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食管癌切除术中腹腔镜高光谱成像——一项评估吻合部位食管胃灌注的初步研究

Intraoperative Laparoscopic Hyperspectral Imaging during Esophagectomy-A Pilot Study Evaluating Esophagogastric Perfusion at the Anastomotic Sites.

作者信息

Ilgen Annalena, Köhler Hannes, Pfahl Annekatrin, Stelzner Sigmar, Mehdorn Matthias, Jansen-Winkeln Boris, Gockel Ines, Moulla Yusef

机构信息

Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.

Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103 Leipzig, Germany.

出版信息

Bioengineering (Basel). 2024 Jan 9;11(1):69. doi: 10.3390/bioengineering11010069.

Abstract

Hyperspectral imaging (HSI) is a non-invasive and contactless technique that enables the real-time acquisition of comprehensive information on tissue within the surgical field. In this pilot study, we investigated whether a new HSI system for minimally-invasive surgery, TIVITA Mini (HSI-MIS), provides reliable insights into tissue perfusion of the proximal and distal esophagogastric anastomotic sites during 21 laparoscopic/thoracoscopic or robotic Ivor Lewis esophagectomies of patients with cancer to minimize the risk of dreaded anastomotic insufficiency. In this pioneering investigation, physiological tissue parameters were derived from HSI measurements of the proximal site of the anastomosis (esophageal stump) and the distal site of the anastomosis (tip of the gastric conduit) during the thoracic phase of the procedure. Tissue oxygenation (StO), Near Infrared Perfusion Index (NIR-PI), and Tissue Water Index (TWI) showed similar median values at both anastomotic sites. Significant differences were observed only for NIR-PI (median: 76.5 vs. 63.9; = 0.012) at the distal site (gastric conduit) compared to our previous study using an HSI system for open surgery. For all 21 patients, reliable and informative measurements were attainable, confirming the feasibility of HSI-MIS to assess anastomotic viability. Further studies on the added benefit of this new technique aiming to reduce anastomotic insufficiency are warranted.

摘要

高光谱成像(HSI)是一种非侵入性和非接触式技术,能够实时获取手术视野内组织的全面信息。在这项初步研究中,我们调查了一种用于微创手术的新型HSI系统TIVITA Mini(HSI-MIS),在21例腹腔镜/胸腔镜或机器人Ivor Lewis食管癌切除术患者中,是否能为食管胃吻合近端和远端部位的组织灌注提供可靠的见解,以将可怕的吻合口漏风险降至最低。在这项开创性研究中,生理组织参数来自于手术胸腔阶段吻合近端部位(食管残端)和吻合远端部位(胃管尖端)的HSI测量。组织氧合(StO)、近红外灌注指数(NIR-PI)和组织水指数(TWI)在两个吻合部位显示出相似的中位数。与我们之前使用HSI系统进行开放手术的研究相比,仅在远端部位(胃管)观察到NIR-PI存在显著差异(中位数:76.5对63.9; = 0.012)。对于所有21例患者,均可获得可靠且信息丰富的测量结果,证实了HSI-MIS评估吻合口活力的可行性。有必要对这项旨在减少吻合口漏的新技术的附加益处进行进一步研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/259a/10812999/a99df770ec93/bioengineering-11-00069-g001.jpg

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