Non-invasive monitoring of tissue oxygenation during laparoscopic donor nephrectomy.
Non-invasive monitoring of tissue oxygenation during laparoscopic donor nephrectomy.
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DOI：
10.1186/1471-2482-8-8
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发表时间：
2008-04-17
期刊：
影响因子：
1.9
通讯作者：
Elster EA
中科院分区：
文献类型：
--
作者：
Crane NJ;Pinto PA;Hale D;Gage FA;Tadaki D;Kirk AD;Levin IW;Elster EA
用于在手术期间评估器官活力的标准方法通常限于开放手术中的视觉提示和触觉反馈。然而，在腹腔镜手术期间，这些过程受损。这在腹腔镜肾脏捐献过程中特别重要，尽管有相当多的操作，但肾脏的状况必须优化。然而，目前还没有在体内的方法来监测肾实质氧合在腹腔镜手术。我们已经开发了一种用于在腹腔镜肾切除术期间对组织氧合进行真实的体内全器官评估的方法，以在腹腔镜手术期间向外科医生传达有意义的生物学数据。我们应用3-CCD（电荷耦合器件）摄像机来定性监测肾实质氧合与潜在的实时视频功能。我们已经在一系列缺氧条件下的猪模型中验证了这种方法，然后在临床相关气腹期间的临床腹腔镜供体肾切除术中应用该方法。3-CCD图像增强产生平均感兴趣区域（ROI）强度值，其可以与血氧饱和度测量直接相关（R2 > 0.96）。在腹腔镜肾切除术开始时获得的计算的平均ROI强度值与在肾切除术之前立即计算的平均ROI强度值没有显著差异（p > 0.05）。在这里，使用3-CCD相机，我们定性监测组织氧合。这种评估术中组织氧合的方法可能是避免腹腔镜手术期间意外缺血性损伤的有用方法。初步结果表明，没有显着的变化，肾氧合发生作为一个结果，气腹。
Standard methods for assessment of organ viability during surgery are typically limited to visual cues and tactile feedback in open surgery. However, during laparoscopic surgery, these processes are impaired. This is of particular relevance during laparoscopic renal donation, where the condition of the kidney must be optimized despite considerable manipulation. However, there is no in vivo methodology to monitor renal parenchymal oxygenation during laparoscopic surgery. We have developed a method for the real time, in vivo, whole organ assessment of tissue oxygenation during laparoscopic nephrectomy to convey meaningful biological data to the surgeon during laparoscopic surgery. We apply the 3-CCD (charge coupled device) camera to monitor qualitatively renal parenchymal oxygenation with potential real-time video capability. We have validated this methodology in a porcine model across a range of hypoxic conditions, and have then applied the method during clinical laparoscopic donor nephrectomies during clinically relevant pneumoperitoneum. 3-CCD image enhancement produces mean region of interest (ROI) intensity values that can be directly correlated with blood oxygen saturation measurements (R2 > 0.96). The calculated mean ROI intensity values obtained at the beginning of the laparoscopic nephrectomy do not differ significantly from mean ROI intensity values calculated immediately before kidney removal (p > 0.05). Here, using the 3-CCD camera, we qualitatively monitor tissue oxygenation. This means of assessing intraoperative tissue oxygenation may be a useful method to avoid unintended ischemic injury during laparoscopic surgery. Preliminary results indicate that no significant changes in renal oxygenation occur as a result of pneumoperitoneum.