Inter-user variation in the interpretation of near infrared perfusion imaging using indocyanine green in colorectal surgery

Hardy, Niall; Dalli, Jeffrey; Khan, Mohammad Faraz; Andrejevic, Predrag; Neary, Peter; Ra, Chisei

doi:10.1007/s00464-020-08223-x

Cited by 38 publications

(44 citation statements)

References 24 publications

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“…A recent study investigating the inter-user variation in interpretation of ICG-FA during surgical resection found that this variation is influenced not only by surgical experience but also by experience with ICG-FA. The study speculates that experienced surgeons may use ICG-FA only as an adjunct to confirm their surgical conclusions, and highly recommend further development of quantification methods [ 24 ]. Interestingly, we found that the relative risk of performing unsafe resection using ICG-FA compared with q-ICG was 2.0, 6.2, and 4.0 for novice, intermediates, and experienced.…”

Section: Discussionmentioning

confidence: 99%

Quantitative fluorescence angiography aids novice and experienced surgeons in performing intestinal resection in well-perfused tissue

et al. 2021

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Background Anastomotic leakage (AL) after gastrointestinal resection is a devastating complication with huge consequences for the patient. As AL is associated with poor blood supply, tools for objective assessment of perfusion are in high demand. Indocyanine green angiography (ICG-FA) and quantitative analysis of ICG-FA (q-ICG) seem promising. This study aimed to investigate whether ICG-FA and q-ICG could improve perfusion assessment performed by surgeons of different experience levels. Methods Thirteen small bowel segments with a varying degree of devascularization, including two healthy sham segments, were constructed in a porcine model. We recruited students, residents, and surgeons to perform perfusion assessment of the segments in white light (WL), with ICG-FA, and after q-ICG, all blinded to the degree of devascularization. Results Forty-five participants fulfilled the study (18 novices, 12 intermediates, and 15 experienced). ICG and q-ICG helped the novices correctly detect the healthy bowel segments to experienced surgeons’ level. ICG and q-ICG also helped novice surgeons to perform safer resections in healthy tissue compared with normal WL. The relative risk (RR) of leaving ischemic tissue in WL and ICG compared with q-ICG, even for experienced surgeons was substantial, intermediates (RR = 8.9, CI95% [4.0;20] and RR = 6.2, CI95% [2.7;14.1]), and experienced (RR = 4.7, CI95% [2.6;8.7] and RR = 4.0, CI95% [2.1;7.5]). Conclusion Q-ICG seems to guide surgeons, regardless of experience level, to safely perform resection in healthy tissue, compared with standard WL. Future research should focus on this novel tool’s clinical impact.

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Section: Discussionmentioning

confidence: 99%

Quantitative fluorescence angiography aids novice and experienced surgeons in performing intestinal resection in well-perfused tissue

et al. 2021

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“…This result indicated that application of ICG in gastric blood supply requires a learning curve. Hardy NP et al conducted a questionnaire about the interpretation of near infrared perfusion imaging using ICG in colorectal surgery in 40 participants, and 70% felt > 10 cases were needed for competency in use with the majority of experts advocating > 50 ( 33 ). The learning curve of application of ICG in gastric perfusion is still unclear.…”

Section: Discussionmentioning

confidence: 99%

Indocyanine Green Fluorescence Using in Conduit Reconstruction for Patients With Esophageal Cancer to Improve Short-Term Clinical Outcome: A Meta-Analysis

et al. 2022

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ObjectivesThis meta-analysis evaluated the short-term safety and efficacy of indocyanine green (ICG) fluorescence in gastric reconstruction to determine a suitable anastomotic position during esophagectomy.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyzes 2020 (PRISMA) were followed for this analysis.ResultsA total of 9 publications including 1,162 patients were included. The operation time and intraoperative blood loss were comparable in the ICG and control groups. There was also no significant difference in overall postoperative mortality, reoperation, arrhythmia, vocal cord paralysis, pneumonia, and surgical wound infection. The ICG group had a 2.66-day reduction in postoperative stay. The overall anastomotic leak (AL) was 17.6% (n = 131) in the control group and 4.5% (n = 19) in the ICG group with a relative risk (RR) of 0.29 (95% CI 0.18–0.47). A subgroup analysis showed that the application of ICG in cervical anastomosis significantly reduced the incidence of AL (RR of 0.31, 95% CI 0.18–0.52), but for intrathoracic anastomosis, the RR 0.35 was not significant (95% CI 0.09–1.43). Compared to an RR of 0.35 in publications with a sample size of <50, a sample size of >50 had a lower RR of 0.24 (95% CI 0.12–0.48). Regarding intervention time of ICG, the application of ICG both before and after gastric construction had a better RR of 0.25 (95% CI 0.07–0.89).ConclusionsThe application of ICG fluorescence could effectively reduce the incidence of AL and shorten the postoperative hospital stay for patients undergoing cervical anastomosis but was not effective for patients undergoing intrathoracic anastomosis. The application of ICG fluorescence before and after gastric management can better prevent AL.Systematic Review RegistrationPROSPERO, CRD:42021244819.

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“…This leads us to hypothesize that an image analysis pipeline segmenting the colon from the background first and, on this output, running the classification algorithm could lead to improved results. Based on previous work from our group [Soares, AS et al, Interobserver agreement study, under review ] and others [5] significant variation exists between different surgeons' assessments. Standardisation of fluorescence angiography is a necessary step to enable accurate comparison of results.…”

Section: Decision Boundary Estimationmentioning

confidence: 99%

“…The interpretation of the signal in fluorescence angiography is dependent on the surgeon and perhaps represents the actual 'learning curve' for this technique. These decisions have a high degree of variability shown both for static images [Soares, AS et al, Interobserver agreement study, under review ] and dynamic video [5] assessments. Automating the interpretation of the signal would eliminate this variability and provide an alternative means of quantification, thereby leveraging the usefulness of surgical data science [6] in the clinical setting.…”

Section: Introductionmentioning

confidence: 99%

Fluorescence angiography classification in colorectal surgery -- A preliminary report

Soares¹,

Bano²,

Clancy³

et al. 2022

Preprint

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Inter-user variation in the interpretation of near infrared perfusion imaging using indocyanine green in colorectal surgery

Cited by 38 publications

References 24 publications

Quantitative fluorescence angiography aids novice and experienced surgeons in performing intestinal resection in well-perfused tissue

Quantitative fluorescence angiography aids novice and experienced surgeons in performing intestinal resection in well-perfused tissue

Indocyanine Green Fluorescence Using in Conduit Reconstruction for Patients With Esophageal Cancer to Improve Short-Term Clinical Outcome: A Meta-Analysis

Fluorescence angiography classification in colorectal surgery -- A preliminary report

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