Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia

Michele Diana, Bernard Dallemagne, Hyunsoo Chung, Yoshihiro Nagao, Peter Halvax, Vincent Agnus, Luc Soler, Veronique Lindner, Nicolas Demartines, Pierre Diemunsch, Bernard Geny, Lee Swanström, Jacques Marescaux

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background and aim: Surgeons currently rely on visual clues to estimate the presence of sufficient vascularity for safe anastomosis. We aimed to assess the accuracy of endoluminal confocal laser endomicroscopy (CLE) and laparoscopic fluorescence-based enhanced reality (FLER), using near-infrared imaging and fluorescence from injected Indocyanine Green, to identify the transition from ischemic to vascular areas in a porcine model of mesenteric ischemia.

Methods: Six pigs underwent 1-h sigmoid segmental ischemia. The ischemic area was evaluated by clinical assessment and FLER to determine presumed viable margins. For each sigmoid colon, 5 regions of interest (ROIs) were identified: ischemic (ROI 1), presumed viable margins ROI 2a (distal) and 2b (proximal), and vascular areas 3a (distal) and 3b (proximal). After injection of fluorescein, CLE scanning of the mucosa from the ischemic area toward viable margins was performed. Capillary blood samples were obtained by puncturing the serosa at the ROIs, and capillary lactates were measured with the EDGE® analyzer.

Results: Capillary lactates were significantly higher at ROI 1 (4.91 mmol/L) when compared to resection margins (2.8 mmol/L; mean difference: 2.11; p < 0.05) identified by FLER. There was no significant difference in lactates between ROI1 and resection margins identified by clinical evaluation. In 50 % of cases, ROI 2aCLINIC–2bCLINIC were considered to match (<1 cm distance) with ROI 2aFLER–2bFLER. Confocal analysis revealed specific clues to identify the transition from ischemic to viable areas corresponding to those assessed by FLER in 11/12 cases versus 7/12 for those identified by clinical evaluation.

Conclusions: In this experimental model, FLER and CLE were more accurate than clinical evaluation to delineate bowel vascularization.

Original languageEnglish
Pages (from-to)3224-3233
Number of pages10
JournalSurgical endoscopy
Volume28
Issue number11
DOIs
Publication statusPublished - Oct 21 2014

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Sigmoid Colon
Microcirculation
Lactates
Lasers
Swine
Ischemia
Fluorescence
Blood Vessels
Serous Membrane
Indocyanine Green
Optical Imaging
Fluorescein
Mucous Membrane
Theoretical Models
Injections
Margins of Excision

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia. / Diana, Michele; Dallemagne, Bernard; Chung, Hyunsoo; Nagao, Yoshihiro; Halvax, Peter; Agnus, Vincent; Soler, Luc; Lindner, Veronique; Demartines, Nicolas; Diemunsch, Pierre; Geny, Bernard; Swanström, Lee; Marescaux, Jacques.

In: Surgical endoscopy, Vol. 28, No. 11, 21.10.2014, p. 3224-3233.

Research output: Contribution to journalArticle

Diana, M, Dallemagne, B, Chung, H, Nagao, Y, Halvax, P, Agnus, V, Soler, L, Lindner, V, Demartines, N, Diemunsch, P, Geny, B, Swanström, L & Marescaux, J 2014, 'Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia', Surgical endoscopy, vol. 28, no. 11, pp. 3224-3233. https://doi.org/10.1007/s00464-014-3595-6
Diana, Michele ; Dallemagne, Bernard ; Chung, Hyunsoo ; Nagao, Yoshihiro ; Halvax, Peter ; Agnus, Vincent ; Soler, Luc ; Lindner, Veronique ; Demartines, Nicolas ; Diemunsch, Pierre ; Geny, Bernard ; Swanström, Lee ; Marescaux, Jacques. / Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia. In: Surgical endoscopy. 2014 ; Vol. 28, No. 11. pp. 3224-3233.
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abstract = "Background and aim: Surgeons currently rely on visual clues to estimate the presence of sufficient vascularity for safe anastomosis. We aimed to assess the accuracy of endoluminal confocal laser endomicroscopy (CLE) and laparoscopic fluorescence-based enhanced reality (FLER), using near-infrared imaging and fluorescence from injected Indocyanine Green, to identify the transition from ischemic to vascular areas in a porcine model of mesenteric ischemia.Methods: Six pigs underwent 1-h sigmoid segmental ischemia. The ischemic area was evaluated by clinical assessment and FLER to determine presumed viable margins. For each sigmoid colon, 5 regions of interest (ROIs) were identified: ischemic (ROI 1), presumed viable margins ROI 2a (distal) and 2b (proximal), and vascular areas 3a (distal) and 3b (proximal). After injection of fluorescein, CLE scanning of the mucosa from the ischemic area toward viable margins was performed. Capillary blood samples were obtained by puncturing the serosa at the ROIs, and capillary lactates were measured with the EDGE{\circledR} analyzer.Results: Capillary lactates were significantly higher at ROI 1 (4.91 mmol/L) when compared to resection margins (2.8 mmol/L; mean difference: 2.11; p < 0.05) identified by FLER. There was no significant difference in lactates between ROI1 and resection margins identified by clinical evaluation. In 50 {\%} of cases, ROI 2aCLINIC–2bCLINIC were considered to match (<1 cm distance) with ROI 2aFLER–2bFLER. Confocal analysis revealed specific clues to identify the transition from ischemic to viable areas corresponding to those assessed by FLER in 11/12 cases versus 7/12 for those identified by clinical evaluation.Conclusions: In this experimental model, FLER and CLE were more accurate than clinical evaluation to delineate bowel vascularization.",
author = "Michele Diana and Bernard Dallemagne and Hyunsoo Chung and Yoshihiro Nagao and Peter Halvax and Vincent Agnus and Luc Soler and Veronique Lindner and Nicolas Demartines and Pierre Diemunsch and Bernard Geny and Lee Swanstr{\"o}m and Jacques Marescaux",
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T1 - Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia

