Multispectral imaging of organ viability during uterine transplantation surgery in rabbits and sheep

A High-Speed Hyperspectral Laparoscopic Imaging System

Minimally invasive surgery (MIS) has expanded broadly in the field of abdominal and pelvic surgery. Laparoscopic and robotic surgery has improved surgeon ergonomics, instrument precision, operative time, and postoperative recovery across various abdominal procedures. The goal of this study is to establish the feasibility of implementing high-speed hyperspectral imaging into a standard laparoscopic setup and exploring its benefit to common intracorporeal procedures. A hyperspectral laparoscopic imaging system was constructed using a customized hyperspectral camera alongside a standard rigid laparoscope and was validated for both spectral and spatial accuracy. Demosaicing methods were investigated for improved full-resolution visualization. Hyperspectral cameras with different spectral ranges were considered and compared with one another alongside two different light sources to determine the most effective configuration. Finally, different porcine tissues were imaged ex-vivo to test the capabilities of the system and spectral footprints of the various tissues were extracted. The tissue was also imaged in a phantom to simulate the system's use in MIS. The results demonstrated a hyperspectral laparoscopic imaging system that could provide quantitative, diagnostic information while not disrupting normal workflow nor adding excessive weight to the laparoscopic setup. The high-speed hyperspectral laparoscopic imaging system can have immediate applications in image-guided surgery.

Optimized spectral filter design enables more accurate estimation of oxygen saturation in spectral imaging

Oxygen saturation (SO₂) in tissue is a crucially important physiological parameter with ubiquitous clinical utility in diagnosis, treatment, and monitoring, as well as widespread use as an invaluable preclinical research tool. Multispectral imaging can be used to visualize SO₂ non-invasively, non-destructively and without contact in real-time using narrow spectral filter sets, but typically, these spectral filter sets are poorly suited to a specific clinical task, application, or tissue type. In this work, we demonstrate the merit of optimizing spectral filter sets for more accurate estimation of SO₂. Using tissue modelling and simulated multispectral imaging, we demonstrate filter optimization reduces the root-mean-square-error (RMSE) in estimating SO₂ by up to 37% compared with evenly spaced filters. Moreover, we demonstrate up to a 79% decrease in RMSE for optimized filter sets compared with filter sets chosen to minimize mutual information. Wider adoption of this approach will result in more effective multispectral imaging systems that can address specific clinical needs and consequently, more widespread adoption of multispectral imaging technologies in disease diagnosis and treatment.

Involving Animal Models in Uterine Transplantation

Background

Absolute uterine factor infertility affects 0. 2% women of childbearing age around the world. Uterine transplantation (UTx) is a promising solution for many of them since the first birth from UTx was described by the Swedish team in 2014. The success of Utx in humans has become possible after a systematic and meticulous approach involving years of research on animal models. To date, more than 80 UTx procedures have been performed worldwide and 30 children were born.

Material and Method

This review summarizes the research preparation conducted in animals before beginning UTx in humans. It focuses on the advantages and limits of each animal model, their place in surgical training, and current contribution in research to improve UTx successes in humans. The different steps in the process of UTx have been analyzed, such as imaging, surgery, ischemia-reperfusion effects, rejection markers, immunosuppressive treatment, and pregnancy.

Conclusion

Animal models have played an essential role in the implementation of UTx, which is a highly complex procedure. While respecting the 3R requirements (replacement, refinement, and reduction), the surgical training using large animal models, such as notably ewes remain irreplaceable for teams wishing to initiate a UTx program. Furthermore, animal models are still mandatory in current research to improve the success rates of UTx in humans as well as to reduce the morbidity associated with this experimental infertility treatment.

