Evaluation of hyperspectral imaging (HSI) for the measurement of ischemic conditioning effects of the gastric conduit during esophagectomy

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, Ines Gockel (Lead / Corresponding author)

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    Background: Hyperspectral 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. Methods: Intraoperative 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 (StO 2), perfusion—(NIR Perfusion Index), organ hemoglobin (OHI), and tissue water index (TWI). Results: Intraoperative 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 (StO2¯Precond. = 78%; StO2¯NoPrecond. = 66%; p = 0.03). Conclusions: HSI 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.

    Original languageEnglish
    Pages (from-to)3775-3782
    Number of pages8
    JournalSurgical Endoscopy
    Issue number11
    Early online date23 Jan 2019
    Publication statusPublished - Nov 2019


    • Esophagectomy
    • Gastric conduit
    • Hyperspectral imaging
    • Ischemic conditioning
    • Physiologic tissue parameters

    ASJC Scopus subject areas

    • Surgery


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