Novel Intraoperative Imaging of Gastric Tube Perfusion during Oncologic Esophagectomy—A Pilot Study Comparing Hyperspectral Imaging (HSI) and Fluorescence Imaging (FI) with Indocyanine Green (ICG)

Abstract

Background: Novel intraoperative imaging techniques, namely, hyperspectral (HSI) and fluorescence imaging (FI), are promising with respect to reducing severe postoperative complications, thus increasing patient safety. Both tools have already been used to evaluate perfusion of the gastric conduit after esophagectomy and before anastomosis. To our knowledge, this is the first study evaluating both modalities simultaneously during esophagectomy. Methods: In our pilot study, 13 patients, who underwent Ivor Lewis esophagectomy and gastric conduit reconstruction, were analyzed prospectively. HSI and FI were recorded before establishing the anastomosis in order to determine its optimum position. Results: No anastomotic leak occurred during this pilot study. In five patients, the imaging methods resulted in a more peripheral adaptation of the anastomosis. There were no significant differences between the two imaging tools, and no adverse events due to the imaging methods or indocyanine green (ICG) injection occurred. Conclusions: Simultaneous intraoperative application of both modalities was feasible and not time consuming. They are complementary with regard to the ideal anastomotic position and may contribute to better surgical outcomes. The impact of their simultaneous application will be proven in consecutive prospective trials with a large patient cohort.

Imaging perfusion changes in oncological clinical applications by hyperspectral imaging: a literature review

“…Based on this literature review, the following inferences could be made: HSI is still finding its place in oncological clinical applications with the assessment of (i) mastectomy skin flap perfusion after breast reconstructive surgery 8 and (ii) anastomotic perfusion during reconstruction of gastrointenstinal conduit 9,44,45,[48][49][50] as the most promising. However, caution needs to be advised because recently much research has been done in the arena of using HSI during brain surgery for glioblastoma, yet this clinical effort has not been sustained.…”

“…As in Pruimboom 8 As in Pruimboom 8 Hennig 44 13 Hybrid esophagectomy followed by reconstructing gastric conduit…”

“…Hybrid esophagectomy along with intraoperative HSI used in the paper of K öhler et al 9 was presented as a video article by Moulla et al 42 , while another clinical group 43 corroborated the findings of Köhler et al 9 by reporting a case study including four patients. Hennig et al 44 continued the systematic evaluation of the capabilities of intraoperative HSI in 13 consecutive patients who underwent hybrid esophagectomy and reconstruction of the gastric conduit. Researchers also decided to use both intraoperative HSI and fluorescence imaging with indocyanine green (FI-ICG) to define the optimal position of anastomosis.…”

“…It was noteworthy that imaging modalities recorded simultaneously in 10 out of 13 patients identified the perfusion border zone more peripherally than the one desig-nated subjectively by the surgeon. While HSI and FI-ICG may complement each other as intraoperative modalities, Hennig et al 44 were of the opinion that HSI may be advantageous due to "the lower costs, noninvasiveness, and lack of contraindications".…”

“…deviated from the border line determined by HSI; in 13 patients subjectively, planned resection was up to 13 mm too distal in the poorly perfused area, while in 11 patients, it was too far in the well-perfused area. Similar to esophagectomy 44 , intraoperative HSI has shown potential in determining the optimal anastomotic area during colorectal surgery.…”