Intraoperative colon perfusion assessment using multispectral imaging

In colorectal surgery an anastomosis performed using poorly-perfused, ischaemic bowel segments may result in a leak and consequent morbidity. Traditional measures of perfusion assessment rely on clinical judgement and are mainly subjective, based on tissue appearance, leading to variability between clinicians. This paper describes a multispectral imaging (MSI) laparoscope that can derive quantitative measures of tissue oxygen saturation (SO₂ ). The system uses a xenon surgical light source and fast filter wheel camera to capture eight narrow waveband images across the visible range in approximately 0.3 s. Spectral validation measurements were performed by imaging standardised colour tiles and comparing reflectance with ground truth spectrometer data. Tissue spectra were decomposed into individual contributions from haemoglobin, adipose tissue and scattering, using a previously-developed regression approach. Initial clinical results from seven patients undergoing colorectal surgery are presented and used to characterise measurement stability and reproducibility in vivo. Strategies to improve signal-to-noise ratio and correct for motion are described. Images of healthy bowel tissue (in vivo) indicate that baseline SO₂ is approximately 75 ± 6%. The SO₂ profile along a bowel segment following ligation of the inferior mesenteric artery (IMA) shows a decrease from the proximal to distal end. In the clinical cases shown, imaging results concurred with clinical judgements of the location of well-perfused tissue. Adipose tissue, visibly yellow in the RGB images, is shown to surround the mesentery and cover some of the serosa. SO₂ in this tissue is consistently high, with mean value of 90%. These results show that MSI is a potential intraoperative guidance tool for assessment of perfusion. Mapping of SO₂ in the colon could be used by surgeons to guide choice of transection points and ensure that well-perfused tissue is used to form an anastomosis. The observation of high mesenteric SO₂ agrees with work in the literature and warrants further exploration. Larger studies incorporating with a wider cohort of clinicians will help to provide retrospective evidence of how this imaging technique may be able to reduce inter-operator variability.

Comparison of different spectral cameras for image-guided organ transplantation

SIGNIFICANCE

Hyperspectral and multispectral imaging (HMSI) in medical applications provides information about the physiology, morphology, and composition of tissues and organs. The use of these technologies enables the evaluation of biological objects and can potentially be applied as an objective assessment tool for medical professionals.

AIM

Our study investigates HMSI systems for their usability in medical applications.

APPROACH

Four HMSI systems (one hyperspectral pushbroom camera and three multispectral snapshot cameras) were examined and a spectrometer was used as a reference system, which was initially validated with a standardized color chart. The spectral accuracy of the cameras reproducing chemical properties of different biological objects (porcine blood, physiological porcine tissue, and pathological porcine tissue) was analyzed using the Pearson correlation coefficient.

RESULTS

All the HMSI cameras examined were able to provide the characteristic spectral properties of blood and tissues. A pushbroom camera and two snapshot systems achieve Pearson coefficients of at least 0.97 compared to the ground truth, indicating a very high positive correlation. Only one snapshot camera performs moderately to high positive correlation (0.59 to 0.85).

CONCLUSION

The knowledge of the suitability of HMSI cameras for accurate measurement of chemical properties of biological objects offers a good opportunity for the selection of the optimal imaging tool for specific medical applications, such as organ transplantation.

A Novel Hyperspectral Imaging System for Intraoperative Prediction of Cerebral Hyperperfusion Syndrome after Superficial Temporal Artery-Middle Cerebral Artery Anastomosis in Patients with Moyamoya Disease

BACKGROUND

Postoperative cerebral hyperperfusion syndrome (CHS) may occur after superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for moyamoya disease (MMD). Predicting postoperative CHS is challenging; however, we previously reported the feasibility of using a hyperspectral camera (HSC) for monitoring intraoperative changes in brain surface hemodynamics during STA-MCA bypass.

OBJECTIVE

To investigate the utility of HSC to predict postoperative CHS during STA-MCA bypass for patients with MMD.

METHODS

Hyperspectral images of the cerebral cortex of 29 patients with MMD who underwent STA-MCA bypass were acquired by using an HSC before and after anastomosis. We then analyzed the changes in oxygen saturation after anastomosis and assessed its correlation with CHS.

RESULTS

Five patients experienced transient neurological deterioration several days after surgery. 123I-N-Isopropyl-iodoamphetamine single-photon emission computed tomography scan results revealed an intense, focal increase in cerebral blood flow at the site of anastomosis without any cerebral infarction. Patients with CHS showed significantly increased oxygen saturation (SO2) in the cerebral cortex after anastomosis relative to those without CHS (33 ± 28 vs. 8 ± 14%, p < 0.0001). Receiver operating characteristic analysis results show that postoperative CHS likely occurs when the increase rate of cortical SO2 value is >15% (sensitivity, 85.0%; specificity, 81.3%; area under curve, 0.871).

CONCLUSIONS

This study indicates that hyperspectral imaging of the cerebral cortex may be used to predict postoperative CHS in patients with MMD undergoing STA-MCA bypass.

