New Intraoperative Imaging Tools and Image-Guided Surgery in Gastric Cancer Surgery.

Sigmar Stelzner,Michele Diana,Luise Knospe,Jacques Marescaux,René Thieme,Claire Chalopin,Yusef Moulla,Stefan Niebisch,Hannes Köhler,Ji-Hyeon Park,Annekatrin Pfahl,Boris Jansen-Winkeln,Ines Gockel,Orestis Lyros,Han-Kwang Yang,Marianne Maktabi

doi:10.3390/diagnostics12020507

Abstract

Innovations and new advancements in intraoperative real-time imaging have gained significant importance in the field of gastric cancer surgery in the recent past. Currently, the most promising procedures include indocyanine green fluorescence imaging (ICG-FI) and hyperspectral imaging or multispectral imaging (HSI, MSI). ICG-FI is utilized in a broad range of clinical applications, e.g., assessment of perfusion or lymphatic drainage, and additional implementations are currently investigated. HSI is still in the experimental phase and its value and clinical relevance require further evaluation, but initial studies have shown a successful application in perfusion assessment, and prospects concerning non-invasive tissue and tumor classification are promising. The application of machine learning and artificial intelligence technologies might enable an automatic evaluation of the acquired image data in the future. Both methods facilitate the accurate visualization of tissue characteristics that are initially indistinguishable for the human eye. By aiding surgeons in optimizing the surgical procedure, image-guided surgery can contribute to the oncologic safety and reduction of complications in gastric cancer surgery and recent advances hold promise for the application of HSI in intraoperative tissue diagnostics.

Highlights

This article is an open access articleFurther to laparoscopic and robotic technologies, innovations and new advancements in intraoperative real-time imaging have gained significant importance in the recent past in the field of gastric cancer surgery
The technique was associated with a significantly lower rate of bleeding events and shorter time required from omentectomy to right gastro-epiploic vein exposure in the ICG group, resulting from enhanced visual contrast between the mesocolon and the mesogastric tissue provided by indocyanine green fluorescence imaging (ICG-FI)
A recent study by Chen et al found the approaches of preoperative submucosal and intraoperative subserosal injection to be comparable [18], but stronger evidence from larger, randomized studies will be needed to decide on an optimal protocol for a standardized ICG-FI procedure

Summary

Introduction

Further to laparoscopic and robotic technologies, innovations and new advancements in intraoperative real-time imaging have gained significant importance in the recent past in the field of gastric cancer surgery. The procedure has shown promising results in securing the completeness of lymph-node dissection, facilitating surgical dissection, and visualizing anastomotic perfusion and might be implemented in further areas of application in the future. Another highly promising technique is hyperspectral (or multispectral) imaging (HSI or MSI), as it does not require the application of a contrast agent and provides further information on the condition and composition of the examined tissue, on top of different perfusion parameters. While comprehensive and convincing data (prospective-randomized studies and meta-analyses) on the reduction of anastomotic complications with the application of indocyanine green fluorescence imaging (ICG-FI) have been published [2,3,4], there is a paucity of results of comparable studies on gastric cancer surgery. The number of patients and rate of anastomotic insufficiency reported for the described study was relatively low (4/100 patients) and the clinical relevance of the parameter “time difference” (TD) needs to be re-evaluated in a larger cohort of patients

Perfusion assessmentby byICG-FI

Intraoperative

Detection of Micrometastases in the Liver and Peritoneal Carcinomatosis

Findings

Hyperspectral Imaging in Gastric Cancer