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Ilgen A, Köhler H, Pfahl A, Stelzner S, Mehdorn M, Jansen-Winkeln B, Gockel I, Moulla Y. Intraoperative Laparoscopic Hyperspectral Imaging during Esophagectomy-A Pilot Study Evaluating Esophagogastric Perfusion at the Anastomotic Sites. Bioengineering (Basel) 2024; 11:69. [PMID: 38247946 PMCID: PMC10812999 DOI: 10.3390/bioengineering11010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/01/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Hyperspectral imaging (HSI) is a non-invasive and contactless technique that enables the real-time acquisition of comprehensive information on tissue within the surgical field. In this pilot study, we investigated whether a new HSI system for minimally-invasive surgery, TIVITA® Mini (HSI-MIS), provides reliable insights into tissue perfusion of the proximal and distal esophagogastric anastomotic sites during 21 laparoscopic/thoracoscopic or robotic Ivor Lewis esophagectomies of patients with cancer to minimize the risk of dreaded anastomotic insufficiency. In this pioneering investigation, physiological tissue parameters were derived from HSI measurements of the proximal site of the anastomosis (esophageal stump) and the distal site of the anastomosis (tip of the gastric conduit) during the thoracic phase of the procedure. Tissue oxygenation (StO2), Near Infrared Perfusion Index (NIR-PI), and Tissue Water Index (TWI) showed similar median values at both anastomotic sites. Significant differences were observed only for NIR-PI (median: 76.5 vs. 63.9; p = 0.012) at the distal site (gastric conduit) compared to our previous study using an HSI system for open surgery. For all 21 patients, reliable and informative measurements were attainable, confirming the feasibility of HSI-MIS to assess anastomotic viability. Further studies on the added benefit of this new technique aiming to reduce anastomotic insufficiency are warranted.
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Affiliation(s)
- Annalena Ilgen
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (A.I.); (S.S.); (I.G.)
| | - Hannes Köhler
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103 Leipzig, Germany; (H.K.); (A.P.)
| | - Annekatrin Pfahl
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103 Leipzig, Germany; (H.K.); (A.P.)
| | - Sigmar Stelzner
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (A.I.); (S.S.); (I.G.)
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (A.I.); (S.S.); (I.G.)
| | - Boris Jansen-Winkeln
- Department of General, Visceral, Thoracic and Vascular Surgery, Klinikum St. Georg, Delitzscher Str. 141, 04129 Leipzig, Germany;
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (A.I.); (S.S.); (I.G.)
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (A.I.); (S.S.); (I.G.)
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Pfahl A, Polat ST, Köhler H, Gockel I, Melzer A, Chalopin C. Switchable LED-based laparoscopic multispectral system for rapid high-resolution perfusion imaging. J Biomed Opt 2023; 28:126002. [PMID: 38094710 PMCID: PMC10718192 DOI: 10.1117/1.jbo.28.12.126002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Abstract
Significance Multispectral imaging (MSI) is an approach for real-time, quantitative, and non-invasive tissue perfusion measurements. Current laparoscopic systems based on mosaic sensors or filter wheels lack high spatial resolution or acceptable frame rates. Aim To develop a laparoscopic system for MSI-based color video and tissue perfusion imaging during gastrointestinal surgery without compromising spatial or temporal resolution. Approach The system was built with 14 switchable light-emitting diodes in the visible and near-infrared spectral range, a 4K image sensor, and a 10 mm laparoscope. Illumination patterns were created for tissue oxygenation and hemoglobin content monitoring. The system was calibrated to a clinically approved laparoscopic hyperspectral system using linear regression models and evaluated in an occlusion study with 36 volunteers. Results The root mean squared errors between the MSI and reference system were 0.073 for hemoglobin content, 0.039 for oxygenation in deeper tissue layers, and 0.093 for superficial oxygenation. The spatial resolution at a working distance of 45 mm was 156 μ m . The effective frame rate was 20 fps. Conclusions High-resolution perfusion monitoring was successfully achieved. Hardware optimizations will increase the frame rate. Parameter optimizations through alternative illumination patterns, regression, or assumed tissue models are planned. Intraoperative measurements must confirm the suitability during surgery.
