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Visceral Surgery

Currently, the most important clinical applications in visceral surgery are the intraoperative assessment of anastomoses, the resection margin in the context of colorectal surgery, and the blood flow through the stomach tube in esophageal resections. Based on the water, hemoglobin and oxygen content in the tissue, conclusions can be drawn intraoperatively about its vascularization and integrity. HSI technology can also be used to determine the extent of resection of borderline perfused bowel in cases of mesenteric ischemia. In this context, the HSI technique is an objective intraoperative decision tool in identifying the optimal resection line or anastomotic region with the goal of optimizing the surgical outcome, creating ideal conditions for undisturbed healing, and ultimately increasing patient safety.

The feasibility of intraoperative assessment of almost the entire spectrum of intestinal anastomoses in visceral surgery (esophagus, stomach, pancreas, small intestine, colon, and rectum) was demonstrated at various hospitals.

anastomosis marker
Identification of the optimal anastomotic region using HSI. Ten markers, each 5 mm in diameter, were placed on both sides of the boundary line on a straight, light reflection-free line to assess tissue perfusion postoperatively. The markers were placed so that there were five markers on each side of the planned boundary line. Thus, it was possible to analyze the change in perfusion over time in an area up to 25 mm proximal and distal to the boundary line. In addition, the distance between the surgically planned line of transection (marked with scissors) and the boundary line was measured with a ruler. (Source: Jansen-Winkeln B et al. Determination of the transection margin during colorectal resection with hyperspectral imaging (HSI). Int J Colorectal Dis. 2019 Apr;34(4):731-739.)
Mesenteric ischemia 2
Identification of underperfused bowel sections (blue) in a patient with acute mesenteric ischemia. (A) Color image, (B) StO2, (C) NIR perfusion index and the corresponding absorption spectra of the color-coded bowel regions. (Image source: Mehdorn M et al. Hyperspectral Imaging (HSI) in Acute Mesenteric Ischemia to Detect Intestinal Perfusion Deficits. J Surg Res. 2020 Oct;254:7-15)

In addition, HSI technology is increasingly being applied for tissue classification and tumor detection in experimental settings as well as during surgical procedures in clinical research.