,

Ruiz,

LaRochelle

et al. 2023

J. Biomed. Opt.

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Fluorescence guided surgery (FGS) has demonstrated improvements in decision making and patient outcomes for a wide range of surgical procedures. Not only can FGS systems provide a higher level of structural perfusion accuracy in tissue reconstruction cases but they can also serve for real-time functional characterization. Multiple FGS devices have been Food and Drug administration (FDA) cleared for use in open and laparoscopic surgery. Despite the rapid growth of the field, there has been a lack standardization methods.Aim: This work overviews commonalities inherent to optical imaging methods that can be exploited to produce such a standardization procedure. Furthermore, a system evaluation pipeline is proposed and executed through the use of photostable indocyanine green fluorescence phantoms. Five different FDA-approved open-field FGS systems are used and evaluated with the proposed method.Approach: The proposed pipeline encompasses the following characterization:(1) imaging spatial resolution and sharpness, (2) sensitivity and linearity, (3) imaging depth into tissue, (4) imaging system DOF, (5) uniformity of illumination, (6) spatial distortion, (7) signal to background ratio, (8) excitation bands, and (9) illumination wavelength and power. Results:The results highlight how such a standardization approach can be successfully implemented for inter-system comparisons as well as how to better understand essential features within each FGS setup.Conclusions: Despite clinical use being the end goal, a robust yet simple standardization pipeline before clinical trials, such as the one presented herein, should benefit regulatory agencies, manufacturers, and end-users to better assess basic performance and improvements to be made in next generation FGS systems.

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“…A recent study by Seets et al demonstrated this technology's ability to distinguish between well and under-perfused areas of an autologous free flap following anastomosis with a 97.8% sensitivity and 97.4% specificity. 16 This study aims to identify areas of vascular compromise and predict complications in autologous breast reconstruction using objective measures of relative intensity (RI) and relative area (RA) determined with OnLume imaging technology.…”

mentioning

confidence: 99%

Use of Ambient Light Compatible Fluorescence-Guided Surgical Technology for Objective Assessment of Flap Perfusion in Autologous Breast Reconstruction

Shaffrey,

Moura,

Seitz

et al. 2024

J Reconstr Microsurg

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Background Decreased autologous flap vascular perfusion can lead to secondary procedures. Fluorescence angiography during surgery reduces the probability of repeat surgery but suffers from interpretation variability. Recently, the OnLume Avata System was developed, which evaluates real-time vascular perfusion in ambient light. This study aims to predict complications in autologous breast reconstruction using measures of relative intensity (RI) and relative area (RA). Methods Patients undergoing autologous breast reconstruction underwent intraoperative tissue perfusion assessment using the OnLume Avata System. Post-hoc image annotation was completed by labeling areas of the flap interpreted to be “Well Perfused,” “Questionably Perfused,” and “Under Perfused.” RIs and RAs were calculated for the marked areas. Primary complications of interest were overall complication rate, fat and mastectomy skin flap necrosis, and surgical revision. Logistic regression was applied to determine the odds of developing a complication based on RI and RA for each image. Results A total of 25 patients (45 flaps) were included. In total, 17 patients (68%) developed at least one complication. Patients who developed any complication (p = 0.02) or underwent a surgical revision for complications (p = 0.02) had statistically lower RI of under-perfused portions of the flap. Patients with greater areas of under-perfused flap had a significantly higher risk of developing fat necrosis (odds ratio [OR]: 5.71, p = 0.03) and required a revision operation (OR: 1.10, p = 0.01). Conclusion Image-based interpretation using the OnLume Avata System correlated with the risk of developing postoperative complications that standard fluorescence imaging systems may not appreciate. This information can benefit surgeons to improve perfusion assessment and intraoperative decision-making.

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An ambient light-compatible, fluorescence-guided surgery imaging platform for real-time clinical assessment of vascular perfusion and flap viability in breast reconstruction

Cited by 3 publications

References 26 publications

Predicting Nipple Necrosis with a “Lights-on” Indocyanine Green Imaging System: A Report of Two Patients

Predicting Nipple Necrosis with a “Lights-on” Indocyanine Green Imaging System: A Report of Two Patients

Assessment of open-field fluorescence guided surgery systems: implementing a standardized method for characterization and comparison

Use of Ambient Light Compatible Fluorescence-Guided Surgical Technology for Objective Assessment of Flap Perfusion in Autologous Breast Reconstruction

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