Hyperspectral Evaluation of the Human Liver During Major Resection

Elisabeth Sucher; Robert Sucher; Hanna Guice; Stefan Schneeberger; Gerald Brandacher; Ines Gockel; Thomas Berg; Daniel Seehofer

doi:10.1097/AS9.0000000000000169

Hyperspectral Evaluation of the Human Liver During Major Resection

Ann Surg Open. 2022 May 19;3(2):e169. doi: 10.1097/AS9.0000000000000169. eCollection 2022 Jun.

Authors

Elisabeth Sucher¹, Robert Sucher², Hanna Guice², Stefan Schneeberger³, Gerald Brandacher⁴, Ines Gockel², Thomas Berg¹, Daniel Seehofer²

Affiliations

¹ From the Department of Oncology, Gastroenterology, Hepatology, Infectiology, and Pneumology, University Clinic Leipzig, Leipzig, Germany.
² Division of Hepatobiliary Surgery and Visceral Transplant Surgery, Department of Visceral, Transplant-, Thoracic- and Vascular Surgery, University Clinic Leipzig, Leipzig, Germany.
³ Department of Visceral-, Transplant- and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
⁴ Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD.

Abstract

Objective: This study investigates the effects of PVE and vascular inflow control (VIC) on liver microperfusion and tissue oxygenation using hyperspectral imaging (HSI) technology.

Background: Mechanisms triggering future liver remnant (FLR) augmentation introduced by PVE have not been sufficiently studied in humans. Particularly, the arterial buffer response (ABR) of the liver might play a vital role.

Methods: Hyperspectral datacubes (TIVITA) acquired during 58 major liver resections were qualitatively and quantitatively analyzed for tissue oxygenation (StO₂%), near-infrared (NIR) perfusion, organ-hemoglobin indices (OHI), and tissue-water indices (TWI). The primary study endpoint was measurement of hyperspectral differences in liver parenchyma subject to PVE and VIC before resection.

Results: HSI revealed parenchyma specific differences in StO₂% with regard to the underlying disease (P < 0.001). Preoperative PVE (n = 23, 40%) lead to arterial hyperoxygenation and hyperperfusion of corresponding liver segments (StO₂: 77.23% ± 11.93%, NIR: 0.46 ± 0.20[I]) when compared with the FLR (StO₂: 66.13% ± 9.96%, NIR: 0.23 ± 0.12[I]; P < 0.001). In a case of insufficient PVE and the absence of FLR augmentation hyperspectral StO₂ and NIR differences were absent. The hyperspectral assessment demonstrated increased liver tissue-oxygenation and perfusion in PVE-segments (n = 23 cases) and decreased total VIC in nonembolized FLR hemilivers (n = 35 cases; P < 0.001). Intraoperative HSI analysis of tumor tissue revealed marked tumor specific differences in StO₂, NIR, OHI, and TWI (P < 0.001).

Conclusions: HSI allows intraoperative quantitative and qualitative assessment of microperfusion and StO₂% of liver tissue. PVE lead to ABR-triggered tissue hyperoxygenation and cross-talk FLR augmentation. HSI furthermore facilitates intraoperative tumor tissue identification and enables image-guided liver surgery following VIC.

Keywords: arterial buffer response; hyperspectral imaging; liver resection; portal vein embolization.