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Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery

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Abstract

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 4h0  = 34.83 ± 10.39; V 4hmax  = 76.6 ± 29.09; V 6h0  = 44.1 ± 12.37 and V 6hmax  = 116.1 ± 40.1) when compared to 2a-–2b (V 4h0  = 67.1 ± 17.47 p = 0.00039; V 4hmax  = 146.8 ± 55.47 p = 0.0054; V 6h0  = 63.9 ± 28.99 p = 0.03; V 6hmax  = 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.

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Acknowledgment

This study was partly funded by a Research Grant from Karl Storz, Tuttlingen, Germany. Authors are grateful to Christopher Burel and Guy Temporal (medical English reviewers) for their valuable help in proofreading the manuscript.

Disclosures

Michele Diana is recipient of a research grant from Karl Storz, Tuttlingen, Germany. Karl Storz was NOT involved in the study’s design or data acquisition/interpretation. Jacques Marescaux is the President of the IRCAD-IHU Institutes, partly funded by KARL STORZ GmbH & Co. KG, Covidien, and Siemens Healthcare. Remaining authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. IHU, Minimally Invasive Image-Guided Surgical Institute, Strasbourg, France

    Michele Diana, Peter Halvax, Bernard Dallemagne, Yoshihiro Nagao & Jacques Marescaux

  2. IRCAD, Research Institute against Cancer of Digestive System, 1, place de l’Hôpital, 67095, Strasbourg, France

    Michele Diana, Bernard Dallemagne, Vincent Agnus, Luc Soler & Jacques Marescaux

  3. Department of Anesthesiology, University of Strasbourg, Strasbourg, France

    Pierre Diemunsch

  4. EA 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, Translational Medicine Federation of Strasbourg (FMTS), University of Strasbourg, Strasbourg, France

    Michele Diana, Anne-Laure Charles & Bernard Geny

  5. Department of Visceral Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland

    Michele Diana & Nicolas Demartines

  6. Department of Pathology, Regional Hospital of Mulhouse, Mulhouse, France

    Veronique Lindner

Authors
  1. Michele Diana
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  2. Peter Halvax
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  3. Bernard Dallemagne
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  7. Vincent Agnus
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  8. Luc Soler
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  9. Nicolas Demartines
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  11. Bernard Geny
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  12. Jacques Marescaux
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Correspondence to Michele Diana.

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Diana, M., Halvax, P., Dallemagne, B. et al. Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery. Surg Endosc 28, 3108–3118 (2014). https://doi.org/10.1007/s00464-014-3592-9

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  • DOI: https://doi.org/10.1007/s00464-014-3592-9

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