Hyperspectral Imaging in Major Hepatectomies: Preliminary Results from the Ex-Machyna Trial

SIMPLE SUMMARY: Major hepatic resections are associated with higher risk of post-operative complications and post-hepatectomy liver failure. After hepatic pedicle clamping, ischemia-reperfusion injury may sometimes lead to post-hepatectomy liver failure. Early detection or, ideally, intra-operative prediction of liver dysfunction or failure would be essential for timely treatment. Hyperspectral imaging (HSI) is a non-invasive technology that detects the relative reflectance of light at a wavelength between 500 and 1000 nm, allowing the quantification of relevant organic compounds. This is the first clinical application of HSI in a monocentric major hepatectomy series, and the reported results suggest that HSI values could be associated with short-term post-operative outcomes. ABSTRACT: Ischemia-reperfusion injury during major hepatic resections is associated with high rates of post-operative complications and liver failure. Real-time intra-operative detection of liver dysfunction could provide great insight into clinical outcomes. In the present study, we demonstrate the intra-operative application of a novel optical technology, hyperspectral imaging (HSI), to predict short-term post-operative outcomes after major hepatectomy. We considered fifteen consecutive patients undergoing major hepatic resection for malignant liver lesions from January 2020 to June 2021. HSI measures included tissue water index (TWI), organ hemoglobin index (OHI), tissue oxygenation (StO(2)%), and near infrared (NIR). Pre-operative, intra-operative, and post-operative serum and clinical outcomes were collected. NIR values were higher in unhealthy liver tissue (p = 0.003). StO(2)% negatively correlated with post-operative serum ALT values (r = −0.602), while ΔStO(2)% positively correlated with ALP (r = 0.594). TWI significantly correlated with post-operative reintervention and OHI with post-operative sepsis and liver failure. In conclusion, the HSI imaging system is accurate and precise in translating from pre-clinical to human studies in this first clinical trial. HSI indices are related to serum and outcome metrics. Further experimental and clinical studies are necessary to determine clinical value of this technology.