Alternative intraoperative optical imaging modalities for fluorescence angiography in gastrointestinal surgery: spectral imaging and imaging photoplethysmography

Claire Chalopin (Lead / Corresponding author), Annekatrin Pfahl, Hannes Köhler, Luise Knospe, Marianne Maktabi, Michael Unger, Boris Jansen-Winkeln, René Thieme, Yusef Moulla, Matthias Mehdorn, Robert Sucher, Thomas Neumuth, Ines Gockel, Andreas Melzer

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: Intraoperative near-infrared fluorescence angiography with indocyanine green (ICG-FA) is a well-established modality in gastrointestinal surgery. Its main drawback is the application of a fluorescent agent with possible side effects for patients. The goal of this review paper is the presentation of alternative, non-invasive optical imaging methods and their comparison with ICG-FA.

Material and methods: The principles of ICG-FA, spectral imaging, imaging photoplethysmography (iPPG), and their applications in gastrointestinal surgery are described based on selected published works.

Results: The main applications of the three modalities are the evaluation of tissue perfusion, the identification of risk structures, and tissue segmentation or classification. While the ICG-FA images are mainly evaluated visually, leading to subjective interpretations, quantitative physiological parameters and tissue segmentation are provided in spectral imaging and iPPG. The combination of ICG-FA and spectral imaging is a promising method.

Conclusions: Non-invasive spectral imaging and iPPG have shown promising results in gastrointestinal surgery. They can overcome the main drawbacks of ICG-FA, i.e. the use of contrast agents, the lack of quantitative analysis, repeatability, and a difficult standardization of the acquisition. Further technical improvements and clinical evaluations are necessary to establish them in daily clinical routine.
Original languageEnglish
JournalMinimally Invasive Therapy and Allied Technologies
Early online date9 Jan 2023
DOIs
Publication statusE-pub ahead of print - 9 Jan 2023

Keywords

  • Fluorescence angiography
  • indocyanine green
  • spectral imaging
  • photoplethysmography
  • real-time
  • intraoperative
  • tissue perfusion

ASJC Scopus subject areas

  • Surgery

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