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Surgical Endoscopy
Published in: Surgical Endoscopy 11/2020

01-11-2020

Simultaneous computer-assisted assessment of mucosal and serosal perfusion in a model of segmental colonic ischemia

Authors: Barbara Seeliger, Vincent Agnus, Pietro Mascagni, Manuel Barberio, Fabio Longo, Alfonso Lapergola, Didier Mutter, Andrey S. Klymchenko, Manish Chand, Jacques Marescaux, Michele Diana

Published in: Surgical Endoscopy | Issue 11/2020

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Abstract

Background

Fluorescence-based enhanced reality (FLER) enables the quantification of fluorescence signal dynamics, which can be superimposed onto real-time laparoscopic images by using a virtual perfusion cartogram. The current practice of perfusion assessment relies on visualizing the bowel serosa. The aim of this experimental study was to quantify potential differences in mucosal and serosal perfusion levels in an ischemic colon segment.

Methods

An ischemic colon segment was created in 12 pigs. Simultaneous quantitative mucosal and serosal fluorescence imaging was obtained via intravenous indocyanine green injection (0.2 mg/kg), using two near-infrared camera systems, and computer-assisted FLER analysis. Lactate levels were measured in capillary blood of the colonic wall at seven regions of interest (ROIs) as determined with FLER perfusion cartography: the ischemic zone (I), the proximal and distal vascularized areas (PV, DV), and the 50% perfusion threshold proximally and distally at the mucosal and serosal side (P50M, P50S, D50M, D50S).

Results

The mean ischemic zone as measured (mm) for the mucosal side was significantly larger than the serosal one (56.3 ± 21.3 vs. 40.8 ± 14.9, p = 0.001) with significantly lower lactate values at the mucosal ROIs. There was a significant weak inverse correlation between lactate and slope values for the defined ROIs (r = − 0.2452, p = 0.0246).

Conclusions

Mucosal ischemic zones were larger than serosal zones. These results suggest that an assessment of bowel perfusion from the serosal side only can underestimate the extent of ischemia. Further studies are required to predict the optimal resection margin and anastomotic site.
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Metadata
Title
Simultaneous computer-assisted assessment of mucosal and serosal perfusion in a model of segmental colonic ischemia
Authors
Barbara Seeliger
Vincent Agnus
Pietro Mascagni
Manuel Barberio
Fabio Longo
Alfonso Lapergola
Didier Mutter
Andrey S. Klymchenko
Manish Chand
Jacques Marescaux
Michele Diana
Publication date
01-11-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07258-z

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