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Affiliation(s)
- Annekatrin Pfahl
- Leipzig University, Faculty of Medicine, Innovation Center Computer Assisted Surgery, Leipzig, Germany
| | - Süleyman T. Polat
- Leipzig University, Faculty of Medicine, Innovation Center Computer Assisted Surgery, Leipzig, Germany
| | - Hannes Köhler
- Leipzig University, Faculty of Medicine, Innovation Center Computer Assisted Surgery, Leipzig, Germany
| | - Ines Gockel
- University Hospital of Leipzig, Department of Visceral, Transplant, Thoracic, and Vascular Surgery, Leipzig, Germany
| | - Andreas Melzer
- Leipzig University, Faculty of Medicine, Innovation Center Computer Assisted Surgery, Leipzig, Germany
- University of Dundee, School of Medicine, Institute for Medical Science and Technology, Dundee, United Kingdom
| | - Claire Chalopin
- Leipzig University, Faculty of Medicine, Innovation Center Computer Assisted Surgery, Leipzig, Germany
- University of Applied Sciences and Arts, Faculty of Engineering and Health, Göttingen, Germany
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Chalopin C, Pfahl A, Köhler H, Knospe L, Maktabi M, Unger M, Jansen-Winkeln B, Thieme R, Moulla Y, Mehdorn M, Sucher R, Neumuth T, Gockel I, Melzer A. Alternative intraoperative optical imaging modalities for fluorescence angiography in gastrointestinal surgery: spectral imaging and imaging photoplethysmography. MINIM INVASIV THER 2023; 32:222-232. [PMID: 36622288 DOI: 10.1080/13645706.2022.2164469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/29/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Intraoperative near-infrared fluorescence angiography with indocyanine green (ICG-FA) is a well-established modality in gastrointestinal surgery. Its main drawback is the application of a fluorescent agent with possible side effects for patients. The goal of this review paper is the presentation of alternative, non-invasive optical imaging methods and their comparison with ICG-FA. MATERIAL AND METHODS The principles of ICG-FA, spectral imaging, imaging photoplethysmography (iPPG), and their applications in gastrointestinal surgery are described based on selected published works. RESULTS The main applications of the three modalities are the evaluation of tissue perfusion, the identification of risk structures, and tissue segmentation or classification. While the ICG-FA images are mainly evaluated visually, leading to subjective interpretations, quantitative physiological parameters and tissue segmentation are provided in spectral imaging and iPPG. The combination of ICG-FA and spectral imaging is a promising method. CONCLUSIONS Non-invasive spectral imaging and iPPG have shown promising results in gastrointestinal surgery. They can overcome the main drawbacks of ICG-FA, i.e. the use of contrast agents, the lack of quantitative analysis, repeatability, and a difficult standardization of the acquisition. Further technical improvements and clinical evaluations are necessary to establish them in daily clinical routine.
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Affiliation(s)
- Claire Chalopin
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Annekatrin Pfahl
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Hannes Köhler
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Luise Knospe
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig AöR, Leipzig, Germany
| | - Marianne Maktabi
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany
- Department of Electrical, Mechanical and Industrial Engineering, Anhalt University of Applied Science, Köthen (Anhalt), Germany
| | - Michael Unger
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig AöR, Leipzig, Germany
- Department of General, Visceral and Oncological Surgery, St. Georg Hospital, Leipzig, Germany
| | - René Thieme
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig AöR, Leipzig, Germany
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig AöR, Leipzig, Germany
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig AöR, Leipzig, Germany
| | - Robert Sucher
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig AöR, Leipzig, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig AöR, Leipzig, Germany
| | - Andreas Melzer
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Leipzig, Germany
- Institute of Medical Science and Technology (IMSAT), University of Dundee, Dundee, UK
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Köhler H, Pfahl A, Moulla Y, Thomaßen MT, Maktabi M, Gockel I, Neumuth T, Melzer A, Chalopin C. Comparison of image registration methods for combining laparoscopic video and spectral image data. Sci Rep 2022; 12:16459. [PMID: 36180520 PMCID: PMC9525266 DOI: 10.1038/s41598-022-20816-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/19/2022] [Indexed: 11/09/2022] Open
Abstract
Laparoscopic procedures can be assisted by intraoperative modalities, such as quantitative perfusion imaging based on fluorescence or hyperspectral data. If these modalities are not available at video frame rate, fast image registration is needed for the visualization in augmented reality. Three feature-based algorithms and one pre-trained deep homography neural network (DH-NN) were tested for single and multi-homography estimation. Fine-tuning was used to bridge the domain gap of the DH-NN for non-rigid registration of laparoscopic images. The methods were validated on two datasets: an open-source record of 750 manually annotated laparoscopic images, presented in this work, and in-vivo data from a novel laparoscopic hyperspectral imaging system. All feature-based single homography methods outperformed the fine-tuned DH-NN in terms of reprojection error, Structural Similarity Index Measure, and processing time. The feature detector and descriptor ORB1000 enabled video-rate registration of laparoscopic images on standard hardware with submillimeter accuracy.
