Hyperspectral Imaging (HSI)-A New Tool to Estimate the Perfusion of Upper Abdominal Organs during Pancreatoduodenectomy

Abstract

Hyperspectral imaging (HSI) in abdominal surgery is a new non-invasive tool for the assessment of the perfusion and oxygenation of various tissues and organs. Its benefit in pancreatic surgery is still unknown. The aim of this study was to evaluate the key impact of using HSI during pancreatoduodenectomy (PD). In total, 20 consecutive patients were included. HSI was recorded during surgery as part of a pilot study approved by the local Ethics Committee. Data were collected prospectively with the TIVITA^® Tissue System. Intraoperative HS images were recorded before and after gastroduodenal artery (GDA) clamping. We detected four patients with celiac artery stenosis (CAS) caused by a median arcuate ligament (MAL). In two of these patients, a reduction in liver oxygenation (StO₂) was discovered 15 and 30 min after GDA clamping. The MAL was divided in these patients. HSI showed an improvement of liver StO₂ after MAL division (from 61% to 73%) in one of these two patients. There was no obvious decrease in liver StO₂ in the other two patients with CAS. HSI, as a non-invasive procedure, could be helpful in evaluating liver and gastric perfusion during PD, which might assist surgeons in choosing the best surgical approach and in improving patients' outcomes.

Keywords: celiac artery stenosis (CAS); hyperspectral imaging (HSI); pancreatoduodenectomy (PD).

Figure 1

TIVITA^® device and HSI camera in the operative setting. Right: The chemical color imaging procedure is calculated with the attached computer. Bottom-left: operative site

Figure 2

Celiac stenosis in four patients based on preoperative CT images. Arrows show the site of CAS (celiac artery stenosis); CA: celiac artery; SMA: superior mesenteric artery.

Figure 3

Course of postoperative PT-values; PT: prothrombin time; preop.: preoperative; postop.: postoperative (2 hours after the operation); POD: postoperative day.

Figure 4

Course of postoperative bilirubin and Alanin Aminotransferase (ALT) values. Entries are means; preop.: preoperative; postop.: postoperative (2 hours after the operation); POD: postoperative day.

Figure 5

Distribution of tissue oxygenation (StO₂ in %) and hemoglobin content (OHI) (0–100) in all patients before and after the GDA-clamping test.

Figure 6

Distribution of lactate values after 30 min and changes of liver oxygenation after GDA clamping (Delta StO₂ = StO_{2 [30 min after clamping]} − StO_{2 [before clamping]}).

Figure 7

Course of liver oxyegnation (StO₂ in %) and liver hemoglobin content (OHI) (0–100) in the patient with CAS Type B before and after GDA clamping related to MAL dissection. t0: before GDA clamping; t1: directly after GDA clamping; t2: 15 min after GDA clamping; t3: directly after GDA re-opening; t4: directly after MAL dissection; t5: directly after GDA re-clamping; t6: 15 min after GDA re-clamping; t7: 30 min after GDA re-clamping. Gray areas show the time after MAL dissection (t4, t5, t6, t7). GDA: gastroduodenal artery; MAL: median arcuate ligament

Figure 7

Course of liver oxyegnation (StO₂ in %) and liver hemoglobin content (OHI) (0–100) in the patient with CAS Type B before and after GDA clamping related to MAL dissection. t0: before GDA clamping; t1: directly after GDA clamping; t2: 15 min after GDA clamping; t3: directly after GDA re-opening; t4: directly after MAL dissection; t5: directly after GDA re-clamping; t6: 15 min after GDA re-clamping; t7: 30 min after GDA re-clamping. Gray areas show the time after MAL dissection (t4, t5, t6, t7). GDA: gastroduodenal artery; MAL: median arcuate ligament

Figure 8

Color images (left) and color-coded images of the tissue oxygenation in % (right) of the liver from patient 3 with CAS Type B. t0: before GDA clamping, t2: 15 min after GDA clamping, t4: directly after MAL dissection, t5: directly after MAL dissection and GDA re-clamping.