UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland.
Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Dis Esophagus. 2022 Nov 15;35(11). doi: 10.1093/dote/doac016.
Indocyanine Green Fluorescence Angiography (ICGFA) has been deployed to tackle malperfusion-related anastomotic complications. This study assesses variations in operator interpretation of pre-anastomotic ICGFA inflow in the gastric conduit. Utilizing an innovative online interactive multimedia platform (Mindstamp), esophageal surgeons completed a baseline opinion-practice questionnaire and proceeded to interpret, and then digitally assign, a distal transection point on 8 ICGFA videos of esophageal resections (6 Ivor Lewis, 2 McKeown). Annotations regarding gastric conduit transection by ICGFA were compared between expert users versus non-expert participants using ImageJ to delineate longitudinal distances with Shapiro Wilk and t-tests to ascertain significance. Expert versus non-expert correlation was assessed via Intraclass Correlation Coefficients (ICC). Thirty participants (13 consultants, 6 ICGFA experts) completed the study in all aspects. Of these, a high majority (29 participants) stated ICGFA should be used routinely with most (21, including 5/6 experts) stating that 11-50 cases were needed for competency in interpretation. Among users, there were wide variations in dosing (0.05-3 mg/kg) and practice impact. Agreement regarding ICGFA video interpretation concerning transection level among experts was 'moderate' (ICC = 0.717) overall but 'good' (ICC = 0.871) among seven videos with Leave One Out (LOO) exclusion of the video with highest disagreement. Agreement among non-experts was moderate (ICC = 0.641) overall and in every subgroup including among consultants (ICC = 0.626). Experts choose levels that preserved more gastric conduit length versus non-experts in all but one video (P = 0.02). Considerable variability exists with ICGFA interpretation and indeed impact. Even adept users may be challenged in specific cases. Standardized training and/or computerized quantitative fluorescence may help better usage.
吲哚菁绿荧光血管造影（ICGFA）已被用于解决灌注不良相关吻合口并发症。本研究评估了术者在胃管前 ICGFA 流入方面的解读差异。食管外科医生利用创新的在线互动多媒体平台（Mindstamp）完成了基线意见-实践问卷，然后解读并对 8 个食管切除术 ICGFA 视频（6 个 Ivor Lewis，2 个 McKeown）的远端横断点进行数字分配。使用 ImageJ 比较专家用户和非专家参与者之间的 ICGFA 胃管横断标注，以描绘纵向距离，使用 Shapiro-Wilk 和 t 检验确定显著性。使用组内相关系数（ICC）评估专家与非专家之间的相关性。所有方面都有 30 名参与者（13 名顾问，6 名 ICGFA 专家）完成了这项研究。其中，绝大多数（29 名参与者）表示应常规使用 ICGFA，大多数（21 名，包括 5/6 名专家）表示，需要 11-50 例才能达到解读能力。在用户中，剂量（0.05-3mg/kg）和实践影响差异很大。专家对横断水平的 ICGFA 视频解读的一致性总体上是“中度”（ICC=0.717），但在排除了分歧最大的视频后，7 个视频的“良好”（ICC=0.871）。非专家的一致性总体上为中度（ICC=0.641），在每个亚组中均为中度，包括顾问（ICC=0.626）。在除了一个视频外的所有视频中，专家选择的水平保留了更多的胃管长度，而非专家则不然（P=0.02）。ICGFA 解读和实际影响存在很大差异。即使是熟练的用户在特定情况下也可能面临挑战。标准化培训和/或计算机化定量荧光可能有助于更好地使用。
