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Remote computer-assisted analysis of ICG fluorescence signal for evaluation of small intestinal anastomotic perfusion: a blinded, randomized, experimental trial

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Abstract

Background

Indocyanine green fluorescence imaging (ICG-FI) may be used to visualize intestinal perfusion prior to anastomosis. Methods for quantification of the fluorescence signal are required to ensure an objective evaluation. The aim of this study was to evaluate a method for quantification of relative perfusion and to investigate the correlation between the perfusion level and the anastomotic strength.

Method

This blinded, randomized, experimental trial included twenty pigs. Each pig received three small intestinal anastomoses with 30%, 60%, or 100% perfusion, respectively. The perfusion levels were determined relative to healthy intestine using ICG-FI. Ischemia was induced by mesenteric ligation and the perfusion level of each anastomosis was determined using a software-based analysis of the fluorescence signal. On postoperative day 5, the anastomoses were subjected to tensile strength test and histopathological assessment.

Results

No anastomotic leakage occurred. The tensile strength of the 30% perfusion group was 9.09 N, which was significantly lower than the 60% perfusion group (11.5 N) and the 100% perfusion group (12.9 N). The difference between the 60% perfusion group and the 100% perfusion group was not significant. The histopathological assessment showed no significant differences between perfusion groups.

Conclusions

A reduction in blood supply to 30%, as determined by ICG-FI, in small intestinal anastomoses was necessary to demonstrate a decrease in tensile strength.

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Acknowledgements

The authors are grateful to Paola Saccomandi, Alfonso Lapergola, and Pernille Øhlenschläger Larsen for their contribution to data collection.

Funding

Michele Diana is the recipient of a grant (ELIOS project, www.fondation-arc.org) from the ARC foundation for cancer research (9 Rue Guy Môquet, 94803 Villejuif, France). The VR-Perfusion software was partly developed in the framework of the ELIOS project.The project was partly funded by a grant (34-A1806) from Odense University Hospital Free Research Fund.

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Author notes

  1. Kristina Gosvig and Signe Steenstrup Jensen contributed equally to the manuscript and the first authorship.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, OUH, Odense, Denmark

    Kristina Gosvig, Signe Steenstrup Jensen, Niels Qvist & Mark Bremholm Ellebæk

  2. IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France

    Vincent Agnus, Jacques Marescaux & Michele Diana

  3. Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France

    Jacques Marescaux & Michele Diana

  4. Copenhagen, Denmark

    Troels Steenstrup Jensen

  5. Pathology Department, University Hospital of Strasbourg, Strasbourg, France

    Veronique Lindner

Authors
  1. Kristina Gosvig
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Correspondence to Kristina Gosvig.

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Disclosures

Jacques Marescaux is the President of the IRCAD and IHU Institutes, partly funded by Karl Storz, Siemens Healthcare and Medtronic. Karl Storz was NOT involved in study design nor data acquisition/interpretation. Drs. Kristina Gosvig, Signe Steenstrup Jensen, Niels Qvist, Troels Steenstrup Jensen, Vincent Agnus, Veronique Lindler, Michele Diana, Mark Bremholm Ellebæk have no conflicts of interest or financial ties to disclose.

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Gosvig, K., Jensen, S.S., Qvist, N. et al. Remote computer-assisted analysis of ICG fluorescence signal for evaluation of small intestinal anastomotic perfusion: a blinded, randomized, experimental trial. Surg Endosc 34, 2095–2102 (2020). https://doi.org/10.1007/s00464-019-06990-w

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