Quantification of fluorescence angiography: Toward a reliable intraoperative assessment of tissue perfusion - A narrativ
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REVIEW ARTICLE
Quantification of fluorescence angiography: Toward a reliable intraoperative assessment of tissue perfusion - A narrative review Christian Dam Lütken 1,2
&
Michael P. Achiam 1 & Jens Osterkamp 1 & Morten B. Svendsen 3 & Nikolaj Nerup 1
Received: 6 August 2020 / Accepted: 9 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Accurate intraoperative assessments of tissue perfusion are essential in all forms of surgery. As traditional methods of perfusion assessments are not available during minimally invasive surgery, novel methods are required. Here, fluorescence angiography with indocyanine green has shown promising results. However, to secure objective and reproducible assessments, quantification of the fluorescent signal is essential (Q-ICG). This narrative review aims to provide an overview of the current status and applicability of Q-ICG for intraoperative perfusion assessment. Results Both commercial and custom Q-ICG software solutions are available for intraoperative use; however, most studies on QICG have performed post-operative analyses. Q-ICG can be divided into inflow parameters (ttp, t0, slope, and T1/2max) and intensity parameters (Fmax, PI, and DR). The intensity parameters appear unreliable in clinical settings. In comparison, inflow parameters, mainly slope, and T1/2max have had superior clinical performance. Conclusion Intraoperative Q-ICG is clinically available; however, only feasibility studies have been performed, rendering an excellent usability score. Q-ICG in a post-operative setting could detect changes in perfusion following a range of interventions and reflect clinical endpoints, but only if based on inflow parameters. Thus, future studies should include the methodology outlined in this review, emphasizing the use of inflow parameters (slope or T1/2max), a mass-adjusted ICG dosing, and a fixed camera position. Keywords Quantitative fluorescence angiography . Optimization . Indocyanine green . Intraoperative . Perfusion assessment
Background Visceral tissue viability is mainly dependent on adequate tissue perfusion [1–3], and compromised tissue perfusion during surgery is a significant risk factor for complications such as anastomotic leakage (AL) [4–7]. AL is a severe surgical complication associated with significantly increased health expenses, increased length of hospitalization, increased risk of recurrence * Christian Dam Lütken [email protected] 1
Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Copenhagen Ø, Denmark
2
Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N,, Denmark
3
Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
after oncological resection, and reduced survival [8–11]. Thus, securing adequate perfusion during gastrointestinal surgery is essential. Perfusion assessment has historicall
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