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Feasibility and usability of real-time intraoperative quantitative fluorescent-guided perfusion assessment during resection of gastroesophageal junction cancer

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Abstract

Purpose

Anastomotic leakage after resection of gastroesophageal junction cancer is a dangerous complication, and leakage rates have remained stable for decades. Perfusion is crucial for anastomotic healing, but traditional perfusion assessment is limited in a minimally invasive environment. New methods as indocyanine green fluorescence angiography (ICG-FA) have proven promising, but quantitative analysis has been challenging. This study aimed to demonstrate the feasibility and usability of real-time intraoperative quantitative fluorescence angiography (q-ICG) with a touchscreen tablet.

Methods

A software for q-ICG was previously developed and validated. Ten patients underwent perfusion assessment in white light (WL), with ICG-FA, and with q-ICG during Ivor-Lewis esophageal resection. The usability of the tablet-based software was tested with the System Usability Scale (SUS®). Furthermore, we investigated the differences in perfusion assessment as the distance from the conduit margin to a surgeon selected point of sufficient perfusion for anastomosis using the different modalities.

Results

Q-ICG was successful in all patients, with an excellent median SUS® of 82.5 (77.5–93.8). Significant differences in distances from the conduit margin to points of sufficient perfusion selected by the surgeons were found: ICG: WL = 14.1 mm (p = 0.048), q-ICG: WL = 32.08 mm (p < 0.001), and q-ICG: ICG = 17.95 mm (p = 0.002). Furthermore, significant differences of perfusion were found between the points, when q-ICG was performed retrospectively in the surgeon selected areas (p = 0.008–0.013).

Conclusion

Real-time intraoperative touchscreen-based q-ICG was feasible with excellent usability, and differences in sufficient perfusion points selected by the surgeons between modalities were found. Further studies should focus on clinical relevance and determine cutoff values associated with anastomotic leakage.

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Acknowledgments

The authors sincerely thank all participating surgeons, anesthesiologists, nurses, and patients for their valuable effort. The study was sponsored by donations from private foundations, and we are deeply grateful to the Rigshospitalet Research Foundation, King Christian the X Foundation, and Aage and Johanne Louis-Hansen Foundation for their support. Sponsors had no role in study design, interpretation of results, or any other part of the study.

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Authors and Affiliations

  1. Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK- 2100, Copenhagen, Denmark

    Nikolaj Nerup, Lars Bo Svendsen & Michael Patrick Achiam

  2. Copenhagen Academy of Medical Education and Simulation, Copenhagen, Denmark

    Morten Bo Søndergaard Svendsen

Authors
  1. Nikolaj Nerup
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  2. Morten Bo Søndergaard Svendsen
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  3. Lars Bo Svendsen
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  4. Michael Patrick Achiam
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Contributions

Study conception and design: NN, MBSS, LBS, and MA. Acquisition of data: NN. Analysis and interpretation of data: NN, MBSS, LBS, and MA. Drafting of manuscript: NN. Critical revision of manuscript: NN, MBSS, LBS, and MA.

Corresponding author

Correspondence to Nikolaj Nerup.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Danish Committee on Health Research Ethics (ID: H-18006334) and registered at clinicaltrials.gov (ID: NCT03671642) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Nerup, N., Svendsen, M.B.S., Svendsen, L.B. et al. Feasibility and usability of real-time intraoperative quantitative fluorescent-guided perfusion assessment during resection of gastroesophageal junction cancer. Langenbecks Arch Surg 405, 215–222 (2020). https://doi.org/10.1007/s00423-020-01876-1

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  • DOI: https://doi.org/10.1007/s00423-020-01876-1

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