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Simultaneous computer-assisted assessment of mucosal and serosal perfusion in a model of segmental colonic ischemia

Surgical Endoscopy
Barbara Seeliger, Vincent Agnus, Pietro Mascagni, Manuel Barberio, Fabio Longo, Alfonso Lapergola, Didier Mutter, Andrey S. Klymchenko, Manish Chand, Jacques Marescaux, Michele Diana
Wichtige Hinweise
This study was presented at the annual meeting of the international Society for Medical Innovation and Technology (iSMIT), SMIT2018-IBEC2018 Joint Conference, Seoul, Korea, November 2018.
This paper was presented at the 106th Annual Congress of the Swiss Society of Surgery, Bern, Switzerland, May 2019. The abstract of this study has been selected among the best 80 abstracts accepted for the 106th Annual Congress of the Swiss Society of Surgery 2019, and was published in the British Journal of Surgery [1].

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Fluorescence-based enhanced reality (FLER) enables the quantification of fluorescence signal dynamics, which can be superimposed onto real-time laparoscopic images by using a virtual perfusion cartogram. The current practice of perfusion assessment relies on visualizing the bowel serosa. The aim of this experimental study was to quantify potential differences in mucosal and serosal perfusion levels in an ischemic colon segment.


An ischemic colon segment was created in 12 pigs. Simultaneous quantitative mucosal and serosal fluorescence imaging was obtained via intravenous indocyanine green injection (0.2 mg/kg), using two near-infrared camera systems, and computer-assisted FLER analysis. Lactate levels were measured in capillary blood of the colonic wall at seven regions of interest (ROIs) as determined with FLER perfusion cartography: the ischemic zone (I), the proximal and distal vascularized areas (PV, DV), and the 50% perfusion threshold proximally and distally at the mucosal and serosal side (P50M, P50S, D50M, D50S).


The mean ischemic zone as measured (mm) for the mucosal side was significantly larger than the serosal one (56.3 ± 21.3 vs. 40.8 ± 14.9, p = 0.001) with significantly lower lactate values at the mucosal ROIs. There was a significant weak inverse correlation between lactate and slope values for the defined ROIs (r = − 0.2452, p = 0.0246).


Mucosal ischemic zones were larger than serosal zones. These results suggest that an assessment of bowel perfusion from the serosal side only can underestimate the extent of ischemia. Further studies are required to predict the optimal resection margin and anastomotic site.

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