TY - JOUR
T1 - Evaluation of intestinal viability using 3-charge coupled device image enhancement technology in a pediatric laparoscopic appendectomy model
AU - Millendez, Maridelle B.
AU - Crane, Nicole J.
AU - Elster, Eric A.
AU - Safford, Shawn D.
N1 - Funding Information:
This effort was supported (in part) by the US Navy Bureau of Medicine and Surgery under the Medical Development Program and Office of Naval Research work unit number 604771N.0933.001.A0604 .
PY - 2012/1
Y1 - 2012/1
N2 - Background: Intraoperative laparoscopic determination of intestinal viability is currently limited to subjective visible cues. Adjunctive modalities are neither widely available nor practical. Three-charge coupled device (3-CCD) imaging directly correlates the amount of light detected by CCDs to tissue oxygenation. We hypothesize that application of 3-CCD image enhancement detects bowel ischemia in a pediatric laparoscopic appendectomy model. Methods: We recorded 10 laparoscopic appendectomies for appendicitis. Offline analysis involved selecting regions of interest (ROIs) in the appendix, adjacent colon, and nonappendiceal fat and calculating mean intensity values in selected images before and after division of the mesoappendix. The colon was used as a control, and the intensity values were normalized to fat. Results: As an indicator of decreased perfusion, the mean appendix ROI intensity values decreased over time (R 2 = 0.92) compared with the colon mean ROI intensity values, which remained stable. There was a statistically significant difference between fat-normalized intensity values for ischemic and nonischemic appendix after 1 minute. Conclusion: We have demonstrated proof of principle for the determination of bowel ischemia using 3-CCD image enhancement. By quantitatively identifying areas of ischemia, this technique has the potential to significantly change the management of ischemic bowel in the future.
AB - Background: Intraoperative laparoscopic determination of intestinal viability is currently limited to subjective visible cues. Adjunctive modalities are neither widely available nor practical. Three-charge coupled device (3-CCD) imaging directly correlates the amount of light detected by CCDs to tissue oxygenation. We hypothesize that application of 3-CCD image enhancement detects bowel ischemia in a pediatric laparoscopic appendectomy model. Methods: We recorded 10 laparoscopic appendectomies for appendicitis. Offline analysis involved selecting regions of interest (ROIs) in the appendix, adjacent colon, and nonappendiceal fat and calculating mean intensity values in selected images before and after division of the mesoappendix. The colon was used as a control, and the intensity values were normalized to fat. Results: As an indicator of decreased perfusion, the mean appendix ROI intensity values decreased over time (R 2 = 0.92) compared with the colon mean ROI intensity values, which remained stable. There was a statistically significant difference between fat-normalized intensity values for ischemic and nonischemic appendix after 1 minute. Conclusion: We have demonstrated proof of principle for the determination of bowel ischemia using 3-CCD image enhancement. By quantitatively identifying areas of ischemia, this technique has the potential to significantly change the management of ischemic bowel in the future.
KW - 3-CCD
KW - Bowel ischemia
KW - Intestinal viability
KW - Laparoscopy
UR - http://www.scopus.com/inward/record.url?scp=84855847636&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2011.10.033
DO - 10.1016/j.jpedsurg.2011.10.033
M3 - Article
C2 - 22244407
AN - SCOPUS:84855847636
SN - 0022-3468
VL - 47
SP - 142
EP - 147
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 1
ER -