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Feasibility of Novel Software-Based Perfusion Indicators for the Ileal J-Pouch—On the Path towards Objective and Quantifiable Intraoperative Perfusion Assessment with Indocyanine Green Near-Infrared Fluorescence
Background: In restorative proctocolectomy with ileal J-pouch, perfusion assessment is vital to prevent complications such as anastomotic leak (AL). Indocyanine green near-infrared fluorescence (ICG-NIRF) is gaining popularity, while its interpretation and relevance remain subjective. This study aim...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410361/ https://www.ncbi.nlm.nih.gov/pubmed/36013324 http://dx.doi.org/10.3390/life12081144 |
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author | Lobbes, Leonard A. Hoveling, Richelle J. M. Berns, Susanne Schmidt, Leonard R. Strobel, Rahel M. Schineis, Christian Lauscher, Johannes C. Beyer, Katharina Weixler, Benjamin |
author_facet | Lobbes, Leonard A. Hoveling, Richelle J. M. Berns, Susanne Schmidt, Leonard R. Strobel, Rahel M. Schineis, Christian Lauscher, Johannes C. Beyer, Katharina Weixler, Benjamin |
author_sort | Lobbes, Leonard A. |
collection | PubMed |
description | Background: In restorative proctocolectomy with ileal J-pouch, perfusion assessment is vital to prevent complications such as anastomotic leak (AL). Indocyanine green near-infrared fluorescence (ICG-NIRF) is gaining popularity, while its interpretation and relevance remain subjective. This study aimed to evaluate a standardized ICG-NIRF imaging protocol combined with a novel, software-based assessment to detect areas of impaired perfusion and a possible correlation with AL of the pouch. Methods: In this prospective study, patients undergoing ileal J-pouch for ulcerative colitis at an inflammatory bowel disease (IBD) referral center were included. Intraoperatively, strictly standardized ICG-NIRF visualization was performed and video-recorded. Postoperatively, a specific software was utilized to determine the change in fluorescence intensity per second (i/s) for systematic regions of interest, generating perfusion-time curves and a pixel-to-pixel map. These were analysed in detail and correlated with clinical outcome (primary end point: AL within 30 days; clearly defined and screened for by pouchoscopy). Results: Four out of 18 included patients developed AL of the ileal pouch-anal anastomosis (IPAA). In the AL group, the perfusion curves on the area adjacent to the IPAA (pouch apex) displayed considerably lower ingress/inflow (median = 1.7; range = 8.5; interquartile-range = 3.8 i/s) and egress/outflow (median = −0.1; range = 0.7; interquartile-range = 0.5 i/s) values than in the non-AL group (ingress: median = 4.3; range = 10.3; interquartile-range = 4.0 i/s); egress: median = (−1.1); range = 3.9; interquartile range = 1.0 i/s). This was confirmed by further novel parameters of pouch perfusion (maximum ingress; maximum egress) and pixel-to-pixel analysis. Conclusions: This study presents the feasibility of a novel methodology to precisely assess pouch perfusion with ICG-NIRF, identifying comparable, quantifiable, and objective parameters to potentially detect perfusion-associated complications in surgery in real-time. |
format | Online Article Text |
id | pubmed-9410361 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-94103612022-08-26 Feasibility of Novel Software-Based Perfusion Indicators for the Ileal J-Pouch—On the Path towards Objective and Quantifiable Intraoperative Perfusion Assessment with Indocyanine Green Near-Infrared Fluorescence Lobbes, Leonard A. Hoveling, Richelle J. M. Berns, Susanne Schmidt, Leonard R. Strobel, Rahel M. Schineis, Christian Lauscher, Johannes C. Beyer, Katharina Weixler, Benjamin Life (Basel) Article Background: In restorative proctocolectomy with ileal J-pouch, perfusion assessment is vital to prevent complications such as anastomotic leak (AL). Indocyanine green near-infrared