Multispectral tissue mapping: developing a concept for the optical evaluation of liver disease

Purpose: Alterations in the optical absorption behavior of liver tissue secondary to pathological processes can be evaluated by multispectral analysis, which is increasingly being explored as an imaging adjunct for use in liver surgery. Current methods are either invasive or have a limited wavelength spectrum, which restricts utility. This proof of concept study describes the development of a multispectral imaging (MSI) method called multispectral tissue mapping (MTM) that addresses these issues. Approach: The imaging system consists of a tunable excitation light source and a near-infrared camera. Following the development stage, proof of concept experiments are carried out where absorption spectra from colorectal cancer liver metastasis (CRLM), hepatocellular carcinoma (HCC), and liver steatosis specimen are acquired and compared to controls. Absorption spectra are compared to histopathology examination as the current gold standard for tissue assessment. Generalized linear mixed modeling is employed to compare absorption characteristics of individual pixels and to select wavelengths for false color image processing with the aim of visually enhancing cancer tissue. Results: Analysis of individual pixels revealed distinct absorption spectra therefore suggesting that MTM is possible. A prominent absorption peak at 1210 nm was found in lipid-rich animal tissues and steatotic liver specimen. Liver cancer tissue had a heterogeneous appearance on MSI. Subsequent statistical analysis suggests that measuring changes in absorption behavior may be a feasible method to estimate the pixel-based probability of cancer being present. In CRLM, this was observed throughout 1100 to 1700 nm, whereas in HCC it was concentrated around 1140 and 1430 nm. False color image processing visibly enhances contrast between cancer and normal liver tissues. Conclusions: The system's ability to enable no-touch MSI at 1100 to 1700 nm was demonstrated. Preliminary data suggest that MTM warrants further exploration as a potential imaging tool for the detection of liver cancer during surgery.

Custodiol-N Is Superior to Custodiol® Solution in Experimental Rat Uterus Preservation

Uterus transplantation (UTx) is the first and only available treatment for women with absolute uterine factor infertility. However, clinical application is limited by the lack of organs, ischemia/reperfusion injury, as well as immunosuppression after UTx. Several different preservation solutions are used in experimental and clinical UTx, including Custodiol^® solution. Recently, the novel Custodiol-N solution was developed with superior results in organ preservation. However, the solution was not tested yet in UTx. Therefore, the aims of this study were to evaluate the effect of Custodiol-N in uterus prolonged cold preservation time (8 and 24 h), compared to Custodiol^® solution. Uterus tissue samples were obtained from adult Sprague Dawley rats (n = 10/group). Cold ischemic injury was estimated by histology, including immunohistochemistry, and biochemical tissue analyses. After 8 h of cold ischemia, higher percentage of tissue edema, necrosis signs and myeloperoxidase expression, as well as lower superoxide dismutase activity were found in Custodiol^® compared to Custodiol-N (p < 0.05). These differences were more pronounced after 24 h of cold preservation time (p < 0.05). This study demonstrated that Custodiol-N protects uterus grafts from cold ischemic injury better than standard Custodiol^® most likely via inhibition of oxidative stress and tissue edema. It seems that iron chelators in the composition of Custodiol-N play an important protective role against cold ischemia.

Surgical spectral imaging

Recent technological developments have resulted in the availability of miniaturised spectral imaging sensors capable of operating in the multi- (MSI) and hyperspectral imaging (HSI) regimes. Simultaneous advances in image-processing techniques and artificial intelligence (AI), especially in machine learning and deep learning, have made these data-rich modalities highly attractive as a means of extracting biological information non-destructively. Surgery in particular is poised to benefit from this, as spectrally-resolved tissue optical properties can offer enhanced contrast as well as diagnostic and guidance information during interventions. This is particularly relevant for procedures where inherent contrast is low under standard white light visualisation. This review summarises recent work in surgical spectral imaging (SSI) techniques, taken from Pubmed, Google Scholar and arXiv searches spanning the period 2013-2019. New hardware, optimised for use in both open and minimally-invasive surgery (MIS), is described, and recent commercial activity is summarised. Computational approaches to extract spectral information from conventional colour images are reviewed, as tip-mounted cameras become more commonplace in MIS. Model-based and machine learning methods of data analysis are discussed in addition to simulation, phantom and clinical validation experiments. A wide variety of surgical pilot studies are reported but it is apparent that further work is needed to quantify the clinical value of MSI/HSI. The current trend toward data-driven analysis emphasises the importance of widely-available, standardised spectral imaging datasets, which will aid understanding of variability across organs and patients, and drive clinical translation.

