Intraoperative bowel perfusion quantification with hyperspectral imaging: a guidance tool for precision colorectal surgery

Barberio, Manuel; Lapergola, Alfonso; Benedicenti, Sara; Mita, Mariateresa; Barbieri, Vittoria; Rubichi, Francesco; Altamura, Amedeo; Giaracuni, Gloria; Tamburini, Emiliano; Diana, Michèle; Pizzicannella, Margherita; Viola, Massimo

doi:10.1007/s00464-022-09407-3

Cited by 12 publications

(7 citation statements)

References 34 publications

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“…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. Figure 7 illustrates the usefulness of HSI in establishing the transection line during colorectal surgery.…”

Section: Lower Gastrointestinal Tractsupporting

confidence: 74%

“…When evaluating applications of HSI in assessing anastomotic perfusion during reconstructing gastrointestinal conduits, two main challenges become apparent: (i) the first challenge is, as in the case of breast reconstructive surgery, related to the establishment of a clear cutoff value indicating Taken from Barberio et al 51 and reprinted with permission from the publisher.…”

Section: Discussionmentioning

confidence: 99%

“…Jansen-Winkeln 46 24 Colorectal resection As in Pruimboom 8 As in Pruimboom 8 Jansen-Winkeln 47 32 Colorectal resection As in Pruimboom 8 As in Pruimboom 8 Pfahl 48 128 Colorectal resection As in Pruimboom 8 As in Pruimboom 8 Jansen-Winkeln 49 54 Colorectal resection As in Pruimboom 8 As in Pruimboom 8 Jansen-Winkel n5 0 115 Colorectal resection As in Pruimboom 8 As in Pruimboom 8 Barberio 51 52 Colorectal resection As in Pruimboom 8 As in Pruimboom 8…”

Section: Lower Gi Tractmentioning

confidence: 99%

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

Hren

Serša

Simončič

et al. 2022

Radiology and Oncology

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Background Hyperspectral imaging (HSI) is a promising imaging modality that uses visible light to obtain information about blood flow. It has the distinct advantage of being noncontact, nonionizing, and noninvasive without the need for a contrast agent. Among the many applications of HSI in the medical field are the detection of various types of tumors and the evaluation of their blood flow, as well as the healing processes of grafts and wounds. Since tumor perfusion is one of the critical factors in oncology, we assessed the value of HSI in quantifying perfusion changes during interventions in clinical oncology through a systematic review of the literature. Materials and methods The PubMed and Web of Science electronic databases were searched using the terms “hyperspectral imaging perfusion cancer” and “hyperspectral imaging resection cancer”. The inclusion criterion was the use of HSI in clinical oncology, meaning that all animal, phantom, ex vivo, experimental, research and development, and purely methodological studies were excluded. Results Twenty articles met the inclusion criteria. The anatomic locations of the neoplasms in the selected articles were as follows: kidneys (1 article), breasts (2 articles), eye (1 article), brain (4 articles), entire gastrointestinal (GI) tract (1 article), upper GI tract (5 articles), and lower GI tract (6 articles). Conclusions HSI is a potentially attractive imaging modality for clinical application in oncology, with assessment of mastectomy skin flap perfusion after reconstructive breast surgery and anastomotic perfusion during reconstruction of gastrointenstinal conduit as the most promising at present.

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Section: Lower Gastrointestinal Tractsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Lower Gi Tractmentioning

confidence: 99%

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

Hren

Serša

Simončič

et al. 2022

Radiology and Oncology

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“…Furthermore, this technique has only been previously described in an animal model, allowing much greater ischaemia than experienced clinically [ 38 ]), while mitochondrial respiration assessment necessitates full thickness biopsies. Non-invasive tissue oxygen saturation hyperspectral oximetry measurement [ 39 ] has potential but is still of uncertain clinical relevance and there is currently no CE-marked device for use in Europe [ 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical and computational development of a patient-calibrated ICGFA bowel transection recommender

