This study was to evaluate the feasibility of near infrared (NIR) fluorescent images as a tool for evaluating the perfusion of the gastric tube after esophagectomy. In addition, we investigated the time required to acquire enough signal to confirm the presence of ischemia in gastric tube after injection of indocyanine green (ICG) through peripheral versus and central venous route.
4 porcine underwent esophagogastrostomy and their right gastric arteries were ligated to mimic ischemic condition of gastric tube. ICG (0.6mg/kg) was intravenously injected and the fluorescence signal-to-background ratios (SBR) were measured by using the custom-built intraoperative color and fluorescence imaging system (ICFIS). We evaluated perfusion of gastric tubes by comparing their SBR with esophageal SBR.
In ischemic models, SBR of esophagus was higher than that of gastric tube (2.8±0.54 vs. 1.7±0.37, p<0.05). It showed high esophagus-stomach signal to signal ratio. (SSR, 1.8±0.76). We also could observe recovery of blood perfusion in few minutes after releasing the ligation of right gastric artery. In addition, in comparison study according to the injection route of ICG, The time to acquire signal stabilization was faster in central than in peripheral route (119 ± 65.1 seconds in central route vs. 295±130.4 in peripheral route, p<0.05).
NIR fluorescent images could provide the real-time information if there was ischemia or not in gastric tube during operation. And, central injection of ICG might give that information faster than peripheral route.
Minji Kim, Yuhua Quan, Kook Nam Han, Byeong Hyun Choi, Yeonho Choi, Hyun Koo Kim, and Beop-Min Kim, "NIR fluorescent image-based evaluation of gastric tube perfusion after esophagectomy in preclinical model (Conference Presentation)," Proc. SPIE 9698, Advanced Biomedical and Clinical Diagnostic and Surgical Guidance Systems XIV, 96980C (Presented at SPIE BiOS: February 14, 2016; Published: 27 April 2016); https://doi.org/10.1117/12.2214064.4828055428001.
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