Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany.
Department of Visceral, Thoracic, Transplant and Vascular surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
Surg Endosc. 2019 Nov;33(11):3775-3782. doi: 10.1007/s00464-019-06675-4. Epub 2019 Jan 23.
Hyperspectral imaging (HSI) is a relatively new method used in image-guided and precision surgery, which has shown promising results for characterization of tissues and assessment of physiologic tissue parameters. Previous methods used for analysis of preconditioning concepts in patients and animal models have shown several limitations of application. The aim of this study was to evaluate HSI for the measurement of ischemic conditioning effects during esophagectomy.
Intraoperative hyperspectral images of the gastric tube through the mini-thoracotomy were recorded from n = 22 patients, 14 of whom underwent laparoscopic gastrolysis and ischemic conditioning of the stomach with two-step transthoracic esophagectomy and gastric pull-up with intrathoracic anastomosis after 3-7 days. The tip of the gastric tube (later esophagogastric anastomosis) was measured with HSI. Analysis software provides a RGB image and 4 false color images representing physiologic parameters of the recorded tissue area intraoperatively. These parameters contain tissue oxygenation (StO), perfusion-(NIR Perfusion Index), organ hemoglobin (OHI), and tissue water index (TWI).
Intraoperative HSI of the gastric conduit was possible in all patients and did not prolong the regular operative procedure due to its quick applicability. In particular, the tissue oxygenation of the gastric conduit was significantly higher in patients who underwent ischemic conditioning ([Formula: see text] = 78%; [Formula: see text] = 66%; p = 0.03).
HSI is suitable for contact-free, non-invasive, and intraoperative evaluation of physiological tissue parameters within gastric conduits. Therefore, HSI is a valuable method for evaluating ischemic conditioning effects and may contribute to reduce anastomotic complications. Additional studies are needed to establish normal values and thresholds of the presented parameters for the gastric conduit anastomotic site.
高光谱成像（HSI）是一种应用于图像引导和精准手术的相对较新的方法，它在组织特征描述和生理组织参数评估方面显示出了有前景的结果。之前用于分析患者和动物模型中预处理概念的方法已经显示出了其在应用上的几个局限性。本研究旨在评估 HSI 用于测量食管切除术中缺血预处理的效果。
通过小开胸术记录了 n=22 例患者胃管的术中高光谱图像，其中 14 例患者接受了腹腔镜胃松解术和缺血预处理，然后进行两步经胸食管切除术，在 3-7 天后进行胃管提拉和胸腔内吻合。胃管的尖端（即后来的食管胃吻合口）通过 HSI 进行测量。分析软件提供了一个 RGB 图像和 4 个假彩色图像，代表术中记录的组织区域的生理参数。这些参数包含组织氧合（StO）、灌注（NIR 灌注指数）、器官血红蛋白（OHI）和组织水指数（TWI）。
所有患者均能进行术中胃管的 HSI，且由于其快速适用性，不会延长常规手术程序。特别是，接受缺血预处理的患者的胃管组织氧合明显更高（[Formula: see text] = 78%；[Formula: see text] = 66%；p = 0.03）。
HSI 适合于接触式、非侵入式和术中评估胃管内生理组织参数。因此，HSI 是评估缺血预处理效果的一种有价值的方法，可能有助于减少吻合口并发症。需要进一步的研究来建立所提出参数的正常范围和阈值，用于胃管吻合口部位。
