Intraoperative fluorescence-based enhanced reality laparoscopic real-time imaging to assess bowel perfusion at the anastomotic site in an experimental model - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue British Journal of Surgery Année : 2015

Intraoperative fluorescence-based enhanced reality laparoscopic real-time imaging to assess bowel perfusion at the anastomotic site in an experimental model

Vincent Agnus
  • Fonction : Auteur
Peter Halvax
  • Fonction : Auteur
Yu-Yin Liu
  • Fonction : Auteur
Bernard Dallemagne
  • Fonction : Auteur
Pierre Diemunsch
  • Fonction : Auteur
Jacques Marescaux
  • Fonction : Auteur

Résumé

BackgroundFluorescence videography is a promising technique for assessing bowel perfusion. Fluorescence-based enhanced reality (FLER) is a novel concept, in which a dynamic perfusion cartogram, generated by computer analysis, is superimposed on to real-time laparoscopic images. The aim of this experimental study was to assess the accuracy of FLER in detecting differences in perfusion in a small bowel resection-anastomosis model. MethodsA small bowel ischaemic segment was created laparoscopically in 13 pigs. Animals were allocated to having anastomoses performed at either low perfusion (25 per cent; n=7) or high perfusion (75 per cent; n=6), as determined by FLER analysis. Capillary lactate levels were measured in blood samples obtained by serosal puncturing in the ischaemic area, resection lines and vascularized areas. Pathological inflammation scoring of the anastomosis was carried out. ResultsLactate levels in the ischaemic area (mean(s.d.) 56(28) mmol/l) were higher than those in resection lines at 25 per cent perfusion (37(17) mmol/l; P=0010) and 75 per cent perfusion (29(13) mmol/l; P<0001), and higher than levels in vascular zones (25(10) mmol/l; P<0001). Lactate levels in resection lines with 75 per cent perfusion were lower than those in lines with 25 per cent perfusion (P<0001), and similar to those in vascular zones (P=0188). Levels at resection lines with 25 per cent perfusion were higher than those in vascular zones (P=0001). Mean(s.d.) global inflammation scores were higher in the 25 per cent perfusion group compared with the 75 per cent perfusion group for mucosa/submucosa (21(04) versus 12(04); P=0003) and serosa (18(04) versus 08(08); P=0014). A ratio of preanastomotic lactate levels in the ischaemic area relative to the resection lines of 2 or less was predictive of a more severe inflammation score. ConclusionIn an experimental model, FLER appeared accurate in discriminating bowel perfusion levels. Clinical assessment has limited accuracy in evaluating bowel perfusion before anastomosis. Fluorescence videography estimates intestinal perfusion based on the fluorescence intensity of injected fluorophores, which is proportional to bowel vascularization. However, evaluation of fluorescence intensity remains a static and subjective measure. Fluorescence-based enhanced reality (FLER) is a dynamic fluorescence videography technique integrating near-infrared endoscopy and specific software. The software generates a virtual perfusion cartogram based on time to peak fluorescence, which can be superimposed on to real-time laparoscopic images. This experimental study demonstrates the accuracy of FLER in detecting differences in bowel perfusion in a survival model of laparoscopic small bowel resection-anastomosis, based on biochemical and histopathological data. It is concluded that real-time imaging of bowel perfusion is easy to use and accurate, and should be translated into clinical use. Novel, real-time imaging of bowel perfusion

Domaines

Cancer

Dates et versions

hal-04213005 , version 1 (20-09-2023)

Identifiants

Citer

Michele Diana, Vincent Agnus, Peter Halvax, Yu-Yin Liu, Bernard Dallemagne, et al.. Intraoperative fluorescence-based enhanced reality laparoscopic real-time imaging to assess bowel perfusion at the anastomotic site in an experimental model. British Journal of Surgery, 2015, 102 (2), pp.E169-E176. ⟨10.1002/bjs.9725⟩. ⟨hal-04213005⟩
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