Skip to main content

Advertisement

SpringerLink
Log in

HYPerspectral Enhanced Reality (HYPER): a physiology-based surgical guidance tool

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

HSI is an optical technology allowing for a real-time, contrast-free snapshot of physiological tissue properties, including oxygenation. Hyperspectral imaging (HSI) has the potential to quantify the gastrointestinal perfusion intraoperatively. This experimental study evaluates the accuracy of HSI, in order to quantify bowel perfusion, and to obtain a superposition of the hyperspectral information onto real-time images.

Methods

In 6 pigs, 4 ischemic bowel loops were created (A, B, C, D) and imaged at set time points (from 5 to 360 min). A commercially available HSI system provided pseudo-color maps of the perfusion status (StO2, Near-InfraRed perfusion) and the tissue water index. An ad hoc software was developed to superimpose HSI information onto the live video, creating the HYPerspectral-based Enhanced Reality (HYPER). Seven regions of interest (ROIs) were identified in each bowel loop according to StO2 ranges, i.e., vascular (VASC proximal and distal), marginal vascular (MV proximal and distal), marginal ischemic (MI proximal and distal), and ischemic (ISCH). Local capillary lactates (LCL), reactive oxygen species (ROS), and histopathology were measured at the ROIs. A machine-learning-based prediction algorithm of LCL, based on the HSI-StO2%, was trained in the 6 pigs and tested on 5 additional animals.

Results

HSI parameters (StO2 and NIR) were congruent with LCL levels, ROS production, and histopathology damage scores at the ROIs discriminated by HYPER. The global mean error of LCL prediction was 1.18 ± 1.35 mmol/L. For StO2 values > 30%, the mean error was 0.3 ± 0.33.

Conclusions

HYPER imaging could precisely quantify the overtime perfusion changes in this bowel ischemia model.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Campbell C, Reames MK, Robinson M, Symanowski J, Salo JC (2015) Conduit vascular evaluation is associated with reduction in anastomotic leak after esophagectomy. J Gastrointest Surg 19:806–812

    Article  Google Scholar 

  2. Karliczek A, Benaron DA, Baas PC, Zeebregts CJ, Wiggers T, van Dam GM (2010) Intraoperative assessment of microperfusion with visible light spectroscopy for prediction of anastomotic leakage in colorectal anastomoses. Colorectal Dis 12:1018–1025

    Article  CAS  Google Scholar 

  3. Urbanavicius L, Pattyn P, de Putte DV, Venskutonis D (2011) How to assess intestinal viability during surgery: a review of techniques. World J Gastrointest Surg 3:59–69

    Article  Google Scholar 

  4. Karliczek A, Harlaar NJ, Zeebregts CJ, Wiggers T, Baas PC, van Dam GM (2009) Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis 24:569–576

    Article  CAS  Google Scholar 

  5. Baiocchi GL, Diana M, Boni L (2018) Indocyanine green-based fluorescence imaging in visceral and hepatobiliary and pancreatic surgery: state of the art and future directions. World J Gastroenterol 24:2921–2930

    Article  Google Scholar 

  6. Diana M (2017) Enabling precision digestive surgery with fluorescence imaging. Transl Gastroenterol Hepatol 2:97

    Article  Google Scholar 

  7. Diana M (2017) Fluorescence-guided surgery applied to the digestive system: the cybernetic eye to see the invisible. Cir Esp. https://doi.org/10.1016/j.ciresp.2017.07.006

    Article  Google Scholar 

  8. Kudszus S, Roesel C, Schachtrupp A, Hoer JJ (2010) Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbecks Arch Surg 395:1025–1030

    Article  Google Scholar 

  9. Matsui A, Winer JH, Laurence RG, Frangioni JV (2011) Predicting the survival of experimental ischaemic small bowel using intraoperative near-infrared fluorescence angiography. Br J Surg 98:1725–1734

    Article  CAS  Google Scholar 

  10. Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, Lee SW, Senagore AJ, Phelan MJ, Stamos MJ (2015) Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 220(82–92):e81

    Google Scholar 

  11. Ris F, Liot E, Buchs NC, Kraus R, Ismael G, Belfontali V, Douissard J, Cunningham C, Lindsey I, Guy R, Jones O, George B, Morel P, Mortensen NJ, Hompes R, Cahill RA, Near-Infrared Anastomotic Perfusion Assessment Network V (2018) Multicentre phase II trial of near-infrared imaging in elective colorectal surgery. Br J Surg 105:1359–1367

