Surgical Endoscopy ( IF 3.1 ) Pub Date : 2022-09-16 , DOI: 10.1007/s00464-022-09583-2 Chibueze A Nwaiwu 1, 2 , Vasiliy E Buharin 2 , Anderson Mach 2 , Robin Grandl 2 , Matthew L King 2 , Alyson F Dechert 2 , Liam O'Shea 2 , Steven D Schwaitzberg 3 , Peter C W Kim 1, 2
Objective
To determine if laser speckle contrast imaging (LSCI) mitigates variations and subjectivity in the use and interpretation of indocyanine green (ICG) fluorescence in the current visualization paradigm of real-time intraoperative tissue blood flow/perfusion in clinically relevant scenarios.
Methods
De novo laparoscopic imaging form-factor detecting real-time blood flow using LSCI and blood volume by near-infrared fluorescence (NIRF) of ICG was compared to ICG NIRF alone, for dye-less real-time visualization of tissue blood flow/perfusion. Experienced surgeons examined LSCI and ICG in segmentally devascularized intestine, partial gastrectomy, and the renal hilum across six porcine models. Precision and accuracy of identifying demarcating lines of ischemia/perfusion in tissues were determined in blinded subjects with varying levels of surgical experience.
Results
Unlike ICG, LSCI perfusion detection was real time (latency < 150 ms: p < 0.01), repeatable and on-demand without fluorophore injection. Operating surgeons (n = 6) precisely and accurately identified concordant demarcating lines in white light, LSCI, and ICG modes immediately. Blinded subjects (n = 21) demonstrated similar spatial–temporal precision and accuracy with all three modes ≤ 2 min after ICG injection, and discordance in ICG mode at ≥ 5 min in devascularized small intestine (p < 0.0001) and in partial gastrectomy (p < 0.0001).
Conclusions
Combining LSCI for near real-time blood flow detection with ICG fluorescence for blood volume detection significantly improves precision and accuracy of perfusion detection in tissue locations over time, in real time, and repeatably on-demand than ICG alone.
Graphical abstract
中文翻译:
临床前猪模型术中组织血流/组织灌注中吲哚菁绿腹腔镜激光散斑对比成像近红外显示的可行性及比较
客观的
确定激光散斑对比成像 (LSCI) 是否减轻了临床相关场景中实时术中组织血流/灌注的当前可视化范例中吲哚菁绿 (ICG) 荧光的使用和解释的变化和主观性。
方法
使用 LSCI 从头腹腔镜成像形状因数检测实时血流,并通过 ICG 的近红外荧光 (NIRF) 检测血容量,并将其与单独的 ICG NIRF 进行比较,以实现组织血流/灌注的无染料实时可视化。经验丰富的外科医生在六个猪模型中检查了节段性断流肠、部分胃切除术和肾门的 LSCI 和 ICG。在具有不同手术经验水平的盲法受试者中确定了识别组织中缺血/灌注分界线的精度和准确性。
结果
与 ICG 不同,LSCI 灌注检测是实时的(延迟 < 150 毫秒:p < 0.01)、可重复且按需进行,无需荧光团注射。手术外科医生 ( n = 6) 在白光、LSCI 和 ICG 模式下立即准确地识别出一致的分界线。盲法受试者 ( n = 21) 在 ICG 注射后 ≤ 2 分钟的所有三种模式下表现出相似的时空精度和准确性,并且在 ICG 模式中在 ≥ 5 分钟时在断流小肠 ( p < 0.0001) 和部分胃切除术 ( p < 0.0001)。
结论
将用于近实时血流检测的 LSCI 与用于血容量检测的 ICG 荧光相结合,与单独使用 ICG 相比,可显着提高组织位置随时间、实时和可重复按需进行的灌注检测的精度和准确性。