Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
Department of Surgery, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
Surg Endosc. 2023 Feb;37(2):1601-1610. doi: 10.1007/s00464-022-09824-4. Epub 2023 Jan 3.
Unrecognized organ hypoperfusion may cause major postoperative complications with detrimental effects for the patient. The use of Indocyanine Green (ICG) to detect organ hypoperfusion is emerging but the optimal methodology is still uncertain. The purpose of this study was to determine the feasibility of real-time continuous quantitative perfusion assessment with Indocyanine Green (ICG) to monitor organ perfusion during minimally invasive surgery using a novel ICG dosing regimen and quantification software.
In this experimental porcine study, twelve subjects were administered a priming dose of ICG, followed by a regimen of high-frequency (1 dose per minute), low-dose bolus injections with weight-adjusted (0.008 mg/kg) ICG allowing for continuous perfusion monitoring. In each pig, one randomly assigned organ of interest [stomach (n = 3), ascending colon (n = 3), rectum (n = 3) and spleen (n = 3)] was investigated with varying camera conditions. Video recording was performed with the 1588 AIM Stryker camera platform and subsequent quantitative analysis of the ICG signal were performed using a research version of a commercially available surgical real-time analysis software.
Using a high-frequency, low-dose bolus ICG regimen, fluorescence visualization and quantification in abdominal organs were successful in the stomach (3/3), ascending colon (1/3), rectum (2/3), and the spleen (3/3). ICG accumulation in the tissue over time did not affect the quantification process. Considerable variation in fluorescence signal was observed between organs and between the same organ in different subjects. Of the different camera conditions investigated, the highest signal was achieved when the camera was placed 7.5 cm from the target organ.
This proof-of-concept study finds that real-time continuous perfusion monitoring in different abdominal organs using ICG is feasible. However, the study also finds a large variation in fluorescence intensity between organs and between the same organ in different subjects while using a fixed weight-adjusted dosing regimen using the same camera setting and placement.
未识别的器官低灌注可能导致主要的术后并发症，对患者造成不利影响。使用吲哚菁绿（ICG）来检测器官低灌注正在出现，但最佳方法仍不确定。本研究的目的是确定使用新型 ICG 给药方案和量化软件，使用吲哚菁绿（ICG）实时连续定量灌注评估监测微创外科手术中器官灌注的可行性。
在这项实验性猪研究中，十二只猪给予 ICG 预充剂量，然后给予高频（每分钟 1 次）、低剂量（0.008mg/kg）的 ICG 推注方案，允许连续监测灌注。在每只猪中，随机选择一个感兴趣的器官[胃（n=3）、升结肠（n=3）、直肠（n=3）和脾脏（n=3）]进行研究，同时改变相机条件。使用 1588 AIM Stryker 相机平台进行视频记录，随后使用商业实时分析软件的研究版本对 ICG 信号进行定量分析。
使用高频、低剂量的 ICG 推注方案，胃（3/3）、升结肠（1/3）、直肠（2/3）和脾脏（3/3）的荧光可视化和量化均成功。随着时间的推移，ICG 在组织中的积累不会影响定量过程。不同器官和同一器官在不同猪之间观察到荧光信号有很大差异。在所研究的不同相机条件中，当相机放置在距目标器官 7.5cm 处时，信号最强。
这项概念验证研究发现，使用 ICG 对不同腹部器官进行实时连续灌注监测是可行的。然而，研究还发现，在使用相同的相机设置和放置位置，使用固定的重量调整剂量方案时，不同器官之间以及同一器官在不同猪之间的荧光强度存在很大差异。