A Review on Advances in Intra-operative Imaging for Surgery and Therapy: Imagining the Operating Room of the Future

With the advent of Minimally Invasive Surgery (MIS), intra-operative imaging has become crucial for surgery and therapy guidance, allowing to partially compensate for the lack of information typical of MIS. This paper reviews the advancements in both classical (i.e. ultrasounds, X-ray, optical coherence tomography and magnetic resonance imaging) and more recent (i.e. multispectral, photoacoustic and Raman imaging) intra-operative imaging modalities. Each imaging modality was analyzed, focusing on benefits and disadvantages in terms of compatibility with the operating room, costs, acquisition time and image characteristics. Tables are included to summarize this information. New generation of hybrid surgical room and algorithms for real time/in room image processing were also investigated. Each imaging modality has its own (site- and procedure-specific) peculiarities in terms of spatial and temporal resolution, field of view and contrasted tissues. Besides the benefits that each technique offers for guidance, considerations about operators and patient risk, costs, and extra time required for surgical procedures have to be considered. The current trend is to equip surgical rooms with multimodal imaging systems, so as to integrate multiple information for real-time data extraction and computer-assisted processing. The future of surgery is to enhance surgeons eye to minimize intra- and after-surgery adverse events and provide surgeons with all possible support to objectify and optimize the care-delivery process.

Spectral Imaging Of Thermal Damage Induced During Microwave Ablation In The Liver

Induction of thermal damage to tissue through delivery of microwave energy is frequently applied in surgery to destroy diseased tissue such as cancer cells. Minimization of unwanted harm to healthy tissue is still achieved subjectively, and the surgeon has few tools at their disposal to monitor the spread of the induced damage. This work describes the use of optical methods to monitor the time course of changes to the tissue during delivery of microwave energy in the porcine liver. Multispectral imaging and diffuse reflectance spectroscopy are used to monitor temporal changes in optical properties in parallel with thermal imaging. The results demonstrate the ability to monitor the spatial extent of thermal damage on a whole organ, including possible secondary effects due to vascular damage. Future applications of this type of imaging may see the multispectral data used as a feedback mechanism to avoid collateral damage to critical healthy structures and to potentially verify sufficient application of energy to the diseased tissue.

Intraoperative multispectral and hyperspectral label-free imaging: A systematic review of in vivo clinical studies

Multispectral and hyperspectral imaging (HSI) are emerging optical imaging techniques with the potential to transform the way surgery is performed but it is not clear whether current systems are capable of delivering real-time tissue characterization and surgical guidance. We conducted a systematic review of surgical in vivo label-free multispectral and HSI systems that have been assessed intraoperatively in adult patients, published over a 10-year period to May 2018. We analysed 14 studies including 8 different HSI systems. Current in-vivo HSI systems generate an intraoperative tissue oxygenation map or enable tumour detection. Intraoperative tissue oxygenation measurements may help to predict those patients at risk of postoperative complications and in-vivo intraoperative tissue characterization may be performed with high specificity and sensitivity. All systems utilized a line-scanning or wavelength-scanning method but the spectral range and number of spectral bands employed varied significantly between studies and according to the system's clinical aim. The time to acquire a hyperspectral cube dataset ranged between 5 and 30 seconds. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of intraoperative in-vivo label-free HSI but further work is needed to fully integrate it into the current surgical workflow.

Real-time optical properties and oxygenation imaging using custom parallel processing in the spatial frequency domain

The development of real-time, wide-field and quantitative diffuse optical imaging methods is becoming increasingly popular for biological and medical applications. Recent developments introduced a novel approach for real-time multispectral acquisition in the spatial frequency domain using spatio-temporal modulation of light. Using this method, optical properties maps (absorption and reduced scattering) could be obtained for two wavelengths (665 nm and 860 nm). These maps, in turn, are used to deduce oxygen saturation levels in tissues. However, while the acquisition was performed in real-time, processing was performed post-acquisition and was not in real-time. In the present article, we present CPU and GPU processing implementations for this method with special emphasis on processing time. The obtained results show that the proposed custom direct method using a General Purpose Graphic Processing Unit (GPGPU) and C CUDA (Compute Unified Device Architecture) implementation enables 1.6 milliseconds processing time for a 1 Mega-pixel image with a maximum average error of 0.1% in extracting optical properties.

