Purpose: One relevant aspect for anastomotic leakage in colorectal surgery is blood perfusion of both ends of the anastomosis. The clinical evaluation of this issue is limited, but new methods like fluorescence angiography with indocyanine green or non-invasive and contactless hyperspectral imaging have evolved as objective parameters for perfusion evaluation.
Methods: In this prospective, non-randomized, open-label and two-arm study, fluorescence angiography and hyperspectral imaging were compared in 32 consecutive patients with each other and with the clinical assessment by the surgeon. After preparation of the bowel and determination of the surgical resection line, the tissue was evaluated with hyperspectral imaging for 5 minutes before and after cutting the marginal artery and assessed by 6 hyperspectral pictures followed by fluorescence angiography with indocyanine green.
Results: In 30 of 32 patients the image data could be evaluated and compared. Both methods provided a comparable borderline between well perfused and poorly perfused tissue (p = 0.704). In 15 cases, the surgical resection line was shifted to the central position due to the imaging. The border zone was sharper in fluorescence angiography and was best assessed 31sec after injection. With hyperspectral imaging, the border zone was visualized wider and with more differences between proximal and distal border.
Conclusion: Hyperspectral imaging and fluorencence angiography provide similar results in determining the perfusion border. Both methods allow a good and safe visualization of the blood perfusion at the central resection margin to create a well-perfused anastomosis.:Abbildungsverzeichnis II
Abkürzungsverzeichnis III
1. Einleitung 1
1.1 Anastomoseninsuffizienz 1
1.2 Hyperspektralbildgebung 2
Methodik und technische Daten 2
1.3 Fluoreszenzangiographie mit Indocyaningrün 4
Methodik und technische Daten 4
Anwendungsgebiet 6
1.4 Chirurgische Technik 6
1.5 Studiendesign und intraoperative Bildgebung 7
1.6 Bisherige Ergebnisse 10
2. Publikation 12
3. Zusammenfassung der Arbeit 21
4. Literaturverzeichnis IV
5. Darstellung des eigenen Beitrags VIII
6. Erklärung über die eigenständige Abfassung der Arbeit IX
7. Danksagung X
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:77050 |
| Date | 21 December 2021 |
| Creators | Germann, Isabell |
| Contributors | Universität Leipzig |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | German |
| Detected Language | English |
| Type | info:eu-repo/semantics/updatedVersion, doc-type:doctoralThesis, info:eu-repo/semantics/doctoralThesis, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
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