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01-11-2014

Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia

Authors: Michele Diana, Bernard Dallemagne, Hyunsoo Chung, Yoshihiro Nagao, Peter Halvax, Vincent Agnus, Luc Soler, Veronique Lindner, Nicolas Demartines, Pierre Diemunsch, Bernard Geny, Lee Swanström, Jacques Marescaux

Published in: Surgical Endoscopy | Issue 11/2014

Abstract

Background and aim

Surgeons currently rely on visual clues to estimate the presence of sufficient vascularity for safe anastomosis. We aimed to assess the accuracy of endoluminal confocal laser endomicroscopy (CLE) and laparoscopic fluorescence-based enhanced reality (FLER), using near-infrared imaging and fluorescence from injected Indocyanine Green, to identify the transition from ischemic to vascular areas in a porcine model of mesenteric ischemia.

Methods

Six pigs underwent 1-h sigmoid segmental ischemia. The ischemic area was evaluated by clinical assessment and FLER to determine presumed viable margins. For each sigmoid colon, 5 regions of interest (ROIs) were identified: ischemic (ROI 1), presumed viable margins ROI 2a (distal) and 2b (proximal), and vascular areas 3a (distal) and 3b (proximal). After injection of fluorescein, CLE scanning of the mucosa from the ischemic area toward viable margins was performed. Capillary blood samples were obtained by puncturing the serosa at the ROIs, and capillary lactates were measured with the EDGE^® analyzer.

Results

Capillary lactates were significantly higher at ROI 1 (4.91 mmol/L) when compared to resection margins (2.8 mmol/L; mean difference: 2.11; p < 0.05) identified by FLER. There was no significant difference in lactates between ROI1 and resection margins identified by clinical evaluation. In 50 % of cases, ROI 2a_CLINIC–2b_CLINIC were considered to match (<1 cm distance) with ROI 2a_FLER–2b_FLER. Confocal analysis revealed specific clues to identify the transition from ischemic to viable areas corresponding to those assessed by FLER in 11/12 cases versus 7/12 for those identified by clinical evaluation.

Conclusions

In this experimental model, FLER and CLE were more accurate than clinical evaluation to delineate bowel vascularization.

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Title: Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia
Authors: Michele Diana
Bernard Dallemagne
Hyunsoo Chung
Yoshihiro Nagao
Peter Halvax
Vincent Agnus
Luc Soler
Veronique Lindner
Nicolas Demartines
Pierre Diemunsch
Bernard Geny
Lee Swanström
Jacques Marescaux
Publication date: 01-11-2014
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 11/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3595-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia

Abstract

Background and aim

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and aim

Methods

Results

Conclusions

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