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01-04-2021 | Liver Resection

Hyperspectral enhanced reality (HYPER) for anatomical liver resection

Authors: Takeshi Urade, Eric Felli, Manuel Barberio, Mahdi Al-Taher, Emanuele Felli, Laurent Goffin, Vincent Agnus, Giuseppe Maria Ettorre, Jacques Marescaux, Didier Mutter, Michele Diana

Published in: Surgical Endoscopy | Issue 4/2021

Abstract

Background

Clinical evaluation of the demarcation line separating ischemic from non-ischemic liver parenchyma may be challenging. Hyperspectral imaging (HSI) is a noninvasive imaging modality, which combines a camera with a spectroscope and allows quantitative imaging of tissue oxygenation. Our group developed a software to overlay HSI images onto the operative field, obtaining HSI-based enhanced reality (HYPER). The aim of the present study was to evaluate the accuracy of HYPER to identify the demarcation line after a left vascular inflow occlusion during an anatomical left hepatectomy.

Materials and methods

In the porcine model (n = 3), the left branches of the hepatic pedicle were ligated. Before and after vascular occlusion, HSI images based on tissue oxygenation (StO₂), obtained through the Near-Infrared index (NIR index), were regularly acquired and superimposed onto RGB video. The demarcation line was marked on the liver surface with electrocautery according to HYPER. Local lactates were measured on blood samples from the liver surface in both ischemic and perfused segments using a strip-based device. At the same areas, confocal endomicroscopy was performed.

Results

After ligation, HSI demonstrated a significantly lower oxygenation (NIR index) in the left medial lobe (LML) (0.27% ± 0.21) when compared to the right medial lobe (RML) (58.60% ± 12.08; p = 0.0015). Capillary lactates were significantly higher (3.07 mmol/L ± 0.84 vs. 1.33 ± 0.71 mmol/L; p = 0.0356) in the LML versus RML, respectively. Concordantly, confocal videos demonstrated the absence of blood flow in the LML and normal perfusion in the RML.

Conclusions

HYPER has made it possible to correctly identify the demarcation line and quantify surface liver oxygenation. HYPER could be an intraoperative tool to guide perfusion-based demarcation line assessment and segmentation.

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Title: Hyperspectral enhanced reality (HYPER) for anatomical liver resection
Authors: Takeshi Urade
Eric Felli
Manuel Barberio
Mahdi Al-Taher
Emanuele Felli
Laurent Goffin
Vincent Agnus
Giuseppe Maria Ettorre
Jacques Marescaux
Didier Mutter
Michele Diana
Publication date: 01-04-2021
Publisher: Springer US
Keywords: Liver Resection
Liver Resection
Published in: Surgical Endoscopy / Issue 4/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07586-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Hyperspectral enhanced reality (HYPER) for anatomical liver resection

Abstract

Background

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

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