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Quantitative Fluorescence Imaging of Perfusion-An Algorithm to Predict Anastomotic Leakage.

Sanne M Jansen1,2,3, Daniel M de Bruin1, Leah S Wilk1

  • 1Amsterdam UMC, Unit L0, Department of Biomedical Engineering & Physics, Faculty of Medicine, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

Life (Basel, Switzerland)
|February 25, 2022
PubMed
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Quantitative fluorescence imaging can assess gastric tube perfusion during surgery. This technique helps predict anastomotic leakage by evaluating blood flow to the gastric fundus, potentially reducing complications.

Keywords:
anastomosisfluorescence imagingparametersperfusionsurgery

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Area of Science:

  • Surgical oncology
  • Medical imaging
  • Gastrointestinal surgery

Background:

  • Anastomotic leakage and strictures are significant complications after gastric surgery.
  • Poor perfusion of the gastric fundus is a primary risk factor for these adverse outcomes.
  • Intraoperative fluorescence imaging offers a potential method to assess tissue perfusion.

Purpose of the Study:

  • To evaluate quantitative parameters derived from fluorescence imaging for assessing gastric tube perfusion.
  • To correlate these perfusion parameters with patient outcomes, specifically anastomotic leakage.
  • To establish reliable methods for quantifying fluorescence signals in surgical settings.

Main Methods:

  • Quantitative analysis of fluorescence imaging data, including maximal intensity, mean slope, and influx timepoint.
  • Comparison of perfusion parameters across four distinct areas of the gastric tube in 22 patients.
  • Statistical analysis using repeated ANOVA to determine significant differences between perfusion areas.
  • Correlation of quantitative perfusion parameters with patient outcomes, including anastomotic leakage.

Main Results:

  • Significant differences (p < 0.0001) were observed in maximal intensity, mean slope, and influx timepoint between the gastric tube base and fundus.
  • Patients who developed anastomotic leakage exhibited a mean slope near 0 in Location 4.
  • A significantly greater distance of indocyanine green (ICG) demarcation to the fundus was noted in patients with anastomotic leakage (p < 0.0001).

Conclusions:

  • Quantitative intraoperative perfusion imaging using fluorescence is feasible and provides valuable data.
  • Quantification of fluorescence signals enables early risk stratification for gastric necrosis.
  • This approach may help reduce the incidence of anastomotic leakage and improve surgical outcomes.