Sherwinter Danny, Chandler Paul, Martz Joseph
Department of Surgery, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY, 11219, USA.
Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
Surg Endosc. 2022 Mar;36(3):2192-2196. doi: 10.1007/s00464-021-08737-y. Epub 2021 Sep 22.
Adequate tissue oxygenation and perfusion remain fundamental to safe bowel resection surgery. Near infrared (NIR) imaging using indocyanine green has proven itself superior to clinical evaluation alone in assessing bowel perfusion, but requires expensive equipment not readily available in many centers.
We studied the IntraOx device (Vioptix Inc, Newark, CA USA), a handheld, tissue oxygen saturation assessment tool, to assess whether tissue bed oxygen saturation (StO2) is comparable to NIR assessment of bowel viability. Patients undergoing elective colon resection for benign and malignant disease were included. After choosing a clinical margin (CM) and dividing the mesentery, StO2 was measured at 5-cm intervals along the colon. A tissue oxygen saturation margin (TOM) was assigned where StO2 dropped off by at least 10 percentage points. NIR perfusion was then assessed to determine NIR margin (NIRM). Intraoperative and postoperative data were collected.
32 consecutive patients undergoing colectomies were analyzed. IntraOx sensitivity was 90.6%, specificity was 94.3%. The mean StO2 difference across the NIRM was 23.1%. In all but one case, the TOM matched the NIRM. In 3 cases, the TOM and NIRM concurred, but were a mean of 3.3 cm proximal to the CM and altered the surgical plan. At 4-week follow-up, no significant complications were reported.
The IntraOx device consistently identified a margin of significant saturation "drop-off" which correlated with the findings on NIR perfusion and clinical assessment. These early data indicate that StO2 measurement may be equivalent to NIR assessment of bowel perfusion. In addition, the IntraOx device may be a more cost-effective solution for surgeons looking for adjunctive evaluation of bowel viability. More study is warranted in a larger group of patients to confirm these preliminary findings and to judge the impact of StO2 assessment on reducing anastomotic leaks.
充足的组织氧合和灌注仍然是安全进行肠道切除手术的基础。使用吲哚菁绿的近红外（NIR）成像在评估肠道灌注方面已证明优于单纯的临床评估，但需要昂贵的设备，许多中心难以随时获取。
我们研究了IntraOx设备（美国加利福尼亚州纽瓦克市的Vioptix公司），这是一种手持式组织氧饱和度评估工具，以评估组织床氧饱和度（StO2）是否与肠道活力的近红外评估相当。纳入因良性和恶性疾病接受择期结肠切除术的患者。选择临床切缘（CM）并划分肠系膜后，沿结肠以5厘米间隔测量StO2。当StO2下降至少10个百分点时，确定组织氧饱和度切缘（TOM）。然后评估近红外灌注以确定近红外切缘（NIRM）。收集术中及术后数据。
对32例连续接受结肠切除术的患者进行了分析。IntraOx的敏感性为90.6%，特异性为94.3%。NIRM处的平均StO2差异为23.1%。除1例病例外，在所有病例中TOM与NIRM相符。在3例病例中，TOM和NIRM一致，但比CM平均近端3.3厘米，并改变了手术计划。在4周随访时，未报告明显并发症。
IntraOx设备始终能识别出明显的饱和度“下降”切缘，这与近红外灌注结果及临床评估相关。这些早期数据表明，StO2测量可能等同于肠道灌注的近红外评估。此外，对于寻求肠道活力辅助评估的外科医生而言，IntraOx设备可能是一种更具成本效益的解决方案。有必要在更大规模的患者群体中进行更多研究，以证实这些初步发现，并判断StO2评估对减少吻合口漏的影响。
