Optimization of anastomotic technique and gastric conduit perfusion with hyperspectral imaging and machine learning in an experimental model for minimally invasive esophagectomy.

IF 3.5 2区医学 Q2 ONCOLOGY Ejso Pub Date : 2025-01-01 Epub Date: 2023-04-18 DOI:10.1016/j.ejso.2023.04.007

F Nickel, A Studier-Fischer, B Özdemir, J Odenthal, L R Müller, S Knoedler, K F Kowalewski, I Camplisson, M M Allers, M Dietrich, K Schmidt, G A Salg, H G Kenngott, A T Billeter, I Gockel, C Sagiv, O E Hadar, J Gildenblat, L Ayala, S Seidlitz, L Maier-Hein, B P Müller-Stich

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Abstract

Introduction: Esophagectomy is the mainstay of esophageal cancer treatment, but anastomotic insufficiency related morbidity and mortality remain challenging for patient outcome. Therefore, the objective of this work was to optimize anastomotic technique and gastric conduit perfusion with hyperspectral imaging (HSI) for total minimally invasive esophagectomy (MIE) with linear stapled anastomosis.

Material and methods: A live porcine model (n = 58) for MIE was used with gastric conduit formation and simulation of linear stapled side-to-side esophagogastrostomy. Four main experimental groups differed in stapling length (3 vs. 6 cm) and simulation of anastomotic position on the conduit (cranial vs. caudal). Tissue oxygenation around the anastomotic simulation site was evaluated using HSI and was validated with histopathology.

Results: The tissue oxygenation (ΔStO₂) after the anastomotic simulation remained constant only for the short stapler in caudal position (-0.4 ± 4.4%, n.s.) while it was impaired markedly in the other groups (short-cranial: -15.6 ± 11.5%, p = 0.0002; long-cranial: -20.4 ± 7.6%, p = 0.0126; long-caudal: -16.1 ± 9.4%, p < 0.0001). Tissue samples from avascular stomach as measured by HSI showed correspondent eosinophilic pre-necrotic changes in 35.7 ± 9.7% of the surface area.

Conclusion: Tissue oxygenation at the site of anastomotic simulation of the gastric conduit during MIE is influenced by stapling technique. Optimal oxygenation was achieved with a short stapler (3 cm) and sufficient distance of the simulated anastomosis to the cranial end of the gastric conduit. HSI tissue deoxygenation corresponded to histopathologic necrotic tissue changes. The experimental model with HSI and ML allow for systematic optimization of gastric conduit perfusion and anastomotic technique while clinical translation will have to be proven.

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微创食管切除术实验模型吻合技术及胃管灌注的高光谱成像和机器学习优化。

食管切除术是食管癌治疗的主要方法，但吻合口功能不全相关的发病率和死亡率仍然是患者预后的挑战。因此，本研究的目的是利用高光谱成像(HSI)优化全微创食管切除术(MIE)线性吻合术的吻合技术和胃管灌注。材料与方法:采用58只MIE活体猪模型，建立胃管，模拟线性侧对侧食管胃吻合术。四个主要实验组在吻合器长度(3 cm vs. 6 cm)和导管吻合位置模拟(颅端vs.尾端)上存在差异。用HSI评估吻合模拟部位周围的组织氧合情况，并用组织病理学进行验证。结果:吻合模拟后组织氧合(ΔStO2)仅尾侧短吻合器保持不变(-0.4±4.4%，n.s)，其余各组(短颅:-15.6±11.5%，p = 0.0002;长颅:-20.4±7.6%，p = 0.0126;结论:吻合器技术对MIE吻合口模拟胃导管部位组织氧合有影响。通过短吻合器(3cm)和模拟吻合口与胃导管颅端足够的距离实现最佳氧合。HSI组织缺氧与组织病理学坏死组织改变相对应。HSI和ML的实验模型允许系统优化胃管灌注和吻合技术，但临床翻译有待证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.