Intraoperative Fluorescence Imaging During Robotic Pancreatoduodenectomy to Detect Suture-Induced Hypoperfusion of the Pancreatic Stump as a Predictor of Postoperative Pancreatic Fistula (FLUOPAN): Prospective Proof-of-concept Study
Background:. A potential downside of robotic pancreatoduodenectomy (RPD) is the lack of tactile feedback when tying sutures, which could be especially perilous during pancreatic anastomosis. Near-infrared fluorescence imaging with indocyanine green (NIRF-ICG) could detect transpancreatic-suture-indu...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2023-12-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000354 |
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| author | Jeffrey W. Chen Sanne Lof Maurice J. W. Zwart Olivier R. Busch Freek Daams Sebastiaan Festen Zhi Ven Fong Melissa E. Hogg Maxime D. Slooter Els J.M. Nieveen van Dijkum Marc G. Besselink for HPB-Amsterdam |
| author_facet | Jeffrey W. Chen Sanne Lof Maurice J. W. Zwart Olivier R. Busch Freek Daams Sebastiaan Festen Zhi Ven Fong Melissa E. Hogg Maxime D. Slooter Els J.M. Nieveen van Dijkum Marc G. Besselink for HPB-Amsterdam |
| author_sort | Jeffrey W. Chen |
| collection | DOAJ |
| description | Background:. A potential downside of robotic pancreatoduodenectomy (RPD) is the lack of tactile feedback when tying sutures, which could be especially perilous during pancreatic anastomosis. Near-infrared fluorescence imaging with indocyanine green (NIRF-ICG) could detect transpancreatic-suture-induced hypoperfusion of the pancreatic stump during RPD, which may be related to postoperative pancreatic fistula (POPF) grade B/C, but studies are lacking.
Methods:. This prospective study included 37 patients undergoing RPD to assess the relation between pancreatic stump hypoperfusion as objectified with NIRF-ICG using Firefly and the rate of POPF grade B/C. In 27 patients, NIRF-ICG was performed after tying down the transpancreatic U-sutures. In 10 ‘negative control’ patients, NIRF-ICG was performed before tying these sutures.
Results:. Pancreatic stump hypoperfusion was detected using NIRF-ICG in 9/27 patients (33%) during RPD. Hypoperfusion was associated with POPF grade B/C (67% [6/9 patients] versus 17% [3/18 patients], P = 0.026). No hypoperfusion was objectified in 10 ‘negative controls’.
Conclusions:. Transpancreatic-suture-induced pancreatic stump hypoperfusion can be detected using NIRF-ICG during RPD and was associated with POPF grade B/C. Surgeons could use NIRF-ICG to adapt their suturing approach during robotic pancreatico-jejunostomy. Further larger prospective studies are needed to validate the association between transpancreatic-suture-induced hypoperfusion and POPF. |
| format | Article |
| id | doaj-art-33b3e00c9c3d48d4bf42e9a33fba008a |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-33b3e00c9c3d48d4bf42e9a33fba008a2025-01-24T09:18:12ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932023-12-0144e35410.1097/AS9.0000000000000354202312000-00027Intraoperative Fluorescence Imaging During Robotic Pancreatoduodenectomy to Detect Suture-Induced Hypoperfusion of the Pancreatic Stump as a Predictor of Postoperative Pancreatic Fistula (FLUOPAN): Prospective Proof-of-concept StudyJeffrey W. Chen0Sanne Lof1Maurice J. W. Zwart2Olivier R. Busch3Freek Daams4Sebastiaan Festen5Zhi Ven Fong6Melissa E. Hogg7Maxime D. Slooter8Els J.M. Nieveen van Dijkum9Marc G. Besselink10for HPB-AmsterdamFrom the * Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The NetherlandsFrom the * Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The NetherlandsFrom the * Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The NetherlandsFrom the * Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands† Cancer Center Amsterdam, Treatment and Quality of life, Amsterdam, The Netherlands§ Department of Surgery, OLVG, Location Oost, Amsterdam, The Netherlands∥ Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ¶ Department of Surgery, Northshore University HealthSystem, Chicago, IL.From the * Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The NetherlandsFrom the * Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The NetherlandsFrom the * Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The NetherlandsBackground:. A potential downside of robotic pancreatoduodenectomy (RPD) is the lack of tactile feedback when tying sutures, which could be especially perilous during pancreatic anastomosis. Near-infrared fluorescence imaging with indocyanine green (NIRF-ICG) could detect transpancreatic-suture-induced hypoperfusion of the pancreatic stump during RPD, which may be related to postoperative pancreatic fistula (POPF) grade B/C, but studies are lacking. Methods:. This prospective study included 37 patients undergoing RPD to assess the relation between pancreatic stump hypoperfusion as objectified with NIRF-ICG using Firefly and the rate of POPF grade B/C. In 27 patients, NIRF-ICG was performed after tying down the transpancreatic U-sutures. In 10 ‘negative control’ patients, NIRF-ICG was performed before tying these sutures. Results:. Pancreatic stump hypoperfusion was detected using NIRF-ICG in 9/27 patients (33%) during RPD. Hypoperfusion was associated with POPF grade B/C (67% [6/9 patients] versus 17% [3/18 patients], P = 0.026). No hypoperfusion was objectified in 10 ‘negative controls’. Conclusions:. Transpancreatic-suture-induced pancreatic stump hypoperfusion can be detected using NIRF-ICG during RPD and was associated with POPF grade B/C. Surgeons could use NIRF-ICG to adapt their suturing approach during robotic pancreatico-jejunostomy. Further larger prospective studies are needed to validate the association between transpancreatic-suture-induced hypoperfusion and POPF.http://journals.lww.com/10.1097/AS9.0000000000000354 |
| spellingShingle | Jeffrey W. Chen Sanne Lof Maurice J. W. Zwart Olivier R. Busch Freek Daams Sebastiaan Festen Zhi Ven Fong Melissa E. Hogg Maxime D. Slooter Els J.M. Nieveen van Dijkum Marc G. Besselink for HPB-Amsterdam Intraoperative Fluorescence Imaging During Robotic Pancreatoduodenectomy to Detect Suture-Induced Hypoperfusion of the Pancreatic Stump as a Predictor of Postoperative Pancreatic Fistula (FLUOPAN): Prospective Proof-of-concept Study Annals of Surgery Open |
| title | Intraoperative Fluorescence Imaging During Robotic Pancreatoduodenectomy to Detect Suture-Induced Hypoperfusion of the Pancreatic Stump as a Predictor of Postoperative Pancreatic Fistula (FLUOPAN): Prospective Proof-of-concept Study |
| title_full | Intraoperative Fluorescence Imaging During Robotic Pancreatoduodenectomy to Detect Suture-Induced Hypoperfusion of the Pancreatic Stump as a Predictor of Postoperative Pancreatic Fistula (FLUOPAN): Prospective Proof-of-concept Study |
| title_fullStr | Intraoperative Fluorescence Imaging During Robotic Pancreatoduodenectomy to Detect Suture-Induced Hypoperfusion of the Pancreatic Stump as a Predictor of Postoperative Pancreatic Fistula (FLUOPAN): Prospective Proof-of-concept Study |
| title_full_unstemmed | Intraoperative Fluorescence Imaging During Robotic Pancreatoduodenectomy to Detect Suture-Induced Hypoperfusion of the Pancreatic Stump as a Predictor of Postoperative Pancreatic Fistula (FLUOPAN): Prospective Proof-of-concept Study |
| title_short | Intraoperative Fluorescence Imaging During Robotic Pancreatoduodenectomy to Detect Suture-Induced Hypoperfusion of the Pancreatic Stump as a Predictor of Postoperative Pancreatic Fistula (FLUOPAN): Prospective Proof-of-concept Study |
| title_sort | intraoperative fluorescence imaging during robotic pancreatoduodenectomy to detect suture induced hypoperfusion of the pancreatic stump as a predictor of postoperative pancreatic fistula fluopan prospective proof of concept study |
| url | http://journals.lww.com/10.1097/AS9.0000000000000354 |
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