• Hannes Köhler, Boris Jansen-Winkeln, Marianne Maktabi, Manuel Barberio, Jonathan Takoh, Nico Holfert, Yusef Moulla, Stefan Niebisch, Michele Diana, Thomas Neumuth, Sebastian M Rabe, Claire Chalopin, Andreas Melzer, and Ines Gockel.
• Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany.
• Surg Endosc. 2019 Nov 1; 33 (11): 3775-3782.

BackgroundHyperspectral imaging (HSI) is a relatively new method used in image-guided and precision surgery, which has shown promising results for characterization of tissues and assessment of physiologic tissue parameters. Previous methods used for analysis of preconditioning concepts in patients and animal models have shown several limitations of application. The aim of this study was to evaluate HSI for the measurement of ischemic conditioning effects during esophagectomy.MethodsIntraoperative hyperspectral images of the gastric tube through the mini-thoracotomy were recorded from n = 22 patients, 14 of whom underwent laparoscopic gastrolysis and ischemic conditioning of the stomach with two-step transthoracic esophagectomy and gastric pull-up with intrathoracic anastomosis after 3-7 days. The tip of the gastric tube (later esophagogastric anastomosis) was measured with HSI. Analysis software provides a RGB image and 4 false color images representing physiologic parameters of the recorded tissue area intraoperatively. These parameters contain tissue oxygenation (StO2), perfusion-(NIR Perfusion Index), organ hemoglobin (OHI), and tissue water index (TWI).ResultsIntraoperative HSI of the gastric conduit was possible in all patients and did not prolong the regular operative procedure due to its quick applicability. In particular, the tissue oxygenation of the gastric conduit was significantly higher in patients who underwent ischemic conditioning ([Formula: see text] = 78%; [Formula: see text] = 66%; p = 0.03).ConclusionsHSI is suitable for contact-free, non-invasive, and intraoperative evaluation of physiological tissue parameters within gastric conduits. Therefore, HSI is a valuable method for evaluating ischemic conditioning effects and may contribute to reduce anastomotic complications. Additional studies are needed to establish normal values and thresholds of the presented parameters for the gastric conduit anastomotic site.

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