4 March 2016 Fluorescence-based enhanced reality (FLER) for real-time estimation of bowel perfusion in minimally invasive surgery
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Abstract
Pre-anastomotic bowel perfusion is a key factor for a successful healing process. Clinical judgment has limited accuracy to evaluate intestinal microperfusion. Fluorescence videography is a promising tool for image-guided intraoperative assessment of the bowel perfusion at the future anastomotic site in the setting of minimally invasive procedures. The standard configuration for fluorescence videography includes a Near-Infrared endoscope able to detect the signal emitted by a fluorescent dye, more frequently Indocyanine Green (ICG), which is administered by intravenous injection. Fluorescence intensity is proportional to the amount of fluorescent dye diffusing in the tissue and consequently is a surrogate marker of tissue perfusion. However, fluorescence intensity alone remains a subjective approach and an integrated computer-based analysis of the over-time evolution of the fluorescence signal is required to obtain quantitative data. We have developed a solution integrating computer-based analysis for intra-operative evaluation of the optimal resection site, based on the bowel perfusion as determined by the dynamic fluorescence intensity. The software can generate a "virtual perfusion cartography", based on the “fluorescence time-to-peak”. The virtual perfusion cartography can be overlapped onto real-time laparoscopic images to obtain the Enhanced Reality effect. We have defined this approach FLuorescence-based Enhanced Reality (FLER). This manuscript describes the stepwise development of the FLER concept.
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Michele Diana, "Fluorescence-based enhanced reality (FLER) for real-time estimation of bowel perfusion in minimally invasive surgery", Proc. SPIE 9696, Molecular-Guided Surgery: Molecules, Devices, and Applications II, 96960P (4 March 2016); doi: 10.1117/12.2224852; https://doi.org/10.1117/12.2224852
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