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Affiliation(s)
- Hannes Köhler
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, 04103, Leipzig, Germany.
| | - Annekatrin Pfahl
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, 04103, Leipzig, Germany
| | - Yusef Moulla
- Department of Visceral, Thoracic, Transplant, and Vascular Surgery, University Hospital of Leipzig, 04103, Leipzig, Germany
| | - Madeleine T Thomaßen
- Department of Visceral, Thoracic, Transplant, and Vascular Surgery, University Hospital of Leipzig, 04103, Leipzig, Germany
| | - Marianne Maktabi
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, 04103, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Thoracic, Transplant, and Vascular Surgery, University Hospital of Leipzig, 04103, Leipzig, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, 04103, Leipzig, Germany
| | - Andreas Melzer
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, 04103, Leipzig, Germany
| | - Claire Chalopin
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, 04103, Leipzig, Germany
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Chalopin C, Nickel F, Pfahl A, Köhler H, Maktabi M, Thieme R, Sucher R, Jansen-Winkeln B, Studier-Fischer A, Seidlitz S, Maier-Hein L, Neumuth T, Melzer A, Müller-Stich BP, Gockel I. [Artificial intelligence and hyperspectral imaging for image-guided assistance in minimally invasive surgery]. Chirurgie (Heidelb) 2022; 93:940-947. [PMID: 35798904 DOI: 10.1007/s00104-022-01677-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Intraoperative imaging assists surgeons during minimally invasive procedures. Hyperspectral imaging (HSI) is a noninvasive and noncontact optical technique with great diagnostic potential in medicine. The combination with artificial intelligence (AI) approaches to analyze HSI data is called intelligent HSI in this article. OBJECTIVE What are the medical applications and advantages of intelligent HSI for minimally invasive visceral surgery? MATERIAL AND METHODS Within various clinical studies HSI data from multiple in vivo tissue types and oncological resections were acquired using an HSI camera system. Different AI algorithms were evaluated for detection and discrimination of organs, risk structures and tumors. RESULTS In an experimental animal study 20 different organs could be differentiated with high precision (> 95%) using AI. In vivo, the parathyroid glands could be discriminated from surrounding tissue with an F1 score of 47% and sensitivity of 75%, and the bile duct with an F1 score of 79% and sensitivity of 90%. Furthermore, ex vivo tumor tissue could be successfully detected with an area under the receiver operating characteristic (ROC) curve (AUC) larger than 0.91. DISCUSSION This study demonstrates that intelligent HSI can automatically and accurately detect different tissue types. Despite great progress in the last decade intelligent HSI still has limitations. Thus, accurate AI algorithms that are easier to understand for the user and an extensive standardized and continuously growing database are needed. Further clinical studies should support the various medical applications and lead to the adoption of intelligent HSI in the clinical routine practice.