Estimation of tissue oxygen saturation from RGB images and sparse hyperspectral signals based on conditional generative adversarial network

PURPOSE

Intra-operative measurement of tissue oxygen saturation ([Formula: see text]) is important in detection of ischaemia, monitoring perfusion and identifying disease. Hyperspectral imaging (HSI) measures the optical reflectance spectrum of the tissue and uses this information to quantify its composition, including [Formula: see text]. However, real-time monitoring is difficult due to capture rate and data processing time.

METHODS

An endoscopic system based on a multi-fibre probe was previously developed to sparsely capture HSI data (sHSI). These were combined with RGB images, via a deep neural network, to generate high-resolution hypercubes and calculate [Formula: see text]. To improve accuracy and processing speed, we propose a dual-input conditional generative adversarial network, Dual2StO2, to directly estimate [Formula: see text] by fusing features from both RGB and sHSI.

RESULTS

Validation experiments were carried out on in vivo porcine bowel data, where the ground truth [Formula: see text] was generated from the HSI camera. Performance was also compared to our previous super-spectral-resolution network, SSRNet in terms of mean [Formula: see text] prediction accuracy and structural similarity metrics. Dual2StO2 was also tested using simulated probe data with varying fibre number.

CONCLUSIONS

[Formula: see text] estimation by Dual2StO2 is visually closer to ground truth in general structure and achieves higher prediction accuracy and faster processing speed than SSRNet. Simulations showed that results improved when a greater number of fibres are used in the probe. Future work will include refinement of the network architecture, hardware optimization based on simulation results, and evaluation of the technique in clinical applications beyond [Formula: see text] estimation.

Use of Laser Speckle Contrast Analysis during pelvic surgery in a uterine transplantation model

Aim

Uterine transplantation (UTx) is proposed for treatment of uterine factor infertility. Our aim was to assess whether Endoscopic Laser Speckle Contrast Analysis (eLASCA) could evaluate pelvic blood flow at anastomotic sites required for sheep and rabbit UTx.

Results/methodology

eLASCA detected blood flow in rabbit UTx #7 and #9. In sheep UTx #2, #3 and #5, the results allowed us to conclude that blood flow was present in the uterine graft following transplantation; and post-UTx, the animal had heart and respiratory rates, and oxygen saturation compatible with a normal hemodynamic status.

Conclusion

These preliminary results establish the potential of Laser Speckle Contrast Analysis as noncontact and real-time tool for observation of spatially-resolved blood flow from which other parameters can be derived.

Dual-modality endoscopic probe for tissue surface shape reconstruction and hyperspectral imaging enabled by deep neural networks

Surgical guidance and decision making could be improved with accurate and real-time measurement of intra-operative data including shape and spectral information of the tissue surface. In this work, a dual-modality endoscopic system has been proposed to enable tissue surface shape reconstruction and hyperspectral imaging (HSI). This system centers around a probe comprised of an incoherent fiber bundle, whose fiber arrangement is different at the two ends, and miniature imaging optics. For 3D reconstruction with structured light (SL), a light pattern formed of randomly distributed spots with different colors is projected onto the tissue surface, creating artificial texture. Pattern decoding with a Convolutional Neural Network (CNN) model and a customized feature descriptor enables real-time 3D surface reconstruction at approximately 12 frames per second (FPS). In HSI mode, spatially sparse hyperspectral signals from the tissue surface can be captured with a slit hyperspectral imager in a single snapshot. A CNN based super-resolution model, namely "super-spectral-resolution" network (SSRNet), has also been developed to estimate pixel-level dense hypercubes from the endoscope cameras standard RGB images and the sparse hyperspectral signals, at approximately 2 FPS. The probe, with a 2.1 mm diameter, enables the system to be used with endoscope working channels. Furthermore, since data acquisition in both modes can be accomplished in one snapshot, operation of this system in clinical applications is minimally affected by tissue surface movement and deformation. The whole apparatus has been validated on phantoms and tissue (ex vivo and in vivo), while initial measurements on patients during laryngeal surgery show its potential in real-world clinical applications.