AU - Diana, Michele

AU - Dallemagne, Bernard

AU - Chung, Hyunsoo

AU - Nagao, Yoshihiro

AU - Halvax, Peter

AU - Agnus, Vincent

AU - Soler, Luc

AU - Lindner, Veronique

AU - Demartines, Nicolas

AU - Diemunsch, Pierre

AU - Geny, Bernard

AU - Swanström, Lee

AU - Marescaux, Jacques

PY - 2014/10/21

Y1 - 2014/10/21

N2 - Background and aim: Surgeons currently rely on visual clues to estimate the presence of sufficient vascularity for safe anastomosis. We aimed to assess the accuracy of endoluminal confocal laser endomicroscopy (CLE) and laparoscopic fluorescence-based enhanced reality (FLER), using near-infrared imaging and fluorescence from injected Indocyanine Green, to identify the transition from ischemic to vascular areas in a porcine model of mesenteric ischemia.Methods: Six pigs underwent 1-h sigmoid segmental ischemia. The ischemic area was evaluated by clinical assessment and FLER to determine presumed viable margins. For each sigmoid colon, 5 regions of interest (ROIs) were identified: ischemic (ROI 1), presumed viable margins ROI 2a (distal) and 2b (proximal), and vascular areas 3a (distal) and 3b (proximal). After injection of fluorescein, CLE scanning of the mucosa from the ischemic area toward viable margins was performed. Capillary blood samples were obtained by puncturing the serosa at the ROIs, and capillary lactates were measured with the EDGE® analyzer.Results: Capillary lactates were significantly higher at ROI 1 (4.91 mmol/L) when compared to resection margins (2.8 mmol/L; mean difference: 2.11; p < 0.05) identified by FLER. There was no significant difference in lactates between ROI1 and resection margins identified by clinical evaluation. In 50 % of cases, ROI 2aCLINIC–2bCLINIC were considered to match (<1 cm distance) with ROI 2aFLER–2bFLER. Confocal analysis revealed specific clues to identify the transition from ischemic to viable areas corresponding to those assessed by FLER in 11/12 cases versus 7/12 for those identified by clinical evaluation.Conclusions: In this experimental model, FLER and CLE were more accurate than clinical evaluation to delineate bowel vascularization.

AB - Background and aim: Surgeons currently rely on visual clues to estimate the presence of sufficient vascularity for safe anastomosis. We aimed to assess the accuracy of endoluminal confocal laser endomicroscopy (CLE) and laparoscopic fluorescence-based enhanced reality (FLER), using near-infrared imaging and fluorescence from injected Indocyanine Green, to identify the transition from ischemic to vascular areas in a porcine model of mesenteric ischemia.Methods: Six pigs underwent 1-h sigmoid segmental ischemia. The ischemic area was evaluated by clinical assessment and FLER to determine presumed viable margins. For each sigmoid colon, 5 regions of interest (ROIs) were identified: ischemic (ROI 1), presumed viable margins ROI 2a (distal) and 2b (proximal), and vascular areas 3a (distal) and 3b (proximal). After injection of fluorescein, CLE scanning of the mucosa from the ischemic area toward viable margins was performed. Capillary blood samples were obtained by puncturing the serosa at the ROIs, and capillary lactates were measured with the EDGE® analyzer.Results: Capillary lactates were significantly higher at ROI 1 (4.91 mmol/L) when compared to resection margins (2.8 mmol/L; mean difference: 2.11; p < 0.05) identified by FLER. There was no significant difference in lactates between ROI1 and resection margins identified by clinical evaluation. In 50 % of cases, ROI 2aCLINIC–2bCLINIC were considered to match (<1 cm distance) with ROI 2aFLER–2bFLER. Confocal analysis revealed specific clues to identify the transition from ischemic to viable areas corresponding to those assessed by FLER in 11/12 cases versus 7/12 for those identified by clinical evaluation.Conclusions: In this experimental model, FLER and CLE were more accurate than clinical evaluation to delineate bowel vascularization.

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