Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Karliczek, Anne; Harlaar, Niels J.; Zeebregts, Clark J.; Wiggers, Theo; Baas, Peter C.; Dam, van Gooitzen

doi:10.1007/s00384-009-0658-6

Cited by 387 publications

(278 citation statements)

References 23 publications

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“…The imaging systems are typically sufficiently compact and portable to be brought into the operating room and can provide images rapidly and conveniently, in a manner similar to intraoperative ultrasound (24). Optoacoustic imaging could assess the perfusion status of tissue by detecting hemoglobin dynamics and oxygenation, potentially providing better prediction of anastomotic leakage resulting from ischemic conditions in the colon or esophagus while it can still be prevented (83).…”

Section: Intraoperative Imagingmentioning

confidence: 99%

Mesoscopic and Macroscopic Optoacoustic Imaging of Cancer

2015

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Optoacoustic imaging combines the rich contrast of optical methods with the resolution of ultrasound imaging. It can therefore deliver optical visualization of cancer far deeper in tissue than optical microscopy and other conventional optical imaging methods. Technological progress and novel contrast media have resulted in optoacoustic imaging being propagated to basic cancer research and in clinical translation projects. We briefly review recent technological advances, showcase the ability to resolve unique cancer biomarkers based on spectral features at different imaging scales, and highlight the imaging performance achieved in preclinical and clinical imaging applications.

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Section: Intraoperative Imagingmentioning

confidence: 99%

Mesoscopic and Macroscopic Optoacoustic Imaging of Cancer

2015

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“…Assessment of the perfusion of an organ post-transplant, for example, provides an indicator of the efficacy of the vascular anastomoses 1 . Similarly, imaging of the microperfusion in the perianastomotic region following bowel resection and reattachment surgery may also allow prediction of areas at risk of leakage 2 , thus preventing subsequent complications 3 .…”

Section: Introductionmentioning

confidence: 99%

Dual multispectral and 3D structured light laparoscope

et al. 2015

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Intraoperative feedback on tissue function, such as blood volume and oxygenation would be useful to the surgeon in cases where current clinical practice relies on subjective measures, such as identification of ischaemic bowel or tissue viability during anastomosis formation. Also, tissue surface profiling may be used to detect and identify certain pathologies, as well as diagnosing aspects of tissue health such as gut motility. In this paper a dual modality laparoscopic system is presented that combines multispectral reflectance and 3D surface imaging. White light illumination from a xenon source is detected by a laparoscope-mounted fast filter wheel camera to assemble a multispectral image (MSI) cube. Surface shape is then calculated using a spectrally-encoded structured light (SL) pattern detected by the same camera and triangulated using an active stereo technique. Images of porcine small bowel were acquired during open surgery. Tissue reflectance spectra were acquired and blood volume was calculated at each spatial pixel across the bowel wall and mesentery. SL features were segmented and identified using a 'normalised cut' algoritm and the colour vector of each spot. Using the 3D geometry defined by the camera coordinate system the multispectral data could be overlaid onto the surface mesh. Dual MSI and SL imaging has the potential to provide augmented views to the surgeon supplying diagnostic information related to blood supply health and organ function. Future work on this system will include filter optimisation to reduce noise in tissue optical property measurement, and minimise spot identification errors in the SL pattern.

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“…He then reviewed the known and controversial risk factors for anastomotic leak. He presented data from a prospective study assessing whether surgeons, at the time of anastomotic construction, can predict which patients will leak [10]. Results demonstrated that surgeons cannot predict which patients will leak.…”

Section: Doctor Hans Schardey and Doctor James Fleshman Presentationmentioning

confidence: 99%

Proceedings of the First International Summit on Intestinal Anastomotic Leak, Chicago, Illinois, October 4–5, 2012

Shogan

Schardey³

et al. 2014

Surgical Infections

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Objective: The first international summit on anastomotic leak was held in Chicago in October, 2012 to assess current knowledge in the field and develop novel lines of inquiry. The following report is a summary of the proceedings with commentaries and future prospects for clinical trials and laboratory investigations. Background: Anastomotic leakage remains a devastating problem for the patient, and a continuing challenge to the surgeon operating on high-risk areas of the gastrointestinal tract such as the esophagus and rectum. Despite the traditional wisdom that anastomotic leak is because of technique, evidence to support this is weak-to-non-existent.Outcome data continue to demonstrate that expert high-volume surgeons working in high-volume centers continue to experience anastomotic leaks and that surgeons cannot predict reliably which patients will leak. Methods: A one and one-half day summit was held and a small working group assembled to review current practices, opinions, scientific evidence, and potential paths forward to understand and decrease the incidence of anastomotic leak. Results: Results of a survey of the opinions of the group demonstrated that the majority of participants believe that anastomotic leak is a complicated biologic problem whose pathogenesis remains ill-defined. The group opined that anastomotic leak is underreported clinically, it is not because of technique except when there is gross inattention to it, and that results from animal models are mostly irrelevant to the human condition. Conclusions: A fresh and unbiased examination of the causes and strategies for prevention of anastomotic leak needs to be addressed by a continuous working group of surgeons, basic scientists, and clinical trialists to realize a real and significant reduction in its incidence and morbidity. Such a path forward is discussed.

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Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Cited by 387 publications

References 23 publications

Mesoscopic and Macroscopic Optoacoustic Imaging of Cancer

Mesoscopic and Macroscopic Optoacoustic Imaging of Cancer

Dual multispectral and 3D structured light laparoscope

Proceedings of the First International Summit on Intestinal Anastomotic Leak, Chicago, Illinois, October 4–5, 2012

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