Enhanced-Reality Video Fluorescence: A Real-Time Assessment of Intestinal Viability
Abstract
OBJECTIVE: Our aim was to evaluate a fluorescence-based enhanced-reality system to assess intestinal viability in a laparoscopic mesenteric ischemia model. MATERIALS AND METHODS: A small bowel loop was exposed, and 3 to 4 mesenteric vessels were clipped in 6 pigs. Indocyanine green (ICG) was administered intravenously 15 minutes later. The bowel was illuminated with an incoherent light source laparoscope (D-light-P, KarlStorz). The ICG fluorescence signal was analyzed with Ad Hoc imaging software (VR-RENDER), which provides a digital perfusion cartography that was superimposed to the intraoperative laparoscopic image [augmented reality (AR) synthesis]. Five regions of interest (ROIs) were marked under AR guidance (1, 2a-2b, 3a-3b corresponding to the ischemic, marginal, and vascularized zones, respectively). One hour later, capillary blood samples were obtained by puncturing the bowel serosa at the identified ROIs and lactates were measured using the EDGE analyzer. A surgical biopsy of each intestinal ROI was sent for mitochondrial respiratory rate assessment and for metabolites quantification. RESULTS: Mean capillary lactate levels were 3.98 (SD = 1.91) versus 1.05 (SD = 0.46) versus 0.74 (SD = 0.34) mmol/L at ROI 1 versus 2a-2b (P = 0.0001) versus 3a-3b (P = 0.0001), respectively. Mean maximal mitochondrial respiratory rate was 104.4 (±21.58) pmolO2/second/mg at the ROI 1 versus 191.1 ± 14.48 (2b, P = 0.03) versus 180.4 ± 16.71 (3a, P = 0.02) versus 199.2 ± 25.21 (3b, P = 0.02). Alanine, choline, ethanolamine, glucose, lactate, myoinositol, phosphocholine, sylloinositol, and valine showed statistically significant different concentrations between ischemic and nonischemic segments. CONCLUSIONS: Fluorescence-based AR may effectively detect the boundary between the ischemic and the vascularized zones in this experimental model.
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Real time ICGFI quantification using time to peak, slope of fluorescent intensity, and background subtracted peak fluorescent intensity may predict tissue injury, especially if visual assessment is difficult.
“Real time ICGFI quantification using time to peak, slope of fluorescent intensity, and background subtracted peak fluorescent intensity may predict tissue injury, especially if visual assessment is difficult. 119,171,172”
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Heeman, W. T., Wildeboer, A. C. L., Al‐Taher, M., Calon, J., Stassen, L. P. S., Diana, M., Derikx, J. P. M., van Dam, G. M., Boerma, E. C., & Bouvy, N. D. (2022) · Surgical Endoscopy · doi:10.1007/s00464-022-09536-9 · Cited by 27 · see citing works
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Nakashima, K., Ryu, S., Okamoto, A., Hara, K., Ishida, K., Ito, R., & Nakabayashi, Y. (2021) · Asian Journal of Surgery · doi:10.1016/j.asjsur.2021.08.020 · Cited by 23 · see citing works
Munechika, T., Kajitani, R., Matsumoto, Y., Nagano, H., Komono, A., Aisu, N., Morimoto, M., Yoshimatsu, G., Yoshida, Y., & Hasegawa, S. (2020) · Surgical Endoscopy · doi:10.1007/s00464-020-07556-x · Cited by 23 · see citing works
Intraoperative ureter identification with a novel fluorescent catheter
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Gosvig, K., Jensen, S. S., Qvist, N., Agnus, V., Jensen, T. S., Lindner, V., Marescaux, J., Diana, M., & Ellebæk, M. B. (2019) · Surgical Endoscopy · doi:10.1007/s00464-019-06990-w · Cited by 22 · see citing works
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Zhuk, S. M., Epperlein, J. P., Nair, R. S., Thirupati, S., Aonghusa, P. M., O’Shea, D. F., & Cahill, R. A. (2020) · Lecture notes in computer science · doi:10.1007/978-3-030-59716-0_68 · Cited by 20 · see citing works
Barberio, M., Felli, É., Pizzicannella, M., Agnus, V., Al‐Taher, M., Seyller, E., Moulla, Y., Jansen‐Winkeln, B., Gockel, I., Marescaux, J., et al. (2020) · Surgical Endoscopy · doi:10.1007/s00464-020-08077-3 · Cited by 19 · see citing works
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Ris, F., Hompes, R., Lindsey, I., Cunningham, C., Mortensen, N. J. M., & Cahill, R. A. (2014) · Colorectal Disease · doi:10.1111/codi.12593 · Cited by 18 · see citing works
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Seeliger, B., Walz, M. K., Alesina, P. F., Agnus, V., Pop, R., Barberio, M., Saadi, A., Worreth, M. D., Marescaux, J., & Diana, M. (2019) · Surgical Endoscopy · doi:10.1007/s00464-019-06997-3 · Cited by 16 · see citing works
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Gastric Supply Manipulation to Modulate Ghrelin Production and Enhance Vascularization to the Cardia
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Soares, A. S., Bano, S., Clancy, N. T., Stoyanov, D. V., Lovat, L. B., & Chand, M. (2022) · Surgery · doi:10.1016/j.surg.2021.12.021 · Cited by 12 · see citing works
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Self-citationKanammit, P., Sirisreetreerux, P., Boongird, S., Worawichawong, S., & Kijvikai, K. (2021) · Translational Andrology and Urology · doi:10.21037/tau-21-160 · Cited by 10 · see citing works
- Authors
- Diana, M., Noll, E., Diemunsch, P., Dallemagne, B., Benahmed, M. A., Agnus, V., Soler, L., Barry, B., Namer, I. J., Demartines, N., Charles, A.-L., Geny, B., & Marescaux, J.
- Affiliations
- Institut de Recherche contre les Cancers de l’Appareil Digestif (FR)
- Centre Hospitalier Universitaire Vaudois (CH)
- Université de Strasbourg (FR)
- Corresponding author
- Dallemagne, Bernard
- Agnus, Vincent
- Soler, Luc
- Barry, Brian
- Marescaux, Jacques
- ORCID
- Venue
- Annals of Surgery
- Published
- 2014-04
- Volume
- 259
- Issue
- 4
- Pages
- 700-707
- ISSN
- 0003-4932 (ISSN-L)
- OpenAlex
- W2020670928
- Cited by
- 168
- References
- 26
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 7 · 2023: 8 · 2022: 18 · 2021: 19 · 2020: 21 · 2019: 14 · 2018: 21 · 2017: 9 · 2016: 10 · 2015: 16 · 2014: 11 · 2013: 4
- FWCI
- 13.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Optical Imaging and Spectroscopy Techniques
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Augmented Reality Applications
- Keywords
- fluorescence imaging, indocyanine green, mesenteric ischemia, intestinal viability, augmented reality, laparoscopic surgery, capillary lactate, intestinal metabolites, porcine model
- MeSH terms
- Animals, Female, Fluorescent Dyes, Image Interpretation, Computer-Assisted, Indocyanine Green, Intestine, Small, Ischemia, Male, Mesenteric Arteries, Mesentery, Mitochondria, Magnetic Resonance Spectroscopy, Laparoscopy, Spectrometry, Fluorescence, Swine, Video Recording, Biomarkers, Lactic Acid, Metabolome
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