Border Line Definition Using Hyperspectral Imaging in Colorectal Resections

Abstract

Background: A perfusion deficit is a well-defined and intraoperatively influenceable cause of anastomotic leak (AL). Current intraoperative perfusion assessment methods do not provide objective and quantitative results. In this study, the ability of hyperspectral imaging (HSI) to quantify tissue oxygenation intraoperatively was assessed. Methods: 115 patients undergoing colorectal resections were included in the final analysis. Before anastomotic formation, the bowel was extracted and the resection line was outlined and imaged using a compact HSI camera, in order to provide instantaneously quantitative perfusion assessment. Results: In 105 patients, a clear demarcation line was visible with HSI one minute after marginal artery transection, reaching a plateau after 3 min. In 58 (55.2%) patients, the clinically determined transection line matched with HSI. In 23 (21.9%) patients, the clinically established resection margin was entirely within the less perfused area. In 24 patients (22.8%), the HSI transection line had an irregular course and crossed the clinically established resection line. In four cases, HSI disclosed a clinically undetected lesion of the marginal artery. Conclusions: Intraoperative HSI is safe, well reproducible, and does not disrupt the surgical workflow. It also quantifies bowel surface perfusion. HSI might become an intraoperative guidance tool, potentially preventing postoperative complications.

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

“…In another study 49 , Jansen-Winkeln et al imaged colorectal tumors in 54 consecutive patients during colorectal resections and found that HSI used in combination with a neural-network algorithm was able to classify cancer or adenomatous margins around the central tumor with a sensitivity of 86% and a specificity of 95%. Recently, they published a large study 50 enrolling 115 patients who underwent colorectal resection to systematically assess the feasibility of HSI in quantifying tissue perfusion, and in accordance with a smaller patient series, they found that "well-perfused areas were clearly distinguishable from the less perfused ones only after one minute". 46,47 Similar conclusions were reached in a group of 52 patients undergoing colorectal surgery by Barberio et al 51 , who also found that the physiological HSI parameter StO 2 was significantly lower in patients receiving neoadjuvant radio/chemotherapy than in other oncological patients.…”

“…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.…”

“…The first challenge will need to be approached by enrolling progressively larger patient groups undergoing various oncological surgical interventions. It appears that the group of Jansen-Winkeln et al 48,50 is already moving in this direction by conducting progressively larger clinical studies. However, with the application of neural networks, requirements for cohort sizes become far higher but could also be partially satisfied with the data augmentation.…”

Indocyanine Green(Icg) And Colorectal Surgery: A Literature Review on Qualitative and Quantitative Methods of Usage

“…Jansen-Winkeln [73] found that in 115 patients with colorectal resections, intraoperative HIS (hyperspectral imaging) was safe, repeatable, and not disruptive to the surgical process. Additionally, it assesses the surface perfusion of the gut.…”

Quantitative Methods for the Use of Icg in Colorectal Surgery - An Updated Literature Review

“…The combined application of ICG-FA and HSI within a single imaging system could provide supportive and complementary information regarding tissue vascularization, reduce perioperative mortality, and shorten surgical procedures. Jansen-Winkeln [61] found that , in 115 patients undergoing colorectal resections, intraoperative HIS(hyperspectral imaging) is safe, reproducible, and does not interfere with the surgical workflow. In addition, it measures bowel surface perfusion.…”