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Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery

Diana, Michele ; Halvax, Peter ; Dallemagne, Bernard ; Nagao, Yoshihiro ; Diemunsch, Pierre ; Charles, Anne-Laure ; Agnus, Vincent ; Soler, Luc ; Demartines, Nicolas ; Lindner, Veronique ; Geny, Bernard ; Marescaux, Jacques

In: Surgical Endoscopy, 2014, vol. 28, no. 11, p. 3108-3118

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    Titre
    • Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery
    Auteur
    • Diana, Michele. IHU, Minimally Invasive Image-Guided Surgical Institute, Strasbourg, France
    • Halvax, Peter. IHU, Minimally Invasive Image-Guided Surgical Institute, Strasbourg, France
    • Dallemagne, Bernard. IHU, Minimally Invasive Image-Guided Surgical Institute, Strasbourg, France
    • Nagao, Yoshihiro. IHU, Minimally Invasive Image-Guided Surgical Institute, Strasbourg, France
    • Diemunsch, Pierre. Department of Anesthesiology, University of Strasbourg, Strasbourg, France
    • Charles, Anne-Laure. EA 3072 "Mitochondria, Oxidative Stress and Muscle Protection”, Translational Medicine Federation of Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
    • Agnus, Vincent. IRCAD, Research Institute against Cancer of Digestive System, 1, place de l'Hôpital, 67095, Strasbourg, France
    • Soler, Luc. IRCAD, Research Institute against Cancer of Digestive System, 1, place de l'Hôpital, 67095, Strasbourg, France
    • Demartines, Nicolas. Department of Visceral Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland
    • Lindner, Veronique. Department of Pathology, Regional Hospital of Mulhouse, Mulhouse, France
    • Geny, Bernard. EA 3072 "Mitochondria, Oxidative Stress and Muscle Protection”, Translational Medicine Federation of Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
    • Marescaux, Jacques. IHU, Minimally Invasive Image-Guided Surgical Institute, Strasbourg, France
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • Surgical Endoscopy, 2014, vol. 28, no. 11, p. 3108-3118. Springer US; http://www.springer-ny.com
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:326440
    Summary
    Background: Fluorescence-based enhanced reality (FLER) is a technique to evaluate intestinal perfusion based on the elaboration of the Indocyanine Green fluorescence signal. The aim of the study was to assess FLER's performances in evaluating perfusion in an animal model of long-lasting intestinal ischemia. Materials and methods: An ischemic segment was created in 18 small bowel loops in 6 pigs. After 2h (n=6), 4h (n=6), and 6h (n=6), loops were evaluated clinically and by FLER to delineate five regions of interest (ROIs): ischemic zone (ROI 1), presumed viable margins (ROI 2a-2b), and vascularized areas (3a-3b). Capillary lactates were measured to compare clinical vs. FLER assessment. Basal (V 0 ) and maximal (V max) mitochondrial respiration rates were determined according to FLER. Results: Lactates (mmol/L) at clinically identified resection lines were significantly higher when compared to those identified by FLER (2.43±0.95 vs. 1.55±0.33 p=0.02) after 4h of ischemia. Lactates at 2h at ROI 1 were 5.45±2.44 vs. 1.9±0.6 (2a-2b; p<0.0001) vs. 1.2±0.3 (3a-3b; p<0.0001). At 4h, lactates were 4.36±1.32 (ROI 1) vs. 1.83±0.81 (2a-2b; p<0.0001) vs. 1.35±0.67 (3a-3b; p<0.0001). At 6h, lactates were 4.16±2.55 vs. 1.8±1.2 vs. 1.45±0.83 at ROI 1 vs. 2a--2b (p=0.013) vs. 3a-3b (p=0.0035). Mean V 0 and V max (pmolO2/second/mg of tissue) were significantly impaired after 4 and 6h at ROI 1 (V 0 4h =34.83±10.39; V max 4h =76.6±29.09; V 0 6h =44.1±12.37 and V max 6h =116.1±40.1) when compared to 2a--2b (V 0 4h =67.1±17.47 p=0.00039; V max 4h =146.8±55.47 p=0.0054; V 0 6h =63.9±28.99 p=0.03; V max 6h =167.2±56.96 p=0.01). V 0 and V max were significantly higher at 3a-3b. Conclusions: FLER may identify the future anastomotic site even after repetitive assessments and long-standing bowel ischemia.