Hyperspektral-Imaging bei gastrointestinalen Anastomosen

Jansen-Winkeln, Boris; Maktabi, Marianne; Takoh, JP; Rabe, SM; Barberio, Manuel; Köhler, Helmut; Neumuth, Thomas; Melzer, Andreas; Chalopin, Claire; Gockel, Ines

doi:10.1007/s00104-018-0633-2

Cited by 54 publications

(42 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Adequate bowel perfusion is a major requirement for good anastomotic healing [14,15]. The intraoperative evaluation of blood supply is mostly based on the surgeon's subjective perception, including the assessment of serosal color, palpable pulsation, and signs of active bleeding from marginal arteries [13,16,17]. However, in order to prevent anastomotic leaks owing to poor blood circulation, there is a need to control this subjective perception by objective data.…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

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

View full text Add to dashboard Cite

show abstract

“…30 We, therefore, feel that our results may influence the decisionmaking whether to resect a segmental esophageal stenosis or perform an esophageal replacement. Within decision-making, techniques to quantitatively assess esophageal blood flowsuch as hyperspectral 31 or indocyanine green imaging 32 -that are already in use in adults may provide additional information.…”

Section: Discussionmentioning

confidence: 99%

Esophageal Blood Flow May Not Be Directly Influenced by Anastomotic Tension: An Exploratory Laser Doppler Study in Swine

et al. 2019

View full text Add to dashboard Cite

Background Anastomotic tension has been linked to leakage and stenosis in esophageal surgery in both adults and children. We aimed to determine the effects of esophageal topography, operative technique, and anastomotic tension on esophageal blood flow. Materials and Methods We divided and reanastomosed the esophagi at the carinal level with increasing levels of anastomotic tension in piglets (n = 10) and sham controls (n = 4). We examined esophageal blood flow pre- and postoperatively using laser Doppler flowmetry at the anastomosis and two predetermined proximal and distal points. Blood flow in relation to distance from the anastomosis was examined by multivariate linear regression. Results Thoracotomy alone did not influence perfusion at the carinal level in shams (Δ = 3.13 laser Doppler units, 95% confidence interval: −3.4 to 9.7, p = 0.2686). We constructed a (F[5,134] = 6.34, p < 0.0001) multinomial regression model based on distance to the anastomotic site and pre-/postoperative measurements (adjusted R 2 = 0.1624). Tissue blood flow was higher distant to the carina, but lower postoperatively and not influenced by the tension resulting from the extent of resection (F[1, 8] = 1.134, p = 0.318). Conclusion Esophageal blood flow is higher at greater distances to the carinal level and hampered by esophageal division and reanastomosis. The extent of resection has less influence than previously assumed. Therefore, leakage and stenosis after esophageal anastomosis may not solely be caused by insufficient anastomotic blood flow.

show abstract

“…Assessing dynamic changes in tissue perfusion and oxygenation aids patient management in various clinical settings and several studies have already demonstrated its potential for guiding surgical procedures. The Dallas group developed HSI technologies to quantify tissue oxygenation in renal surgery whilst others have applied the technology to guide flap reconstruction and assess vessel and bowel anastomoses.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, in future work, it would be helpful to compare the viability of skin flaps performed with and without the intraoperative use of HSI‐data. Following on from existing pre‐clinical work , it will also be exciting to see whether HSI‐generated tissue oxygenation maps of vessel and bowel anastomoses may be acquired in human patients and whether its use helps to improve surgical technique and outcomes.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative multispectral and hyperspectral label‐free imaging: A systematic review of in vivo clinical studies

Shapey

Xie

Nabavi

et al. 2019

Journal of Biophotonics

View full text Add to dashboard Cite

Multispectral and hyperspectral imaging (HSI) are emerging optical imaging techniques with the potential to transform the way surgery is performed but it is not clear whether current systems are capable of delivering real-time tissue characterization and surgical guidance. We conducted a systematic review of surgical in vivo label-free multispectral and HSI systems that have been assessed intraoperatively in adult patients, published over a 10-year period to May 2018. We analysed 13 studies including 7 different HSI systems. Current in-vivo HSI systems generate an intraoperative tissue oxygenation map or enable tumour detection. Intraoperative tissue oxygenation measurements may help to predict those patients at risk of postoperative complications and in-vivo intraoperative tissue characterization may be performed with high specificity and sensitivity. All systems utilized a line-scanning or wavelength-scanning method but the spectral range and number of spectral bands employed varied significantly between studies and according to the system's clinical aim. The time to acquire a hyperspectral cube dataset ranged between 5 and 30 seconds. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of intraoperative in-vivo label-free HSI but further work is needed to fully integrate it into the current surgical workflow.

show abstract

Hyperspektral-Imaging bei gastrointestinalen Anastomosen

Cited by 54 publications

References 45 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

Esophageal Blood Flow May Not Be Directly Influenced by Anastomotic Tension: An Exploratory Laser Doppler Study in Swine

Intraoperative multispectral and hyperspectral label‐free imaging: A systematic review of in vivo clinical studies

Contact Info

Product

Resources

About