fluorescence (ICG-NIRF) is gaining popularity, while its interpretation and relevance remain subjective. This study aimed to evaluate a standardized ICG-NIRF imaging protocol combined with a novel, software-based assessment to detect areas of impaired perfusion and a possible correlation with AL of the pouch. Methods: In this prospective study, patients undergoing ileal J-pouch for ulcerative colitis at an inflammatory bowel disease (IBD) referral center were included. Intraoperatively, strictly standardized ICG-NIRF visualization was performed and video-recorded. Postoperatively, a specific software was utilized to determine the change in fluorescence intensity per second (i/s) for systematic regions of interest, generating perfusion-time curves and a pixel-to-pixel map. These were analysed in detail and correlated with clinical outcome (primary end point: AL within 30 days; clearly defined and screened for by pouchoscopy). Results: Four out of 18 included patients developed AL of the ileal pouch-anal anastomosis (IPAA). In the AL group, the perfusion curves on the area adjacent to the IPAA (pouch apex) displayed considerably lower ingress/inflow (median = 1.7; range = 8.5; interquartile-range = 3.8 i/s) and egress/outflow (median = −0.1; range = 0.7; interquartile-range = 0.5 i/s) values than in the non-AL group (ingress: median = 4.3; range = 10.3; interquartile-range = 4.0 i/s); egress: median = (−1.1); range = 3.9; interquartile range = 1.0 i/s). This was confirmed by further novel parameters of pouch perfusion (maximum ingress; maximum egress) and pixel-to-pixel analysis. Conclusions: This study presents the feasibility of a novel methodology to precisely assess pouch perfusion with ICG-NIRF, identifying comparable, quantifiable, and objective parameters to potentially detect perfusion-associated complications in surgery in real-time. MDPI 2022-07-28 /pmc/articles/PMC9410361/ /pubmed/36013324 http://dx.doi.org/10.3390/life12081144 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Lobbes, Leonard A. Hoveling, Richelle J. M. Berns, Susanne Schmidt, Leonard R. Strobel, Rahel M. Schineis, Christian Lauscher, Johannes C. Beyer, Katharina Weixler, Benjamin Feasibility of Novel Software-Based Perfusion Indicators for the Ileal J-Pouch—On the Path towards Objective and Quantifiable Intraoperative Perfusion Assessment with Indocyanine Green Near-Infrared Fluorescence |
title | Feasibility of Novel Software-Based Perfusion Indicators for the Ileal J-Pouch—On the Path towards Objective and Quantifiable Intraoperative Perfusion Assessment with Indocyanine Green Near-Infrared Fluorescence |
title_full | Feasibility of Novel Software-Based Perfusion Indicators for the Ileal J-Pouch—On the Path towards Objective and Quantifiable Intraoperative Perfusion Assessment with Indocyanine Green Near-Infrared Fluorescence |
title_fullStr | Feasibility of Novel Software-Based Perfusion Indicators for the Ileal J-Pouch—On the Path towards Objective and Quantifiable Intraoperative Perfusion Assessment with Indocyanine Green Near-Infrared Fluorescence |
title_full_unstemmed | Feasibility of Novel Software-Based Perfusion Indicators for the Ileal J-Pouch—On the Path towards Objective and Quantifiable Intraoperative Perfusion Assessment with Indocyanine Green Near-Infrared Fluorescence |
title_short | Feasibility of Novel Software-Based Perfusion Indicators for the Ileal J-Pouch—On the Path towards Objective and Quantifiable Intraoperative Perfusion Assessment with Indocyanine Green Near-Infrared Fluorescence |
title_sort | feasibility of novel software-based perfusion indicators for the ileal j-pouch—on the path towards objective and quantifiable intraoperative perfusion assessment with indocyanine green near-infrared fluorescence |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410361/ https://www.ncbi.nlm.nih.gov/pubmed/36013324 http://dx.doi.org/10.3390/life12081144 |
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