Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Ann Surg. 2021 Dec 1;274(6):e659-e663. doi: 10.1097/SLA.0000000000004978.
This study aims to generate a reproducible and generalizable Workflow model of ICG-angiography integrating Standardization and Quantification (WISQ) that can be applied uniformly within the surgical innovation realm independent of the user.
Tissue perfusion based on indocyanine green (ICG)-angiography is a rapidly growing application in surgical innovation. Interpretation of results has been subjective and error-prone due to the lack of a standardized and quantitative ICG-workflow and analytical methodology. There is a clinical need for a more generic, reproducible, and quantitative ICG perfusion model for objective assessment of tissue perfusion.
In this multicenter, proof-of-concept study, we present a generic and reproducible ICG-workflow integrating standardization and quantification for perfusion assessment. To evaluate our model's clinical feasibility and reproducibility, we assessed the viability of parathyroid glands after performing thyroidectomy. Biochemical hypoparathyroidism was used as the postoperative endpoint and its correlation with ICG quantification intraoperatively. Parathyroid gland is an ideal model as parathyroid function post-surgery is only affected by perfusion.
We show that visual subjective interpretation of ICG-angiography by experienced surgeons on parathyroid perfusion cannot reliably predict organ function impairment postoperatively, emphasizing the importance of an ICG quantification model. WISQ was able to standardize and quantify ICG-angiography and provided a robust and reproducible perfusion curve analysis. A low ingress slope of the perfusion curve combined with a compromised egress slope was indicative for parathyroid organ dysfunction in 100% of the cases.
WISQ needs prospective validation in larger series and may eventually support clinical decision-making to predict and prevent postoperative organ function impairment in a large and varied surgical population.
本研究旨在生成一种可重复且可推广的整合标准化和量化（WISQ）的吲哚菁绿（ICG）血管造影工作流程模型，该模型可在独立于用户的手术创新领域内统一应用。
基于吲哚菁绿（ICG）的血管造影术在手术创新中应用迅速增长。由于缺乏标准化和定量的 ICG 工作流程和分析方法，结果的解释一直具有主观性且容易出错。临床需要一种更通用、可重复且定量的 ICG 灌注模型，以客观评估组织灌注。
在这项多中心概念验证研究中，我们提出了一种通用且可重复的整合标准化和量化的 ICG 工作流程，用于灌注评估。为了评估我们模型的临床可行性和可重复性，我们评估了甲状腺切除术后甲状旁腺的活力。术后生化性甲状旁腺功能减退症被用作术后终点，并与其术中 ICG 定量相关。甲状旁腺是一个理想的模型，因为手术后甲状旁腺功能仅受灌注影响。
我们表明，经验丰富的外科医生对甲状旁腺灌注的 ICG 血管造影术进行视觉主观解释不能可靠地预测术后器官功能障碍，这强调了 ICG 定量模型的重要性。WISQ 能够标准化和量化 ICG 血管造影术，并提供稳健且可重复的灌注曲线分析。灌注曲线的低入口斜率结合出口斜率受损提示甲状旁腺器官功能障碍在 100%的病例中。
WISQ 需要在更大的系列中进行前瞻性验证，最终可能支持临床决策，以预测和预防大而多样化的手术人群中的术后器官功能障碍。