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Affiliation(s)
- Claire Chalopin
- Innovation Center Computer Assisted Surgery, Universität Leipzig, Semmelweisstr. 14, 04103, Leipzig, Deutschland.
| | - Felix Nickel
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Annekatrin Pfahl
- Innovation Center Computer Assisted Surgery, Universität Leipzig, Semmelweisstr. 14, 04103, Leipzig, Deutschland
| | - Hannes Köhler
- Innovation Center Computer Assisted Surgery, Universität Leipzig, Semmelweisstr. 14, 04103, Leipzig, Deutschland
| | - Marianne Maktabi
- Innovation Center Computer Assisted Surgery, Universität Leipzig, Semmelweisstr. 14, 04103, Leipzig, Deutschland
| | - René Thieme
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Robert Sucher
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Boris Jansen-Winkeln
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
- Abteilung für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg Leipzig, Leipzig, Deutschland
| | - Alexander Studier-Fischer
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Silvia Seidlitz
- Division of Intelligent Medical Systems, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - Lena Maier-Hein
- Division of Intelligent Medical Systems, Deutsches Krebsforschungszentrum, Heidelberg, Deutschland
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery, Universität Leipzig, Semmelweisstr. 14, 04103, Leipzig, Deutschland
| | - Andreas Melzer
- Innovation Center Computer Assisted Surgery, Universität Leipzig, Semmelweisstr. 14, 04103, Leipzig, Deutschland
| | - Beat Peter Müller-Stich
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Ines Gockel
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
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Pfahl A, Köhler H, Thomaßen MT, Maktabi M, Bloße AM, Mehdorn M, Lyros O, Moulla Y, Niebisch S, Jansen-Winkeln B, Chalopin C, Gockel I. Video: Clinical evaluation of a laparoscopic hyperspectral imaging system. Surg Endosc 2022; 36:7794-7799. [PMID: 35546207 PMCID: PMC9485189 DOI: 10.1007/s00464-022-09282-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/16/2022] [Indexed: 11/30/2022]
Abstract
Background Hyperspectral imaging (HSI) during surgical procedures is a new method for perfusion quantification and tissue discrimination. Its use has been limited to open surgery due to large camera sizes, missing color video, or long acquisition times. A hand-held, laparoscopic hyperspectral camera has been developed now to overcome those disadvantages and evaluated clinically for the first time. Methods In a clinical evaluation study, gastrointestinal resectates of ten cancer patients were investigated using the laparoscopic hyperspectral camera. Reference data from corresponding anatomical regions were acquired with a clinically approved HSI system. An image registration process was executed that allowed for pixel-wise comparisons of spectral data and parameter images (StO2: oxygen saturation of tissue, NIR PI: near-infrared perfusion index, OHI: organ hemoglobin index, TWI: tissue water index) provided by both camera systems. The mean absolute error (MAE) and root mean square error (RMSE) served for the quantitative evaluations. Spearman’s rank correlation between factors related to the study design like the time of spectral white balancing and MAE, respectively RMSE, was calculated. Results The obtained mean MAEs between the TIVITA® Tissue and the laparoscopic hyperspectral system resulted in StO2: 11% ± 7%, NIR PI: 14±3, OHI: 14± 5, and TWI: 10 ± 2. The mean RMSE between both systems was 0.1±0.03 from 500 to 750 nm and 0.15 ±0.06 from 750 to 1000 nm. Spearman’s rank correlation coefficients showed no significant correlation between MAE or RMSE and influencing factors related to the study design. Conclusion Qualitatively, parameter images of the laparoscopic system corresponded to those of the system for open surgery. Quantitative deviations were attributed to technical differences rather than the study design. Limitations of the presented study are addressed in current large-scale in vivo trials. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09282-y.
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Affiliation(s)
- Annekatrin Pfahl
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany.
| | - Hannes Köhler
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Madeleine T Thomaßen
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Marianne Maktabi
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Albrecht M Bloße
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Orestis Lyros
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Stefan Niebisch
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany.,Department of General, Visceral, Thoracic, and Vascular Surgery, Klinikum St. Georg, Leipzig, Germany
| | - Claire Chalopin
- Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
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Pfahl A, Radmacher GK, Köhler H, Maktabi M, Neumuth T, Melzer A, Gockel I, Chalopin C, Jansen-Winkeln B. Combined indocyanine green and quantitative perfusion assessment with hyperspectral imaging during colorectal resections. Biomed Opt Express 2022; 13:3145-3160. [PMID: 35774324 PMCID: PMC9203086 DOI: 10.1364/boe.452076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 05/26/2023]
Abstract
Anastomotic insufficiencies still represent one of the most severe complications in colorectal surgery. Since tissue perfusion highly affects anastomotic healing, its objective assessment is an unmet clinical need. Indocyanine green-based fluorescence angiography (ICG-FA) and hyperspectral imaging (HSI) have received great interest in recent years but surgeons have to decide between both techniques. For the first time, two data processing pipelines capable of reconstructing an ICG-FA correlating signal from hyperspectral data were developed. Results were technically evaluated and compared to ground truth data obtained during colorectal resections. In 87% of 46 data sets, the reconstructed images resembled the ground truth data. The combined applicability of ICG-FA and HSI within one imaging system might provide supportive and complementary information about tissue vascularization, shorten surgery time, and reduce perioperative mortality.
