Enhanced-Reality Video Fluorescence A Real-Time Assessment of Intestinal Viability
Enhanced-Reality Video Fluorescence A Real-Time Assessment of Intestinal Viability
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DOI：
10.1097/sla.0b013e31828d4ab3
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发表时间：
2014-04-01
影响因子：
9
通讯作者：
Marescaux, Jacques
中科院分区：
文献类型：
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作者：
Diana, Michele;Noll, Eric;Marescaux, Jacques
目的：我们的目的是评估基于荧光的增强现实系统在腹腔镜肠系膜缺血模型中评估肠道活力。材料与方法：6头猪暴露小肠袢，夹断3 ~ 4条肠系膜血管。15分钟后静脉注射吲哚菁绿（ICG）。用非相干光源腹腔镜（D-light-P, KarlStorz）照射肠道。使用Ad Hoc成像软件（VR-RENDER）对ICG荧光信号进行分析，该软件提供了叠加到术中腹腔镜图像的数字灌注制图[增强现实（AR）合成]。在AR引导下标记出五个感兴趣区域（roi）（分别对应缺血区、边缘区和血管化区，分别为1,2a -2b、3a-3b）。1小时后，在确定的roi处穿刺肠浆膜获得毛细血管血液样本，并使用EDGE分析仪测量乳酸盐。每个肠道ROI的手术活检进行线粒体呼吸率评估和代谢物量化。结果：平均毛细血管乳酸水平分别为3.98 （SD = 1.91）、1.05 （SD = 0.46）、0.74 (SD = 0.34) mmol/L、2a-2b （P = 0.0001）和3a-3b （P = 0.0001）。ROI 1的平均最大线粒体呼吸速率分别为104.4 (21.58)pmolO(2)/秒/mg、191.1 +/- 14.48 （2b, P = 0.03）、180.4 +/- 16.71 （3a, P = 0.02）和199.2 +/- 25.21 （3b, P = 0.02）。丙氨酸、胆碱、乙醇胺、葡萄糖、乳酸、肌醇、磷胆碱、sylloinsitol和缬氨酸在缺血和非缺血节段间的浓度差异有统计学意义。结论：在本实验模型中，荧光AR可有效检测缺血区和血管化区之间的边界。
Objective: Our aim was to evaluate a fluorescence-based enhanced-reality system to assess intestinal viability in a laparoscopic mesenteric ischemia model.Materials and Methods: A small bowel loop was exposed, and 3 to 4 mesenteric vessels were clipped in 6 pigs. Indocyanine green (ICG) was administered intravenously 15 minutes later. The bowel was illuminated with an incoherent light source laparoscope (D-light-P, KarlStorz). The ICG fluorescence signal was analyzed with Ad Hoc imaging software (VR-RENDER), which provides a digital perfusion cartography that was superimposed to the intraoperative laparoscopic image [augmented reality (AR) synthesis]. Five regions of interest (ROIs) were marked under AR guidance (1, 2a-2b, 3a-3b corresponding to the ischemic, marginal, and vascularized zones, respectively). One hour later, capillary blood samples were obtained by puncturing the bowel serosa at the identified ROIs and lactates were measured using the EDGE analyzer. A surgical biopsy of each intestinal ROI was sent for mitochondrial respiratory rate assessment and for metabolites quantification.Results: Mean capillary lactate levels were 3.98 (SD = 1.91) versus 1.05 (SD = 0.46) versus 0.74 (SD = 0.34) mmol/L at ROI 1 versus 2a-2b (P = 0.0001) versus 3a-3b (P = 0.0001), respectively. Mean maximal mitochondrial respiratory rate was 104.4 (21.58) pmolO(2)/second/mg at the ROI 1 versus 191.1 +/- 14.48 (2b, P = 0.03) versus 180.4 +/- 16.71 (3a, P = 0.02) versus 199.2 +/- 25.21 (3b, P = 0.02). Alanine, choline, ethanolamine, glucose, lactate, myoinositol, phosphocholine, sylloinositol, and valine showed statistically significant different concentrations between ischemic and nonischemic segments.Conclusions: Fluorescence-based AR may effectively detect the boundary between the ischemic and the vascularized zones in this experimental model.