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Kashchenko VA, Lodygin AV, Krasnoselsky KY, Zaytsev VV, Kamshilin AA. Intra-abdominal laparoscopic assessment of organs perfusion using imaging photoplethysmography. Surg Endosc 2023; 37:8919-8929. [PMID: 37872427 DOI: 10.1007/s00464-023-10506-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND An objective evaluation of the functional state and viability of biological tissues during minimally invasive surgery remains unsolved task. Various non-contact methods for evaluating perfusion during laparoscopic surgery are discussed in the literature, but so far there have been no reports of their use in clinical settings. METHODS AND PATIENTS Imaging photoplethysmography (iPPG) is a new method for quantitative assessment of perfusion distribution along the tissue. This is the first study in which we demonstrate successful use of iPPG to assess perfusion of organs during laparoscopic surgery in an operation theater. We used a standard rigid laparoscope connected to a standard digital monochrome camera, and abdominal organs were illuminated by green light. A distinctive feature is the synchronous recording of video frames and electrocardiogram with subsequent correlation data processing. During the laparoscopically assisted surgeries in nine cancer patients, the gradient of perfusion of the affected organs was evaluated. In particular, measurements were carried out before preparing a part of the intestine or stomach for resection, after anastomosis, or during physiological tests. RESULTS The spatial distribution of perfusion and its changes over time were successfully measured in all surgical cases. In particular, perfusion gradient of an intestine before resection was visualized and quantified by our iPPG laparoscope in all respective cases. It was also demonstrated that systemic administration of norepinephrine leads to a sharper gradient between well and poorly perfused areas of the colon. In four surgical cases, we have shown capability of the laparoscopic iPPG system for intra-abdominal assessment of perfusion in the anastomosed organs. Moreover, good repeatability of continuous long-term measurements of tissue perfusion inside the abdominal cavity was experimentally demonstrated. CONCLUSION Our study carried out in real clinical settings has shown that iPPG laparoscope is feasible for intra-abdominal visualization and quantitative assessment of perfusion distribution.
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Affiliation(s)
- Victor A Kashchenko
- First Surgical Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291
- Department of Faculty Surgery, St. Petersburg State University, Saint Petersburg, Russia, 199106
| | - Alexander V Lodygin
- First Surgical Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291
- Department of Faculty Surgery, St. Petersburg State University, Saint Petersburg, Russia, 199106
| | - Konstantin Yu Krasnoselsky
- First Surgical Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291
- Department of Anesthesiology-Resuscitation and Emergency Pediatrics, St. Petersburg State Pediatric Medical University, Saint Petersburg, Russia, 194100
| | - Valeriy V Zaytsev
- Laboratory of New Functional Materials for Photonics, Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok, Russia, 690041
- Organizational and Methodological Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291
| | - Alexei A Kamshilin
- Laboratory of New Functional Materials for Photonics, Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok, Russia, 690041.
- Organizational and Methodological Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291.
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Thomaßen MT, Köhler H, Pfahl A, Stelzner S, Mehdorn M, Thieme R, Jansen-Winkeln B, Gockel I, Chalopin C, Moulla Y. In vivo evaluation of a hyperspectral imaging system for minimally invasive surgery (HSI-MIS). Surg Endosc 2023. [PMID: 36645484 DOI: 10.1007/s00464-023-09874-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hyperspectral Imaging (HSI) is a reliable and safe imaging method for taking intraoperative perfusion measurements. This is the first study translating intraoperative HSI to an in vivo laparoscopic setting using a CE-certified HSI-system for minimally invasive surgery (HSI-MIS). We aim to compare it to an established HSI-system for open surgery (HSI-Open). METHODS Intraoperative HSI was done using the HSI-MIS and HSI-Open at the Region of Interest (ROI). 19 patients undergoing gastrointestinal resections were analyzed in this study. The HSI-MIS-acquired images were aligned with those from the HSI-Open, and spectra and parameter images were compared pixel-wise. We calculated the Mean Absolute Error (MAE) for Tissue Oxygen Saturation (StO2), Near-Infrared Perfusion Index (NIR-PI), Tissue Water Index (TWI), and Organ Hemoglobin Index (OHI), as well as the Root Mean Squared Error (RMSE) over the whole spectrum. Our analysis of parameters was optimized using partial least squares (PLS) regression. Two experienced surgeons carried out an additional color-change analysis, comparing the ROI images and deciding whether they provided the same (acceptable) or different visual information (rejected). RESULTS HSI and subsequent image registration was possible in 19 patients. MAE results for the original calculation were StO2 orig. 17.2% (± 7.7%), NIR-PIorig. 16.0 (± 9.5), TWIorig. 18.1 (± 7.9), OHIorig. 14.4 (± 4.5). For the PLS calculation, they were StO2 PLS 12.6% (± 5.2%), NIR-PIPLS 10.3 (± 6.0), TWIPLS 10.6 (± 5.1), and OHIPLS 11.6 (± 3.0). The RMSE between both systems was 0.14 (± 0.06). In the color-change analysis; both surgeons accepted more images generated using the PLS method. CONCLUSION Intraoperative HSI-MIS is a new technology and holds great potential for future applications in surgery. Parameter deviations are attributable to technical differences and can be reduced by applying improved calculation methods. This study is an important step toward the clinical implementation of HSI for minimally invasive surgery.
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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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