Dalli,

Epperlein,

Hardy

et al. 2024

Surg Endosc

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Introduction Intraoperative indocyanine green fluorescence angiography (ICGFA) aims to reduce colorectal anastomotic complications. However, signal interpretation is inconsistent and confounded by patient physiology and system behaviours. Here, we demonstrate a proof of concept of a novel clinical and computational method for patient calibrated quantitative ICGFA (QICGFA) bowel transection recommendation. Methods Patients undergoing elective colorectal resection had colonic ICGFA both immediately after operative commencement prior to any dissection and again, as usual, just before anastomotic construction. Video recordings of both ICGFA acquisitions were blindly quantified post hoc across selected colonic regions of interest (ROIs) using tracking-quantification software and computationally compared with satisfactory perfusion assumed in second time-point ROIs, demonstrating 85% agreement with baseline ICGFA. ROI quantification outputs detailing projected perfusion sufficiency-insufficiency zones were compared to the actual surgeon-selected transection/anastomotic construction site for left/right-sided resections, respectively. Anastomotic outcomes were recorded, and tissue lactate was also measured in the devascularised colonic segment in a subgroup of patients. The novel perfusion zone projections were developed as full-screen recommendations via overlay heatmaps. Results No patient suffered intra- or early postoperative anastomotic complications. Following computational development (n = 14) the software recommended zone (ROI) contained the expert surgical site of transection in almost all cases (Jaccard similarity index 0.91) of the nine patient validation series. Previously published ICGFA time-series milestone descriptors correlated moderately well, but lactate measurements did not. High resolution augmented reality heatmaps presenting recommendations from all pixels of the bowel ICGFA were generated for all cases. Conclusions By benchmarking to the patient’s own baseline perfusion, this novel QICGFA method could allow the deployment of algorithmic personalised NIR bowel transection point recommendation in a way fitting existing clinical workflow.

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“…There is also an added clinical step in administering the agent whether before or during a surgical procedure. Given the potential clinical impact of enhanced intraoperative visualization, there has been increasing interest in developing ‘dye-free’ ways of analysing tissue texture and character via multispectral analysis 111 . Such hyperspectral imaging is technically possible and generates huge amounts of information, which again may benefit from computational interpretation 112 .…”

Section: Future Opportunities and Horizon Scanningmentioning

confidence: 99%

Fluorescence-guided surgery: comprehensive review

Sutton

Dam

et al. 2023

BJS Open

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Background Despite significant improvements in preoperative workup and surgical planning, surgeons often rely on their eyes and hands during surgery. Although this can be sufficient in some patients, intraoperative guidance is highly desirable. Near-infrared fluorescence has been advocated as a potential technique to guide surgeons during surgery. Methods A literature search was conducted to identify relevant articles for fluorescence-guided surgery. The literature search was performed using Medical Subject Headings on PubMed for articles in English until November 2022 and a narrative review undertaken. Results The use of invisible light, enabling real-time imaging, superior penetration depth, and the possibility to use targeted imaging agents, makes this optical imaging technique increasingly popular. Four main indications are described in this review: tissue perfusion, lymph node assessment, anatomy of vital structures, and tumour tissue imaging. Furthermore, this review provides an overview of future opportunities in the field of fluorescence-guided surgery. Conclusion Fluorescence-guided surgery has proven to be a widely innovative technique applicable in many fields of surgery. The potential indications for its use are diverse and can be combined. The big challenge for the future will be in bringing experimental fluorophores and conjugates through trials and into clinical practice, as well as validation of computer visualization with large data sets. This will require collaborative surgical groups focusing on utility, efficacy, and outcomes for these techniques.

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Intraoperative bowel perfusion quantification with hyperspectral imaging: a guidance tool for precision colorectal surgery

Cited by 12 publications

References 34 publications

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

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

Clinical and computational development of a patient-calibrated ICGFA bowel transection recommender

Fluorescence-guided surgery: comprehensive review

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