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Affiliation(s)
- A. Pfahl
- Innovation Center Computer Assisted Surgery
(ICCAS), Faculty of Medicine, Leipzig
University, Leipzig, 04103, Germany
- Contributed equally
| | - G. K. Radmacher
- Department of Visceral, Thoracic,
Transplant, and Vascular Surgery, University Hospital of
Leipzig, Leipzig, 04103, Germany
- Contributed equally
| | - H. Köhler
- Innovation Center Computer Assisted Surgery
(ICCAS), Faculty of Medicine, Leipzig
University, Leipzig, 04103, Germany
| | - M. Maktabi
- Innovation Center Computer Assisted Surgery
(ICCAS), Faculty of Medicine, Leipzig
University, Leipzig, 04103, Germany
| | - T. Neumuth
- Innovation Center Computer Assisted Surgery
(ICCAS), Faculty of Medicine, Leipzig
University, Leipzig, 04103, Germany
| | - A. Melzer
- Innovation Center Computer Assisted Surgery
(ICCAS), Faculty of Medicine, Leipzig
University, Leipzig, 04103, Germany
- Institute for Medical Science and
Technology (IMSaT), University of Dundee,
Dundee, DD2 1FD, United Kingdom
| | - I. Gockel
- Department of Visceral, Thoracic,
Transplant, and Vascular Surgery, University Hospital of
Leipzig, Leipzig, 04103, Germany
| | - C. Chalopin
- Innovation Center Computer Assisted Surgery
(ICCAS), Faculty of Medicine, Leipzig
University, Leipzig, 04103, Germany
| | - B. Jansen-Winkeln
- Department of Visceral, Thoracic,
Transplant, and Vascular Surgery, University Hospital of
Leipzig, Leipzig, 04103, Germany
- Department of General, Visceral, Thoracic,
and Vascular Surgery, Klinikum St. Georg,
Leipzig, 04129, Germany
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Knospe L, Gockel I, Jansen-Winkeln B, Thieme R, Niebisch S, Moulla Y, Stelzner S, Lyros O, Diana M, Marescaux J, Chalopin C, Köhler H, Pfahl A, Maktabi M, Park JH, Yang HK. New Intraoperative Imaging Tools and Image-Guided Surgery in Gastric Cancer Surgery. Diagnostics (Basel) 2022; 12:diagnostics12020507. [PMID: 35204597 PMCID: PMC8871069 DOI: 10.3390/diagnostics12020507] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 02/05/2023] Open
Abstract
Innovations and new advancements in intraoperative real-time imaging have gained significant importance in the field of gastric cancer surgery in the recent past. Currently, the most promising procedures include indocyanine green fluorescence imaging (ICG-FI) and hyperspectral imaging or multispectral imaging (HSI, MSI). ICG-FI is utilized in a broad range of clinical applications, e.g., assessment of perfusion or lymphatic drainage, and additional implementations are currently investigated. HSI is still in the experimental phase and its value and clinical relevance require further evaluation, but initial studies have shown a successful application in perfusion assessment, and prospects concerning non-invasive tissue and tumor classification are promising. The application of machine learning and artificial intelligence technologies might enable an automatic evaluation of the acquired image data in the future. Both methods facilitate the accurate visualization of tissue characteristics that are initially indistinguishable for the human eye. By aiding surgeons in optimizing the surgical procedure, image-guided surgery can contribute to the oncologic safety and reduction of complications in gastric cancer surgery and recent advances hold promise for the application of HSI in intraoperative tissue diagnostics.
