Evaluation of hyperspectral imaging (HSI) for the measurement of ischemic conditioning effects of the gastric conduit during esophagectomy

Evaluation of hyperspectral imaging (HSI) for the measurement of ischemic conditioning effects of the gastric conduit during esophagectomy

Background Hyperspectral imaging (HSI) is a relatively new method used in image-guided and precision surgery, which has shown promising results for characterization of tissues and assessment of physiologic tissue parameters. Previous methods used for analysis of preconditioning concepts in patients...

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Bibliographic Details
Published in:Surgical endoscopy Vol. 33; no. 11; pp. 3775 - 3782
Main Authors: Köhler, Hannes, Jansen-Winkeln, Boris, Maktabi, Marianne, Barberio, Manuel, Takoh, Jonathan, Holfert, Nico, Moulla, Yusef, Niebisch, Stefan, Diana, Michele, Neumuth, Thomas, Rabe, Sebastian M., Chalopin, Claire, Melzer, Andreas, Gockel, Ines
Format: Journal Article
Language:English
Published: New York Springer US 01-11-2019
Springer Nature B.V
Subjects:
Abdominal Surgery
Diabetes
Endoscopy
Esophagus
Foot diseases
Gastroenterology
Gastrointestinal surgery
Gynecology
Hemoglobin
Hepatology
Ischemia
Laparoscopy
Medicine
Medicine & Public Health
Methods
Ostomy
Proctology
Stomach
Studies
Surgery
Esophagectomy
Ischemic conditioning
Physiologic tissue parameters
Gastric conduit
Hyperspectral imaging
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Summary:Background Hyperspectral imaging (HSI) is a relatively new method used in image-guided and precision surgery, which has shown promising results for characterization of tissues and assessment of physiologic tissue parameters. Previous methods used for analysis of preconditioning concepts in patients and animal models have shown several limitations of application. The aim of this study was to evaluate HSI for the measurement of ischemic conditioning effects during esophagectomy. Methods Intraoperative hyperspectral images of the gastric tube through the mini-thoracotomy were recorded from n  = 22 patients, 14 of whom underwent laparoscopic gastrolysis and ischemic conditioning of the stomach with two-step transthoracic esophagectomy and gastric pull-up with intrathoracic anastomosis after 3–7 days. The tip of the gastric tube (later esophagogastric anastomosis) was measured with HSI. Analysis software provides a RGB image and 4 false color images representing physiologic parameters of the recorded tissue area intraoperatively. These parameters contain tissue oxygenation (StO 2 ), perfusion—(NIR Perfusion Index), organ hemoglobin (OHI), and tissue water index (TWI). Results Intraoperative HSI of the gastric conduit was possible in all patients and did not prolong the regular operative procedure due to its quick applicability. In particular, the tissue oxygenation of the gastric conduit was significantly higher in patients who underwent ischemic conditioning ( St O 2 ¯ Precond .  = 78%; St O 2 ¯ NoPrecond .  = 66%; p  = 0.03). Conclusions HSI is suitable for contact-free, non-invasive, and intraoperative evaluation of physiological tissue parameters within gastric conduits. Therefore, HSI is a valuable method for evaluating ischemic conditioning effects and may contribute to reduce anastomotic complications. Additional studies are needed to establish normal values and thresholds of the presented parameters for the gastric conduit anastomotic site.
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ISSN:0930-2794
1432-2218
DOI:10.1007/s00464-019-06675-4