    Article  CAS  Google Scholar 

  12. Blanco-Colino R, Espin-Basany E (2018) Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol 22:15–23

    Article  CAS  Google Scholar 

  13. Karampinis I, Keese M, Jakob J, Stasiunaitis V, Gerken A, Attenberger U, Post S, Kienle P, Nowak K (2018) Indocyanine green tissue angiography can reduce extended bowel resections in acute mesenteric ischemia. J Gastrointest Surg 22:2117–2124

    Article  Google Scholar 

  14. van den Bos J, Al-Taher M, Schols RM, van Kuijk S, Bouvy ND, Stassen LPS (2018) Near-infrared fluorescence imaging for real-time intraoperative guidance in anastomotic colorectal surgery: a systematic review of literature. J Laparoendosc Adv Surg Tech A 28:157–167

    Article  Google Scholar 

  15. Vallance A, Wexner S, Berho M, Cahill R, Coleman M, Haboubi N, Heald RJ, Kennedy RH, Moran B, Mortensen N, Motson RW, Novell R, O’Connell PR, Ris F, Rockall T, Senapati A, Windsor A, Jayne DG (2017) A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery. Colorectal Dis 19:O1–O12

    Article  CAS  Google Scholar 

  16. Diana M, Agnus V, Halvax P, Liu YY, Dallemagne B, Schlagowski AI, Geny B, Diemunsch P, Lindner V, Marescaux J (2015) Intraoperative fluorescence-based enhanced reality laparoscopic real-time imaging to assess bowel perfusion at the anastomotic site in an experimental model. Br J Surg 102:e169–e176

    Article  CAS  Google Scholar 

  17. Diana M, Noll E, Diemunsch P, Dallemagne B, Benahmed MA, Agnus V, Soler L, Barry B, Namer IJ, Demartines N, Charles AL, Geny B, Marescaux J (2014) Enhanced-reality video fluorescence: a real-time assessment of intestinal viability. Ann Surg 259:700–707

    Article  Google Scholar 

  18. Wada T, Kawada K, Takahashi R, Yoshitomi M, Hida K, Hasegawa S, Sakai Y (2017) ICG fluorescence imaging for quantitative evaluation of colonic perfusion in laparoscopic colorectal surgery. Surg Endosc 31:4184–4193

    Article  Google Scholar 

  19. Lu G, Fei B (2014) Medical hyperspectral imaging: a review. J Biomed Opt 19:10901

    Article  Google Scholar 

  20. Akbari H, Kosugi Y, Kojima K, Tanaka N (2010) Detection and analysis of the intestinal ischemia using visible and invisible hyperspectral imaging. IEEE Trans Biomed Eng 57:2011–2017

    Article  Google Scholar 

  21. Holmer A, Marotz J, Wahl P, Dau M, Kammerer PW (2018) Hyperspectral imaging in perfusion and wound diagnostics—methods and algorithms for the determination of tissue parameters. Biomed Tech 63:547–556

    Article  Google Scholar 

  22. Kilkenny C, Browne W, Cuthill IC, Emerson M, Altman DG, Group NCRRGW (2010) Animal research: reporting in vivo experiments: the ARRIVE guidelines. J Gene Med 12:561–563

    Article  Google Scholar 

  23. Noll E, Diana M, Charles AL, Singh F, Gan TJ, Pottecher J, Moussallieh FM, Namer IJ, Geny B, Diemunsch P (2017) Comparative analysis of resuscitation using human serum albumin and crystalloids or 130/0.4 hydroxyethyl starch and crystalloids on skeletal muscle metabolic profile during experimental haemorrhagic shock in swine: a randomised experimental study. Eur J Anaesthesiol 34:89–97

    Article  CAS  Google Scholar 

  24. Chiu CJ, McArdle AH, Brown R, Scott HJ, Gurd FN (1970) Intestinal mucosal lesion in low-flow states. I. A morphological, hemodynamic, and metabolic reappraisal. Arch Surg 101:478–483

    Article  CAS  Google Scholar 

  25. Diana M, Noll E, Charles AL, Diemunsch P, Geny B, Liu YY, Marchegiani F, Schiraldi L, Agnus V, Lindner V, Swanstrom L, Dallemagne B, Marescaux J (2017) Precision real-time evaluation of bowel perfusion: accuracy of confocal endomicroscopy assessment of stoma in a controlled hemorrhagic shock model. Surg Endosc 31:680–691

    Article  Google Scholar 

  26. Diana M, Noll E, Diemunsch P, Moussallieh FM, Namer IJ, Charles AL, Lindner V, Agnus V, Geny B, Marescaux J (2015) Metabolism-guided bowel resection: potential role and accuracy of instant capillary lactates to identify the optimal resection site. Surg Innov 22:453–461