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Affiliation(s)
- Luise Knospe
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
- Correspondence:
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
- Department of General, Visceral and Oncological Surgery, St. Georg Hospital, 04129 Leipzig, Germany
| | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Stefan Niebisch
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Sigmar Stelzner
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Orestis Lyros
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig AöR, 04103 Leipzig, Germany; (L.K.); (B.J.-W.); (R.T.); (S.N.); (Y.M.); (S.S.); (O.L.)
| | - Michele Diana
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.D.); (J.M.)
- ICUBE Laboratory, Photonics Instrumentation for Health, University of Strasbourg, 67400 Strasbourg, France
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, 67091 Strasbourg, France
| | - Jacques Marescaux
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France; (M.D.); (J.M.)
| | - Claire Chalopin
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, 04103 Leipzig, Germany; (C.C.); (H.K.); (A.P.); (M.M.)
| | - Hannes Köhler
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, 04103 Leipzig, Germany; (C.C.); (H.K.); (A.P.); (M.M.)
| | - Annekatrin Pfahl
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, 04103 Leipzig, Germany; (C.C.); (H.K.); (A.P.); (M.M.)
| | - Marianne Maktabi
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, 04103 Leipzig, Germany; (C.C.); (H.K.); (A.P.); (M.M.)
| | - Ji-Hyeon Park
- Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea; (J.-H.P.); (H.-K.Y.)
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea; (J.-H.P.); (H.-K.Y.)
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9
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Hennig S, Jansen-Winkeln B, Köhler H, Knospe L, Chalopin C, Maktabi M, Pfahl A, Hoffmann J, Kwast S, Gockel I, Moulla Y. Novel Intraoperative Imaging of Gastric Tube Perfusion during Oncologic Esophagectomy—A Pilot Study Comparing Hyperspectral Imaging (HSI) and Fluorescence Imaging (FI) with Indocyanine Green (ICG). Cancers (Basel) 2021; 14:cancers14010097. [PMID: 35008261 PMCID: PMC8750976 DOI: 10.3390/cancers14010097] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Novel intraoperative imaging techniques, namely, hyperspectral (HSI) and fluorescence imaging (FI), are promising with respect to reducing severe postoperative complications, thus increasing patient safety. Both tools have already been used to evaluate perfusion of the gastric conduit after esophagectomy and before anastomosis. To our knowledge, this is the first study evaluating both modalities simultaneously during esophagectomy. Methods: In our pilot study, 13 patients, who underwent Ivor Lewis esophagectomy and gastric conduit reconstruction, were analyzed prospectively. HSI and FI were recorded before establishing the anastomosis in order to determine its optimum position. Results: No anastomotic leak occurred during this pilot study. In five patients, the imaging methods resulted in a more peripheral adaptation of the anastomosis. There were no significant differences between the two imaging tools, and no adverse events due to the imaging methods or indocyanine green (ICG) injection occurred. Conclusions: Simultaneous intraoperative application of both modalities was feasible and not time consuming. They are complementary with regard to the ideal anastomotic position and may contribute to better surgical outcomes. The impact of their simultaneous application will be proven in consecutive prospective trials with a large patient cohort.
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Affiliation(s)
- Sebastian Hennig
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, D-04103 Leipzig, Germany; (S.H.); (B.J.-W.); (L.K.)
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, D-04103 Leipzig, Germany; (S.H.); (B.J.-W.); (L.K.)
- Department of General, Visceral, Thoracic and Vascular Surgery, St. Georg Hospital, Delitzscher Str. 141, D-04129 Leipzig, Germany
| | - Hannes Köhler
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Semmelweisstr. 14, D-04103 Leipzig, Germany; (H.K.); (C.C.); (M.M.); (A.P.)
| | - Luise Knospe
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, D-04103 Leipzig, Germany; (S.H.); (B.J.-W.); (L.K.)
| | - Claire Chalopin
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Semmelweisstr. 14, D-04103 Leipzig, Germany; (H.K.); (C.C.); (M.M.); (A.P.)
| | - Marianne Maktabi
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Semmelweisstr. 14, D-04103 Leipzig, Germany; (H.K.); (C.C.); (M.M.); (A.P.)
