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You are here: Home / Abstracts / Discrimination between arterial and venous bowel ischemia by computer-assisted analysis of the fluorescent signal

Discrimination between arterial and venous bowel ischemia by computer-assisted analysis of the fluorescent signal

Giuseppe Quero, MD1, Alfonso Lapergola, MD2, Vincent Agnus, PhD2, Paola Saccomandi, PhD1, Ludovica Guerriero, MD1, Didier Mutter, MD, PhD, FACS2, Jacques Marescaux, MD, FACS, HonFRCS, HonFJSES2, Michele Diana, MD2. 1IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France, 2IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France

Background: The aim of this experimental study was to evaluate the ability of a software-based analysis of the fluorescence signal to identify the patterns of different forms of bowel ischemia.

Methods: Twelve pigs were included. Through a minimally-invasive approach, the sigmoid was exposed and the inferior mesenteric artery (IMA; group A: n=4) or the vein (IMV; group V: n=4) or both (group A-V: n=4) were clipped using two clips on each vessel, 5 cm apart. The sigmoid was divided in 3 areas: P= proximal to the first clip; C= central, between the two clips; D= distal to the second clip. Indocyanine Green (ICG) was injected intravenously (0.2mg/Kg). The Near-Infrared optimized laparoscope (D-Light P, Karl Storz), was switched to near-infrared mode to capture the fluorescence signal. The time-to-peak (seconds) and the maximum fluorescence intensity were recorded within the first 60 seconds after the injection, using ad hoc software (ER PERFUSION). A normalized fluorescence intensity unit (NFIU: 0-to-1) was attributed, pixel-by-pixel as a ratio of the maximal. The over-time variation of the NFIU was evaluated every 10 minutes during 50 minutes, using the same software. Capillary lactates were sampled after puncturing the sigmoid serosa at the 3 zones.

Results: In the group A, the time-to-peak was significantly shorter (8.9±4.1) at the P area vs. C (25.8±11.8; p=0.005) and D (23.04±16; p=0.03). Similarly, in the group A-V, time-to-peak was shorter at the P side (6.7±2.4) vs. C (17.4±7.52; p=0.02) and D (23±10.46; p=0.02). In the group V, the time-to-peak was significantly shorter at the P (7.6±2.7) vs. D (9.04±3.13; p=0.02). Among the groups, there was no difference of time-to-peak at the P side. At the C, it was longer in the group A (25.8±11.8) when compared to the group V (9.14±3.85; p=0.01) and A-V (17.4±7.32; p=0.02). The evolution of the signal, was significantly different among the groups at the various areas. A clinically relevant finding was that in the group A and AV, the fluorescence intensity in the C area, remains stable after the first 10 minutes (p=0.13 and 0.32 respectively), when compared to the maximal, while it decreases significantly in the group V (p=0.006).

Conclusions: The computer-assisted dynamic analysis of the fluorescence signal enables the discrimination between different bowel ischemia models. A machine-learning approach is ongoing to improve the software and enable the conversion of the identified patterns into real-time images.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87640

Program Number: S054

Presentation Session: Instrumentation / Devices / Technologies Session

Presentation Type: Podium

44

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