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

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

Research output: Contribution to journalArticlepeer-review

51 Citations (Scopus)

Abstract

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 2 h (n = 6), 4 h (n = 6), and 6 h (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 (V0) and maximal (Vmax) 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 4 h of ischemia. Lactates at 2 h 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 4 h, 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 6 h, 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 V0 and Vmax (pmolO2/second/mg of tissue) were significantly impaired after 4 and 6 h at ROI 1 (V0 4h = 34.83 ± 10.39; Vmax 4h = 76.6 ± 29.09; V0 6h = 44.1 ± 12.37 and Vmax 6h = 116.1 ± 40.1) when compared to 2a-–2b (V0 4h = 67.1 ± 17.47 p = 0.00039; Vmax 4h = 146.8 ± 55.47 p = 0.0054; V0 6h = 63.9 ± 28.99 p = 0.03; Vmax 6h = 167.2 ± 56.96 p = 0.01). V0 and Vmax were significantly higher at 3a–3b.

Conclusions: FLER may identify the future anastomotic site even after repetitive assessments and long-standing bowel ischemia.

Original languageEnglish
Pages (from-to)3108-3118
Number of pages11
JournalSurgical endoscopy
Volume28
Issue number11
DOIs
Publication statusPublished - Oct 21 2014
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery

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