Comparison of hyperspectral imaging and fluorescence angiography for the determination of the transection margin in colo
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ORIGINAL ARTICLE
Comparison of hyperspectral imaging and fluorescence angiography for the determination of the transection margin in colorectal resections—a comparative study Boris Jansen-Winkeln 1 & Isabell Germann 1 & Hannes Köhler 2 & Matthias Mehdorn 1 & Marianne Maktabi 2 & Robert Sucher 1 & Manuel Barberio 1 & Claire Chalopin 2 & Michele Diana 3 & Yusef Moulla 1 & Ines Gockel 1 Accepted: 17 September 2020 # The Author(s) 2020
Abstract Purpose One relevant aspect for anastomotic leakage in colorectal surgery is blood perfusion of both ends of the anastomosis. The clinical evaluation of this issue is limited, but new methods like fluorescence angiography with indocyanine green or noninvasive and contactless hyperspectral imaging have evolved as objective parameters for perfusion evaluation. Methods In this prospective, non-randomized, open-label and two-arm study, fluorescence angiography and hyperspectral imaging were compared in 32 consecutive patients with each other and with the clinical assessment by the surgeon. After preparation of the bowel and determination of the surgical resection line, the tissue was evaluated with hyperspectral imaging for 5 min before and after cutting the marginal artery and assessed by 6 hyperspectral pictures followed by fluorescence angiography with indocyanine green. Results In 30 of 32 patients, the image data could be evaluated and compared. Both methods provided a comparable borderline between well-perfused and poorly perfused tissue (p = 0.704). In 15 cases, the surgical resection line was shifted to the central position due to the imaging. The border zone was sharper in fluorescence angiography and best assessed 31 s after injection. With hyperspectral imaging, the border zone was visualized wider and with more differences between proximal and distal border. Conclusion Hyperspectral imaging and fluorescence angiography provide similar results in determining the perfusion border. Both methods allow a good and safe visualization of the blood perfusion at the central resection margin to create a well-perfused anastomosis. Trial registration This study was registered at Clinicaltrials.gov (NCT04226781) on January 13, 2020. Keywords Hyperspectral imaging (HSI) . Fluorescence angiography (FA) . Indocyanine green (ICG) . Anastomotic leak . Colorectal resection
Introduction Boris Jansen-Winkeln and Isabell Germann contributed equally as first author * Boris Jansen-Winkeln [email protected] 1
Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
2
Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
3
Institute of Image-Guided Surgery (IHU), IRCAD, Strasbourg, France
Anastomotic leakage represents a serious complication after colorectal resections associated with reported rates ranging from 7 to 19.2 % [1–3]. The reasons are multifactorial, and surgeons are not able to influence all of them, for example, patient-related factors
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