Determination of the transection margin during colorectal resection with hyperspectral imaging (HSI)

Jansen-Winkeln, Boris; Holfert, N; Köhler, Helmut; Moulla, Yusef; Takoh, JP; Rabe, SM; Mehdorn, Matthias; Barberio, Manuel; Chalopin, Claire; Neumuth, Thomas; Gockel, Ines

doi:10.1007/s00384-019-03250-0

Cited by 77 publications

(52 citation statements)

References 19 publications

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“…Furthermore, the spread of the dye over time could be visualized. [24]. Oxygenation (StO 2 ) 3 min after devascularization (0-100%) was compared with the ICG data corresponding to the maximum initial flooding of the dye.…”

Section: Surgical Techniquementioning

confidence: 99%

Comparison of hyperspectral imaging and fluorescence angiography for the determination of the transection margin in colorectal resections—a comparative study

Jansen-Winkeln

Germann

Köhler

et al. 2020

Int J Colorectal Dis

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Purpose One relevant aspect for anastomotic leakage in colorectal surgery is blood perfusion of both ends of the anastomosis. The clinical evaluation of this issue is limited, but new methods like fluorescence angiography with indocyanine green or non-invasive and contactless hyperspectral imaging have evolved as objective parameters for perfusion evaluation. Methods In this prospective, non-randomized, open-label and two-arm study, fluorescence angiography and hyperspectral imaging were compared in 32 consecutive patients with each other and with the clinical assessment by the surgeon. After preparation of the bowel and determination of the surgical resection line, the tissue was evaluated with hyperspectral imaging for 5 min before and after cutting the marginal artery and assessed by 6 hyperspectral pictures followed by fluorescence angiography with indocyanine green. Results In 30 of 32 patients, the image data could be evaluated and compared. Both methods provided a comparable borderline between well-perfused and poorly perfused tissue (p = 0.704). In 15 cases, the surgical resection line was shifted to the central position due to the imaging. The border zone was sharper in fluorescence angiography and best assessed 31 s after injection. With hyperspectral imaging, the border zone was visualized wider and with more differences between proximal and distal border. Conclusion Hyperspectral imaging and fluorescence angiography provide similar results in determining the perfusion border. Both methods allow a good and safe visualization of the blood perfusion at the central resection margin to create a well-perfused anastomosis. Trial registration This study was registered at Clinicaltrials.gov (NCT04226781) on January 13, 2020.

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Section: Surgical Techniquementioning

confidence: 99%

Comparison of hyperspectral imaging and fluorescence angiography for the determination of the transection margin in colorectal resections—a comparative study

Jansen-Winkeln

Germann

Köhler

et al. 2020

Int J Colorectal Dis

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“…Hyperspectral imaging (HSI) is a contrast-free technology, which can provide a real-time snapshot of the chemical characteristics of a tissue. In particular, this imaging technique allows for tissue oxygen saturation (StO 2 ) quantification and its utility during gastrointestinal procedures has been previously assessed [9][10][11]. The main shortcoming of HSI is the lack of video rate, which de facto greatly limits its usability as a surgical navigation tool.…”

mentioning

confidence: 99%

Quantitative serosal and mucosal optical imaging perfusion assessment in gastric conduits for esophageal surgery: an experimental study in enhanced reality

