Intraoperative Thermal Imaging in Esophageal Replacement: Its Use in the Assessment of Gastric Tube Viability

Abstract

We examined the use of intraoperative thermal imaging to assess the gastric vascularization and gastric tube viability during esophagectomy. The surface temperatures of the intact stomach, devascularized stomach, and gastric tube were measured in 13 patients from the proximal end to the pylorus longitudinally along the greater curvature or along the entire gastric tube during esophagectomy. Thermal images clearly demonstrated a surface temperature decline in the proximal region of the gastric tube. The mean decline rate in the surface temperature in the proximal region of the gastric tube in comparison to the intact stomach was 17.7% (P < 0.001). One patient who developed gastric tube necrosis exhibited a prominent drop in the surface temperature in the proximal region of 20.6% in comparison to that in the distal region, compared to that of 12.5% in other patients. Intraoperative thermal imaging is a noninvasive and reliable technique for the assessment of the gastric tube viability.

The Effect of Perfusion Pressure on Gastric Tissue Blood Flow in an Experimental Gastric Tube Model

“…Our results emphasize that thermography is a suitable method to evaluate blood flow of the gastric tube during surgery, as is demonstrated by Nishikawa et al 15 The noninvasiveness of the technique makes it especially suitable in a surgical setting. However, thermography provides a global impression of blood flow, which is attributable to the fact that temperature is a derivate of blood flow and can be influenced by other factors.…”

How to assess intestinal viability during surgery: A review of techniques

“…The current medical application of thermal imaging is mainly limited to the detection of peripheral circulatory disturbances or breast cancer and to assess graft patency in plastic or cardiac surgery. Low surface temperature can be interpreted to be the poor vascularization that may cause an anastomotic impairment [57] . Thermal imaging was applied for assessment of the intestinal blood supply in several studies.…”

“…Nishikawa et al examined the use of intraoperative thermal imaging to assess gastric vascularization and gastric tube viability in patients during esophagectomy. They found intraoperative thermal imaging to be a noninvasive and reliable technique [57] . However, this is an indirect indicator of perfusion and oxygenation and the measurements are dependent on ambient temperature.…”

Noninvasive intratumoral thermal dose determination during in vivo magnetic nanoparticle hyperthermia: combining surface temperature measurements and computer simulations

“…Another modality that appears in several preclinical studies is infrared thermometry (IRT) that monitors the surface temperature during in vivo MNH [19][20][21][22]. This kind of thermometry, out of the context of any kind of intraoperative thermal imaging during a surgical procedure [23,24], has the limitation of being useful only for superficial tumors (close to/or at the surface of the skin) and needs to be properly employed, or else it may result in gross errors in determining the temperature of a region of interest (ROI). First, this kind of thermometry is strongly dependent on the angle (h) formed between the direction of the camera's objective lens and the normal direction of the imaged surface, and this is due to the spectraldirectional dependence of the skin's thermal emissivity e k, h ð Þ [25].…”