Intraoperative Laparoscopic Hyperspectral Imaging during Esophagectomy-A Pilot Study Evaluating Esophagogastric Perfusion at the Anastomotic Sites

Annalena Ilgen; Hannes Köhler; Annekatrin Pfahl; Sigmar Stelzner; Matthias Mehdorn; Boris Jansen-Winkeln; Ines Gockel; Yusef Moulla

doi:10.3390/bioengineering11010069

Intraoperative Laparoscopic Hyperspectral Imaging during Esophagectomy-A Pilot Study Evaluating Esophagogastric Perfusion at the Anastomotic Sites

Bioengineering (Basel). 2024 Jan 9;11(1):69. doi: 10.3390/bioengineering11010069.

Authors

Annalena Ilgen¹, Hannes Köhler², Annekatrin Pfahl², Sigmar Stelzner¹, Matthias Mehdorn¹, Boris Jansen-Winkeln³, Ines Gockel¹, Yusef Moulla¹

Affiliations

¹ Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
² Innovation Center Computer Assisted Surgery (ICCAS), Faculty of Medicine, Leipzig University, Semmelweisstr. 14, 04103 Leipzig, Germany.
³ Department of General, Visceral, Thoracic and Vascular Surgery, Klinikum St. Georg, Delitzscher Str. 141, 04129 Leipzig, Germany.

Abstract

Hyperspectral imaging (HSI) is a non-invasive and contactless technique that enables the real-time acquisition of comprehensive information on tissue within the surgical field. In this pilot study, we investigated whether a new HSI system for minimally-invasive surgery, TIVITA^® Mini (HSI-MIS), provides reliable insights into tissue perfusion of the proximal and distal esophagogastric anastomotic sites during 21 laparoscopic/thoracoscopic or robotic Ivor Lewis esophagectomies of patients with cancer to minimize the risk of dreaded anastomotic insufficiency. In this pioneering investigation, physiological tissue parameters were derived from HSI measurements of the proximal site of the anastomosis (esophageal stump) and the distal site of the anastomosis (tip of the gastric conduit) during the thoracic phase of the procedure. Tissue oxygenation (StO₂), Near Infrared Perfusion Index (NIR-PI), and Tissue Water Index (TWI) showed similar median values at both anastomotic sites. Significant differences were observed only for NIR-PI (median: 76.5 vs. 63.9; p = 0.012) at the distal site (gastric conduit) compared to our previous study using an HSI system for open surgery. For all 21 patients, reliable and informative measurements were attainable, confirming the feasibility of HSI-MIS to assess anastomotic viability. Further studies on the added benefit of this new technique aiming to reduce anastomotic insufficiency are warranted.

Keywords: clinical evaluation study; esophagectomy; gastrointestinal surgery; hyperspectral imaging; intraoperative imaging; minimally invasive/robotic surgery.

Grants and funding

The authors acknowledge support from the German Research Foundation (DFG-Deutsche Forschungsgesellschaft) and Leipzig University within the program of Open Access Publishing. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Diaspective Vision GmbH (Am Salzhaff-Pepelow, Germany) provided the equipment for the measurements.