HYPerspectral Enhanced Reality (HYPER): a physiology-based surgical guidance tool

Barberio, Manuel; Longo, Fabio; Fiorillo, Claudio; Seeliger, Barbara; Mascagni, Pietro; Agnus, Vincent; Lindner, Véronique; Gény, Bernard; Charles, Anne-Laure; Gockel, Ines; Worreth, Marc; Saadi, Alend; Marescaux, Jacques; Diana, Michèle

doi:10.1007/s00464-019-06959-9

Cited by 51 publications

(49 citation statements)

References 31 publications

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“…Correlation between capillary lactate and StO 2 % HSI preset parameters was used as a primary outcome to compute sample size. The calculation was based on previous publications on bowel ischaemia, which showed a ρ correlation coefficient of − 0.7 16 , 32 . The required paired values were 4, considering α = 0.05 with a power (1 − β) = 0.9.…”

Section: Methodsmentioning

confidence: 99%

Hyperspectral evaluation of hepatic oxygenation in a model of total vs. arterial liver ischaemia

Felli

Collins

Baiocchini

et al. 2020

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Liver ischaemia reperfusion injury (IRI) is a dreaded pathophysiological complication which may lead to an impaired liver function. The level of oxygen hypoperfusion affects the level of cellular damage during the reperfusion phase. Consequently, intraoperative localisation and quantification of oxygen impairment would help in the early detection of liver ischaemia. To date, there is no real-time, non-invasive, and intraoperative tool which can compute an organ oxygenation map, quantify and discriminate different types of vascular occlusions intraoperatively. Hyperspectral imaging (HSI) is a non-invasive optical methodology which can quantify tissue oxygenation and which has recently been applied to the medical field. A hyperspectral camera detects the relative reflectance of a tissue in the range of 500 to 1000 nm, allowing the quantification of organic compounds such as oxygenated and deoxygenated haemoglobin at different depths. Here, we show the first comparative study of liver oxygenation by means of HSI quantification in a model of total vascular inflow occlusion (VIO) vs. hepatic artery occlusion (HAO), correlating optical properties with capillary lactate and histopathological evaluation. We found that liver HSI could discriminate between VIO and HAO. These results were confirmed via cross-validation of HSI which detected and quantified intestinal congestion in VIO. A significant correlation between the near-infrared spectra and capillary lactate was found (r = − 0.8645, p = 0.0003 VIO, r = − 0.7113, p = 0.0120 HAO). Finally, a statistically significant negative correlation was found between the histology score and the near-infrared parameter index (NIR) (r = − 0.88, p = 0.004). We infer that HSI, by predicting capillary lactates and the histopathological score, would be a suitable non-invasive tool for intraoperative liver perfusion assessment.

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Section: Methodsmentioning

confidence: 99%

Hyperspectral evaluation of hepatic oxygenation in a model of total vs. arterial liver ischaemia

Felli

Collins

Baiocchini

et al. 2020

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“…As biological "ground truth," local capillary lactates (LCLs) were measured [12,16,17,[19][20][21][22]. A full-thickness cut of the gastric wall was made in correspondence of the ROI shown by means of HYPER, and a blood drop was obtained.…”

Section: Setup and Experimental Flowmentioning

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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“…Similarly, the results of the present study unequivocally demonstrate that IGP, applied 3 weeks prior to gastric tubulation, improves mucosal and serosal perfusion at the GCF, assessed by means of quantitative optical imaging technologies. These findings are supported by LCL levels, which are a robust surrogate of perfusion in the porcine digestive tract [ 19 , 20 , 21 , 22 , 24 , 26 , 31 ]. Additionally, the presence of incremented vessels and inflammatory cells (eosinophils) in both IGP groups represents an indirect sign of neovascularization [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 74%

“…The level of local capillary lactates was used as primary outcome and the sample size was calculated based on previous works from our group, in which intestinal ischemia had been studied [ 21 ]. Using a non-inferiority design, at least 4 animals per group were required to have a 95% chance of detecting a difference in the primary outcome measure as significant at the 5% level.…”

Section: Methodsmentioning

confidence: 99%

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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

Felli

Pop

et al. 2020

Cancers

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Esophagectomy often presents anastomotic leaks (AL), due to tenuous perfusion of gastric conduit fundus (GCF). Hybrid (endovascular/surgical) ischemic gastric preconditioning (IGP), might improve GCF perfusion. Sixteen pigs undergoing IGP were randomized: (1) Max-IGP (n = 6): embolization of left gastric artery (LGA), right gastric artery (RGA), left gastroepiploic artery (LGEA), and laparoscopic division (LapD) of short gastric arteries (SGA); (2) Min-IGP (n = 5): LGA-embolization, SGA-LapD; (3) Sham (n = 5): angiography, laparoscopy. At day 21 gastric tubulation occurred and GCF perfusion was assessed as: (A) Serosal-tissue-oxygenation (StO2) by hyperspectral-imaging; (B) Serosal time-to-peak (TTP) by fluorescence-imaging; (C) Mucosal functional-capillary-density-area (FCD-A) index by confocal-laser-endomicroscopy. Local capillary lactates (LCL) were sampled. Neovascularization was assessed (histology/immunohistochemistry). Sham presented lower StO2 and FCD-A index (41 ± 10.6%; 0.03 ± 0.03 respectively) than min-IGP (66.2 ± 10.2%, p-value = 0.004; 0.22 ± 0.02, p-value < 0.0001 respectively) and max-IGP (63.8 ± 9.4%, p-value = 0.006; 0.2 ± 0.02, p-value < 0.0001 respectively). Sham had higher LCL (9.6 ± 4.8 mL/mol) than min-IGP (4 ± 3.1, p-value = 0.04) and max-IGP (3.4 ± 1.5, p-value = 0.02). For StO2, FCD-A, LCL, max- and min-IGP did not differ. Sham had higher TTP (24.4 ± 4.9 s) than max-IGP (10 ± 1.5 s, p-value = 0.0008) and min-IGP (14 ± 1.7 s, non-significant). Max- and min-IGP did not differ. Neovascularization was confirmed in both IGP groups. Hybrid IGP improves GCF perfusion, potentially reducing post-esophagectomy AL.

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HYPerspectral Enhanced Reality (HYPER): a physiology-based surgical guidance tool

Cited by 51 publications

References 31 publications

Hyperspectral evaluation of hepatic oxygenation in a model of total vs. arterial liver ischaemia

Hyperspectral evaluation of hepatic oxygenation in a model of total vs. arterial liver ischaemia

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

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

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