    Article  Google Scholar 

  27. Diana M, Noll E, Agnus V, Liu YY, Kong SH, Legner A, Diemunsch P, Marescaux J (2017) Reply to letter: “Enhanced reality fluorescence videography to assess bowel perfusion: the cybernetic eye”. Ann Surg 265:e49–e52

    Article  Google Scholar 

  28. Diana M, Dallemagne B, Chung H, Nagao Y, Halvax P, Agnus V, Soler L, Lindner V, Demartines N, Diemunsch P, Geny B, Swanstrom L, Marescaux J (2014) Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia. Surg Endosc 28:3224–3233

    Article  Google Scholar 

  29. Quero G, Lapergola A, Barberio M, Seeliger B, Saccomandi P, Guerriero L, Mutter D, Saadi A, Worreth M, Marescaux J, Agnus V, Diana M (2018) Discrimination between arterial and venous bowel ischemia by computer-assisted analysis of the fluorescent signal. Surg Endosc 33:1988–1997

    Article  Google Scholar 

  30. Zuzak KJ, Naik SC, Alexandrakis G, Hawkins D, Behbehani K, Livingston E (2008) Intraoperative bile duct visualization using near-infrared hyperspectral video imaging. Am J Surg 195:491–497

    Article  Google Scholar 

  31. Kohler H, Jansen-Winkeln B, Maktabi M, Barberio M, Takoh J, Holfert N, Moulla Y, Niebisch S, Diana M, Neumuth T, Rabe SM, Chalopin C, Melzer A, Gockel I (2019) Evaluation of hyperspectral imaging (HSI) for the measurement of ischemic conditioning effects of the gastric conduit during esophagectomy. Surg Endosc. https://doi.org/10.1007/s00464-019-06675-4

    Article  Google Scholar 

  32. Jansen-Winkeln B, Maktabi M, Takoh JP, Rabe SM, Barberio M, Kohler H, Neumuth T, Melzer A, Chalopin C, Gockel I (2018) Hyperspectral imaging of gastrointestinal anastomoses. Chirurg 89:717–725

    Article  CAS  Google Scholar 

Download references

Acknowledgements

Authors are grateful to Guy Temporal and Camille Goustiaux, professionals in medical English proofreading, for their valuable help with revising the manuscript.

Funding

This work was funded by the ARC Foundation through the ELIOS (Endoscopic Luminescent Imaging for precision Oncologic Surgery) Grant.

Author information

Authors and Affiliations

  1. IHU Strasbourg, Institute of Image-Guided Surgery, 1 Place de l’Hôpital, 67091, Strasbourg, France

    Manuel Barberio, Fabio Longo, Claudio Fiorillo, Barbara Seeliger, Pietro Mascagni, Vincent Agnus, Jacques Marescaux & Michele Diana

  2. IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France

    Jacques Marescaux & Michele Diana

  3. Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France

    Michele Diana

  4. Department of Pathology, University Hospital of Strasbourg, Strasbourg, France

    Veronique Lindner

  5. EA 3072, Fédération de Médecine Translationnelle de Strasbourg, Medical University of Strasbourg, Strasbourg, France

    Manuel Barberio, Barbara Seeliger, Bernard Geny, Anne-Laure Charles & Michele Diana

  6. Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany

    Manuel Barberio & Ines Gockel

  7. Department of Surgery, Pourtalès Neuchâtel Hospital, Neuchâtel, Switzerland

    Marc Worreth, Alend Saadi & Michele Diana

Authors
  1. Manuel Barberio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabio Longo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claudio Fiorillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barbara Seeliger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pietro Mascagni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vincent Agnus
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Veronique Lindner
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bernard Geny
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Anne-Laure Charles
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ines Gockel
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Marc Worreth
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Alend Saadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jacques Marescaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Michele Diana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michele Diana.

Ethics declarations

Disclosures

Jacques Marescaux is the President of both IRCAD and IHU Strasbourg Institutes, which are partly funded by KARL STORZ, Siemens, and Medtronic. Michele Diana is the recipient of the ELIOS grant. Manuel Barberio, Fabio Longo, Claudio Fiorillo, Barbara Seeliger, Pietro Mascagni, Vincent Agnus, Veronique Lindner, Bernard Geny, Anne-Laure Charles, Ines Gockel, Marc Worreth, and Alend Saadi have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 22 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barberio, M., Longo, F., Fiorillo, C. et al. HYPerspectral Enhanced Reality (HYPER): a physiology-based surgical guidance tool. Surg Endosc 34, 1736–1744 (2020). https://doi.org/10.1007/s00464-019-06959-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-06959-9

Keywords

Search

Navigation