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Hyperspectral enhanced reality (HYPER) for anatomical liver resection.

Takeshi Urade1, Eric Felli1,2, Manuel Barberio1,2

  • 1Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France.

Surgical Endoscopy
|April 29, 2020
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Summary

Hyperspectral imaging-based enhanced reality (HYPER) accurately identifies the demarcation line in liver segments during surgery. This noninvasive tool quantifies tissue oxygenation, aiding in precise liver segmentation and surgical guidance.

Keywords:
Enhanced realityHepatectomyHyperspectral imagingImage-guided surgery

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Area of Science:

  • Surgical Innovation
  • Medical Imaging
  • Hepatobiliary Surgery

Background:

  • Identifying the boundary between ischemic and non-ischemic liver tissue is crucial but challenging during surgery.
  • Hyperspectral imaging (HSI) offers noninvasive, quantitative assessment of tissue oxygenation.
  • HSI-based enhanced reality (HYPER) software overlays HSI data onto the surgical field.

Purpose of the Study:

  • To evaluate the accuracy of HYPER in identifying the demarcation line after vascular occlusion during anatomical left hepatectomy.
  • To assess HYPER's ability to quantify liver surface oxygenation in real-time.

Main Methods:

  • A porcine model underwent left hepatic pedicle ligation.
  • Hyperspectral imaging (HSI) was used to acquire tissue oxygenation (StO2) via Near-Infrared (NIR) index before and after occlusion.
  • The demarcation line was marked using electrocautery guided by HYPER; lactate levels and confocal endomicroscopy were used for validation.

Main Results:

  • HSI revealed significantly lower oxygenation (NIR index) in the ischemic left medial lobe (LML) compared to the perfused right medial lobe (RML) (0.27% vs. 58.60%, p=0.0015).
  • Capillary lactate levels were significantly higher in the ischemic LML (3.07 mmol/L) versus the RML (1.33 mmol/L, p=0.0356).
  • Confocal microscopy confirmed absent blood flow in the LML and normal perfusion in the RML.

Conclusions:

  • HYPER accurately identified the demarcation line between ischemic and perfused liver segments.
  • The system effectively quantified surface liver oxygenation, demonstrating its potential as an intraoperative tool.
  • HYPER can guide perfusion-based assessment and segmentation during liver surgery.