Anzeige
Erschienen in:
01.11.2014
Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery
Erschienen in: Surgical Endoscopy | Ausgabe 11/2014
Einloggen, um Zugang zu erhaltenAbstract
Background
Fluorescence-based enhanced reality (FLER) is a technique to evaluate intestinal perfusion based on the elaboration of the Indocyanine Green fluorescence signal. The aim of the study was to assess FLER’s performances in evaluating perfusion in an animal model of long-lasting intestinal ischemia.
Materials and methods
An ischemic segment was created in 18 small bowel loops in 6 pigs. After 2 h (n = 6), 4 h (n = 6), and 6 h (n = 6), loops were evaluated clinically and by FLER to delineate five regions of interest (ROIs): ischemic zone (ROI 1), presumed viable margins (ROI 2a–2b), and vascularized areas (3a–3b). Capillary lactates were measured to compare clinical vs. FLER assessment. Basal (V
0
) and maximal (V
max) mitochondrial respiration rates were determined according to FLER.
Results
Lactates (mmol/L) at clinically identified resection lines were significantly higher when compared to those identified by FLER (2.43 ± 0.95 vs. 1.55 ± 0.33 p = 0.02) after 4 h of ischemia. Lactates at 2 h at ROI 1 were 5.45 ± 2.44 vs. 1.9 ± 0.6 (2a–2b; p < 0.0001) vs. 1.2 ± 0.3 (3a–3b; p < 0.0001). At 4 h, lactates were 4.36 ± 1.32 (ROI 1) vs. 1.83 ± 0.81 (2a–2b; p < 0.0001) vs. 1.35 ± 0.67 (3a–3b; p < 0.0001). At 6 h, lactates were 4.16 ± 2.55 vs. 1.8 ± 1.2 vs. 1.45 ± 0.83 at ROI 1 vs. 2a–-2b (p = 0.013) vs. 3a–3b (p = 0.0035). Mean V
0 and V
max (pmolO2/second/mg of tissue) were significantly impaired after 4 and 6 h at ROI 1 (V
0
4h
= 34.83 ± 10.39; V
max
4h
= 76.6 ± 29.09; V
0
6h
= 44.1 ± 12.37 and V
max
6h
= 116.1 ± 40.1) when compared to 2a-–2b (V
0
4h
= 67.1 ± 17.47 p = 0.00039; V
max
4h
= 146.8 ± 55.47 p = 0.0054; V
0
6h
= 63.9 ± 28.99 p = 0.03; V
max
6h
= 167.2 ± 56.96 p = 0.01). V
0 and V
max were significantly higher at 3a–3b.
Conclusions
FLER may identify the future anastomotic site even after repetitive assessments and long-standing bowel ischemia.