Simultaneous computer-assisted assessment of mucosal and serosal perfusion in a model of segmental colonic ischemia

Seeliger, Barbara; Agnus, Vincent; Mascagni, Pietro; Barberio, Manuel; Longo, Fabio; Lapergola, Alfonso; Mutter, Didier; Klymchenko, Andrey S.; Chand, Manish; Marescaux, Jacques; Diana, Michèle

doi:10.1007/s00464-019-07258-z

Cited by 23 publications

(24 citation statements)

References 33 publications

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“…As a result, serosal perfusion only can be quantified. It has been previously shown that the ischemia behavior within the gastrointestinal tract varies when comparing the serosal with the mucosal side [ 14 ]. Confocal laser endomicroscopy (CLE) is a high-resolution microscopic optical imaging modality, which allows for a detailed morphological assessment of the gastrointestinal mucosa.…”

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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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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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“…weight 42⋅8(3⋅9) kg) were used in the study, as part of the ELIOS (Endoscopic Luminescent Imaging for precision Oncologic Surgery) protocol, which received full approval from the local Ethical Committee on Animal Experimentation (ICOMETH 38.2017.01.085), and the Ministry of Superior Education and Research (APAFIS 8721-2017013010316298v2). All animals used in the experimental laboratory were managed according to French laws for animal use and care, European Community Council directives (2010/63/EU), and ARRIVE guidelines, as described previously 11 .…”

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confidence: 99%

“…Focusing on the 40‐s time interval between FSI arrival and signal decrease, the variation from 25 to 75 per cent of maximal intensity was analysed. This slope of FSI evolution dynamics was used for quantitative near‐infrared fluorescence perfusion imaging 11,12 . Perfusion data from each imaging system were translated into a colour‐coded cartogram, which was superimposed on to the real‐time view of the corresponding left and right camera systems 12 .…”

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confidence: 99%

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Intraoperative imaging for remnant viability assessment in bilateral posterior retroperitoneoscopic partial adrenalectomy in an experimental model

Seeliger

Alesina

Walz

et al. 2020

British Journal of Surgery

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Background: A surgical approach preserving functional adrenal tissue allows biochemical cure while avoiding the need for lifelong steroid replacement. The aim of this experimental study was to evaluate the impact of intraoperative imaging during bilateral partial adrenalectomy on remnant perfusion and function. Methods: Five pigs underwent bilateral posterior retroperitoneoscopic central adrenal gland division (9 divided glands, 1 undivided). Intraoperative perfusion assessment included computer-assisted quantitative fluorescence imaging, contrast-enhanced CT, confocal laser endomicroscopy (CLE) and local lactate sampling. Specimen analysis after completion adrenalectomy (10 adrenal glands) comprised mitochondrial activity and electron microscopy. Results: Fluorescence signal intensity evolution over time was significantly lower in the cranial segment of each adrenal gland (mean(s.d.) 0⋅052(0⋅057) versus 0⋅133(0⋅057) change in intensity per s for cranial versus caudal parts respectively; P = 0⋅020). Concordantly, intraoperative CT in the portal phase demonstrated significantly lower contrast uptake in cranial segments (P = 0⋅031). In CLE, fluorescein contrast was observed in all caudal segments, but in only four of nine cranial segments (P = 0⋅035). Imaging findings favouring caudal perfusion were congruent, with significantly lower local capillary lactate levels caudally (mean(s.d.) 5⋅66(5⋅79) versus 11⋅58(6⋅53) mmol/l for caudal versus cranial parts respectively; P = 0⋅008). Electron microscopy showed more necrotic cells cranially (P = 0⋅031). There was no disparity in mitochondrial activity (respiratory rates, reactive oxygen species and hydrogen peroxide production) between the different segments. Conclusion: In a model of bilateral partial adrenalectomy, three intraoperative imaging modalities consistently discriminated between regular and reduced adrenal remnant perfusion. By avoiding circumferential dissection, mitochondrial function was preserved in each segment of the adrenal glands.

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“…29 They report that metrics from this simple semiquantitative approach performed well diagnostically to identify viable and nonviable small bowel in rats. Diana et al [30][31][32][33] developed a fluorescence-based enhanced reality approach that uses time-to-peak (TTP) analysis to produce a perfusion-like map that is overlaid onto the surgeon's view of the field and evaluated the approach in a variety of pig models. Similar TTP methods have also been evaluated in human patients.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative fluorescence perfusion assessment should be corrected by a measured subject-specific arterial input function

et al. 2020

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Significance: The effects of varying the indocyanine green injection dose, injection rate, physiologic dispersion of dye, and intravenous tubing volume propagate into the shape and magnitude of the arterial input function (AIF) during intraoperative fluorescence perfusion assessment, thereby altering the observed kinetics of the fluorescence images in vivo. Aim: Numerical simulations are used to demonstrate the effect of AIF on metrics derived from tissue concentration curves such as peak fluorescence, time-to-peak (TTP), and egress slope. Approach: Forward models of tissue concentration were produced by convolving simulated AIFs with the adiabatic approximation to the tissue homogeneity model using input parameters representing six different tissue examples (normal brain, glioma, normal skin, ischemic skin, normal bone, and osteonecrosis). Results: The results show that AIF perturbations result in variations in estimates of total intensity of up to 80% and TTP error of up to 200%, with the errors more dominant in brain, less in skin, and less in bone. Interestingly, error in ingress slope was as high as 60% across all tissue types. These are key observable parameters used in fluorescence imaging either implicitly by viewing the image or explicitly through intensity fitting algorithms. Correcting by deconvolving the image with a measured subject-specific AIF provides an intuitive means of visualizing the data while also removing the source of variance and allowing intra-and intersubject comparisons. Conclusions: These results suggest that intraoperative fluorescence perfusion assessment should be corrected by patient-specific AIFs measured by pulse dye densitometry.

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Simultaneous computer-assisted assessment of mucosal and serosal perfusion in a model of segmental colonic ischemia

Cited by 23 publications

References 33 publications

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

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

Intraoperative imaging for remnant viability assessment in bilateral posterior retroperitoneoscopic partial adrenalectomy in an experimental model

Intraoperative fluorescence perfusion assessment should be corrected by a measured subject-specific arterial input function

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