et al. 2020

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Introduction/objective Gastric conduit (GC) is used for reconstruction after esophagectomy. Anastomotic leakage (AL) incidence remains high, given the extensive disruption of the gastric circulation. Currently, there is no reliable method to intraoperatively quantify gastric perfusion. Hyperspectral imaging (HSI) has shown its potential to quantify serosal StO2. Confocal laser endomicroscopy (CLE) allows for automatic mucosal microcirculation quantification as functional capillary density area (FCD-A). The aim of this study was to quantify serosal and mucosal GC’s microperfusion using HSI and CLE. Local capillary lactate (LCL) served as biomarker. Methods GC was formed in 5 pigs and serosal StO2% was quantified at 3 regions of interest (ROI) using HSI: fundus (ROI-F), greater curvature (ROI-C), and pylorus (ROI-P). After intravenous injection of sodium-fluorescein (0.5 g), CLE-based mucosal microperfusion was assessed at the corresponding ROIs, and LCLs were quantified via a lactate analyzer. Results StO2 and FCD-A at ROI-F (41 ± 10.6%, 3.3 ± 3.8, respectively) were significantly lower than ROI-C (68.2 ± 6.7%, p value: 0.005; 18.4 ± 7, p value: 0.01, respectively) and ROI-P (72 ± 10.4%, p value: 0.005; 15.7 ± 3.2 p value: 0.001). LCL value at ROI-F (9.6 ± 4.7 mmol/L) was significantly higher than at ROI-C (2.6 ± 1.2 mmol/L, p value: 0.04) and ROI-P (2.6 ± 1.3 mmol/L, p value: 0.04). No statistically significant difference was found in all metrics between ROI-C and ROI-P. StO2 correlated with FCD-A (Pearson’s r = 0.67). The LCL correlated negatively with both FCD-A (Spearman’s r = − 0.74) and StO2 (Spearman’s r = − 0.54). Conclusions GC formation causes a drop in serosal and mucosal fundic perfusion. HSI and CLE correlate well and might become useful intraoperative tools.

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“…Complete resection of solid tumours is usually associated with the best quality of life and possible long term survival of There is a constant need for intraoperative on site method to assess the resection margins, however, so far no reliable method gained acceptance in the daily practices of surgical routine. Jansen-Winkeln et al demonstated a promising dye-free hyperspectral imaging feasibility study involving 20 patients who underwent colorectal surgery to determine the resection margin [26].…”

Section: Discussionmentioning

confidence: 99%

Mid-Infrared Imaging Is Able to Characterize and Separate Cancer Cell Lines

Kontsek

Pesti

Björnstedt

et al. 2020

Pathol. Oncol. Res.

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Malignancies are still responsible for a large share of lethalities. Macroscopical evaluation of the surgical resection margins is uncertain. Big data based imaging approaches have emerged in the recent decade (mass spectrometry, two-photon microscopy, infrared and Raman spectroscopy). Indocianine green labelled MS is the most common approach, however, label free midinfrared imaging is more promising for future practical application. We aimed to identify and separate different transformed (A-375, HT-29) and non-transformed (CCD986SK) cell lines by a label-free infrared spectroscopy method. Our approach applied a novel setup for label-free mid-infrared range classification method. Transflection spectroscopy was used on aluminium coated glass slides. Both whole range spectra (4000-648 cm −1) and hypersensitive fingerprint regions (1800-648 cm −1) were tested on the imaged areas of cell lines fixed in ethanol. Non-cell spectra were possible to be excluded based on mean transmission values being above 90%. Feasibility of a mean transmission based spectra filtering method with principal component analysis and linear discriminant analysis was shown to separate cell lines representing different tissue types. Fingerprint region resulted the best separation of cell lines spectra with accuracy of 99.84% at 70-75 mean transmittance range. Our approach in vitro was able to separate unique cell lines representing different tissues of origin. Proper data handling and spectra processing are key steps to achieve the adaptation of this dye-free technique for intraoperative surgery. Further studies are urgently needed to test this novel, marker-free approach.

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Determination of the transection margin during colorectal resection with hyperspectral imaging (HSI)

Cited by 77 publications

References 19 publications

Comparison of hyperspectral imaging and fluorescence angiography for the determination of the transection margin in colorectal resections—a comparative study

Comparison of hyperspectral imaging and fluorescence angiography for the determination of the transection margin in colorectal resections—a comparative study

Quantitative serosal and mucosal optical imaging perfusion assessment in gastric conduits for esophageal surgery: an experimental study in enhanced reality

Mid-Infrared Imaging Is Able to Characterize and Separate Cancer Cell Lines

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