Evaluation of hyperspectral imaging (HSI) for the measurement of ischemic conditioning effects of the gastric conduit during esophagectomy

Abstract

Background. Hyperspectral imaging (HSI) is a relatively new method used in image-26 guided and precision surgery, which has shown promising results for characterization 27 of tissues and assessment of physiologic tissue parameters. Previous methods used 28 for analysis of preconditioning concepts in patients and animal models have shown 29 several limitations of application. The aim of this study was to evaluate HSI for the 30 measurement of ischemic conditioning effects during esophagectomy. 31 Methods. Intraoperative hyperspectral images of the gastric tube through the mini-32 thoracotomy were recorded from n=22 patients, 14 of whom underwent laparoscopic 33 gastrolysis and ischemic conditioning of the stomach with two-step transthoracic 34 esophagectomy and gastric pull-up with intrathoracic anastomosis after 3-7 days. 35 The tip of the gastric tube (later esophago-gastric anastomosis) was measured with 36 HSI. Analysis software provides a RGB image and 4 false color images representing 37 physiologic parameters of the recorded tissue area intraoperatively. These parameters contain tissue oxygenation (StO2), perfusion-(NIR Perfusion Index), 1 organ hemoglobin-(OHI) and tissue water index (TWI). 2 Results. Intraoperative HSI of the gastric conduit was possible in all patients and did 3 not prolong the regular operative procedure due to its quick applicability. In particular, 4 the tissue oxygenation of the gastric conduit was significantly higher in patients who 5 underwent ischemic conditioning (StO2Precond. = 78%; StO2NoPrecond. = 66%; p = 0.03). Conclusions. HSI is suitable for contact-free, non-invasive and intraoperative 7 evaluation of physiological tissue parameters within gastric conduits. Therefore HSI is 8 a valuable method for evaluating ischemic conditioning effects and may contribute to 9 reduce anastomotic complications. Additional studies are needed to establish normal 10 values and thresholds of the presented parameters for the gastric conduit 11 anastomotic site.

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

“…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.…”

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

“…AL has a multifactorial etiology. However, anastomotic site perfusion is a controllable risk factor of leakage [ 9 , 16 , 17 , 18 ]. It has been previously demonstrated in a number of experimental studies [ 27 , 28 , 29 , 30 ] that IGP improves GCF perfusion, provided that a minimum delay of 2 to 3 weeks is observed between IGP and gastric conduit formation.…”

“…As clinical intraoperative appraisal of the gastrointestinal tract blood flow is not accurate [ 15 ], several technologies have been explored to evaluate gastrointestinal perfusion during esophagectomy [ 9 , 16 , 17 , 18 ]. Fluorescence angiography (FA), a technique requiring a near-infrared (NIR) camera and the injection of a fluorophore, has become increasingly available and has shown promising results [ 9 ].…”

Comparison of spectral characteristics in human and pig biliary system with hyperspectral imaging (HSI)

“…Tissue parameters such as tissue oxygenation saturation (StO 2 ) and tissue perfusion can therefore be calculated and interpreted for the diagnosis of physiology and pathology. HSI has been previously shown to give reliable results in visceral surgery (intestinal resections [5,6], left liver resections [7,8], esophagectomy [9]),with variouscasestudies currentlyinprogress.…”