Abstract
.Significance: Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has proven to be a feasible application for real-time intraoperative assessment of tissue perfusion, although quantification of NIR fluorescence signals is pivotal for standardized assessment of tissue perfusion.Aim: Four patients are described with possible compromised bowel perfusion after mesenteric resection. Based on these patients we want to emphasize the difficulties in the quantification of NIR fluorescence imaging for perfusion analysis.Approach: During image-guided fluorescence assessment, 5 mg of ICG () was intravenously administered by the anesthesiologist. NIR fluorescence imaging was done with the open camera system of Quest Medical Imaging. Fluorescence data taken from the regions of interest (bowel at risk, transition zone of bowel at risk and adjacent normally perfused bowel, and normally perfused reference bowel) were quantitatively analyzed after surgery for fluorescence intensity-and perfusion time-related parameters.Results: Bowel perfusion, as assessed clinically by independent surgeons based on NIR fluorescence imaging, resulted in different treatment strategies, three with excellent clinical outcome, but one with a perfusion related complication. Post-surgery quantitative analysis of fluorescence dynamics showed different patterns in the affected bowel segment compared to the unaffected reference segments for the four patients.Conclusions: Similar intraoperative fluorescence results could lead to different surgical treatment strategies, which demonstrated the difficulties in interpretation of uncorrected fluorescence signals. Real-time quantification and standardization of NIR fluorescence perfusion imaging could probably aid surgeons in the nearby future.
Highlights
Extensive oncological abdominal surgery occasionally includes removal of part of the mesentery containing blood vessels supplying the associated bowel
Similar intraoperative fluorescence results could lead to different surgical treatment strategies, which demonstrated the difficulties in interpretation of uncorrected fluorescence signals
Because mesenteric resection can result in compromised bowel perfusion leading to necrosis, it is commonly combined with bowel resection and subsequent anastomosis formation
Summary
Extensive oncological abdominal surgery occasionally includes removal of part of the mesentery containing blood vessels supplying the associated bowel. Because mesenteric resection can result in compromised bowel perfusion leading to necrosis, it is commonly combined with bowel resection and subsequent anastomosis formation. Accounts for considerable morbidity and mortality.[1,2,3] Indirect perfusion of adjacent bowel segments with intact mesenterial blood supply could be sufficient to avoid bowel resection and subsequent anastomosis after partial mesenteric resection. Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has proven to be a feasible and reproducible application for real-time intraoperative quantification of tissue perfusion.[4,5,6] Surgical procedures in which part of the mesentery is resected can benefit from NIR fluorescence imaging with ICG. This report aims to demonstrate the current shortcomings in intraoperative quantification of NIR fluorescence imaging for bowel perfusion assessment after mesenterial disruption without a planned bowel resection
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