Ischemic and injured bowel evaluation by Fluorescence imaging

Area of Science:

• Medical Imaging
• Surgical Innovation

Background:

• Fluorescence imaging for bowel perfusion assessment has been proposed for decades but lacks widespread clinical adoption.
• Objective criteria are needed to guide surgical decisions in emergency scenarios such as mesenteric ischemia.

Purpose of the Study:

• To evaluate the utility of near-infrared (NIR) angiography for assessing bowel perfusion in acute mesenteric ischemia.
• To determine if NIR angiography can provide objective criteria for surgical decision-making in emergency settings.

Main Methods:

• A university hospital evaluated the PinPoint (Novadaq) NIR angiography system in four emergency cases of acute mesenteric ischemia.
• The system's ease of use and time efficiency in emergency settings were assessed.

Main Results:

• NIR angiography proved easy to handle and time-efficient in emergency situations.
• The system clearly visualized perfusion in areas initially deemed non-viable by surgeons.
• In one case, a significant portion of bowel was successfully preserved due to the insights provided by the system.

Conclusions:

• While NIR angiography offers comprehensible perfusion assessment, establishing threshold levels is necessary for greater objectification.
• Surgeons reported subjective confidence in the system's expressiveness.
• Further randomized or experimental studies are required to objectively quantify the amount of bowel length that can be spared using this technology.