| | - Annekatrin Pfahl
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Semmelweisstr. 14, D-04103 Leipzig, Germany; (H.K.); (C.C.); (M.M.); (A.P.)
| | - Jana Hoffmann
- Department of Sports Medicine and Prevention, University Leipzig, Rosa Luxemburg Str. 20-30, D-04103 Leipzig, Germany; (J.H.); (S.K.)
| | - Stefan Kwast
- Department of Sports Medicine and Prevention, University Leipzig, Rosa Luxemburg Str. 20-30, D-04103 Leipzig, Germany; (J.H.); (S.K.)
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, D-04103 Leipzig, Germany; (S.H.); (B.J.-W.); (L.K.)
- Correspondence: (I.G.); (Y.M.); Tel.: +49-(0)341-9717211(I.G.); Fax: +49-(0)341-9717209
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, D-04103 Leipzig, Germany; (S.H.); (B.J.-W.); (L.K.)
- Correspondence: (I.G.); (Y.M.); Tel.: +49-(0)341-9717211(I.G.); Fax: +49-(0)341-9717209
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10
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Gockel I, Barberio M, Diana M, Thieme R, Pfahl A, Sucher R, Köhler H, Chalopin C, Maktabi M, Jansen-Winkeln B. [New intraoperative fluorescence-based and spectroscopic imaging techniques in visceral medicine - precision surgery in the "high tech"-operating room]. Z Gastroenterol 2021; 59:683-690. [PMID: 34157756 DOI: 10.1055/a-1481-1993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Fluorescence angiography (FA) with indocyanine green (ICG) and hyperspectral imaging (HSI) are novel intraoperative visualization techniques in abdominal, vascular and transplant surgery. With the purpose of precision surgery, and in order to increase patient's safety, these new tools aim at reducing postoperative morbidity and mortality. This review discusses and highlights recent developments and the future potential of real-time imaging modalities. METHODS The underlying mechanisms of the novel imaging methods and their clinical impact are displayed in the context of avoiding anastomotic leaks, the most momentous complications in gastrointestinal surgery after oncologic resections. RESULTS While FA is associated with the admission of a fluorescence agent, HSI is contact-free and non-invasive. Both methods are able to record physiological tissue properties in real-time. Additionally, FA also measures dynamic phenomena. The techniques take a few seconds only and do not hamper the operative workflow considerably. With regard to a potential change of the surgical strategy, FA and HSI have an equal significance. Our own advancements reflect, in particular, the topics of data visualization and automated data analyses together with the implementation of artificial intelligence (AI) and minimalization of the current devices to install them into endoscopes, minimal-invasive and robot-guided surgery. CONCLUSION There are a limited number of studies in the field of intraoperative imaging techniques. Whether precision surgery in the "high-tech" OR together with FA, HSI and robotics will result in more secure operative procedures to minimize the postoperative morbidity and mortality will have to be evaluated in future multicenter trials.
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Affiliation(s)
- Ines Gockel
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Leipzig
| | - Manuel Barberio
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Leipzig.,IRCAD, Research Institute against Digestive Cancer, Straßburg, Frankreich.,IHU-Strasbourg, Institute of Image-Guided Surgery, Frankreich
| | - Michele Diana
- IRCAD, Research Institute against Digestive Cancer, Straßburg, Frankreich.,IHU-Strasbourg, Institute of Image-Guided Surgery, Frankreich
| | - René Thieme
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Leipzig
| | - Annekatrin Pfahl
- ICCAS, Innovation Center Computer Assisted Surgery, Universität Leipzig, Leipzig, Deutschland
| | - Robert Sucher
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Leipzig
| | - Hannes Köhler
- ICCAS, Innovation Center Computer Assisted Surgery, Universität Leipzig, Leipzig, Deutschland
| | - Claire Chalopin
- ICCAS, Innovation Center Computer Assisted Surgery, Universität Leipzig, Leipzig, Deutschland
| | - Marianne Maktabi
- ICCAS, Innovation Center Computer Assisted Surgery, Universität Leipzig, Leipzig, Deutschland
| | - Boris Jansen-Winkeln
- Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Leipzig
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