Enhanced Reality and Intraoperative Imaging in Colorectal Surgery

Abstract

Colorectal surgery is one of the most common procedures performed around the world with more than 600,000 operations each year in the United States, and more than a million worldwide. In the past two decades, there has been a clear trend toward minimal access and surgeons have embraced this evolution. Widespread adoption of advanced minimally invasive procedures is often limited by procedural complexity and the need for specific technical skills. Furthermore, the loss of 3D vision, limited overview of the surgical field, and diminished tactile sensation make major colorectal procedures more challenging and have an impact on the surgeons' learning curves. New technologies are emerging that can compensate for some of the sensory losses associated with laparoscopy. High-definition picture acquisition, 3D camera systems, and the use of biomarkers will allow improved identification of the target structures and help differentiate them from surrounding tissues. In this article, we describe some of the new technologies available and, in particular, focus on the possible implications of biomarkers and fluorescent laparoscopic imaging.

Keywords

laparoscopic colorectal cancer resection - colorectal surgery - biomarkers - indocyanine green - enhanced reality - imaging

^* Both the authors contributed equally to this work.

• References

• 1 Buchs NC, Morel P. Three-dimensional laparoscopy: a new tool in the surgeon's armamentarium. Surg Technol Int 2013; 23 (9) 19-22
• 2 Volonté F, Pugin F, Buchs NC , et al. Console-integrated stereoscopic OsiriX 3D volume-rendered images for da Vinci colorectal robotic surgery. Surg Innov 2013; 20 (2) 158-163
• 3 Kobayashi M, Morishita S, Okabayashi T , et al. Preoperative assessment of vascular anatomy of inferior mesenteric artery by volume-rendered 3D-CT for laparoscopic lymph node dissection with left colic artery preservation in lower sigmoid and rectal cancer. World J Gastroenterol 2006; 12 (4) 553-555
• 4 Mari FS, Nigri G, Pancaldi A , et al. Role of CT angiography with three-dimensional reconstruction of mesenteric vessels in laparoscopic colorectal resections: a randomized controlled trial. Surg Endosc 2013; 27 (6) 2058-2067
• 5 Cahill RA, Ris F, Mortensen NJ. Near-infrared laparoscopy for real-time intra-operative arterial and lymphatic perfusion imaging. Colorectal Dis 2011; 13 (7) (Suppl. 07) 12-17
• 6 Whitney MA, Crisp JL, Nguyen LT , et al. Fluorescent peptides highlight peripheral nerves during surgery in mice. Nat Biotechnol 2011; 29 (4) 352-356
• 7 Ishizawa T, Bandai Y, Ijichi M, Kaneko J, Hasegawa K, Kokudo N. Fluorescent cholangiography illuminating the biliary tree during laparoscopic cholecystectomy. Br J Surg 2010; 97 (9) 1369-1377
• 8 Daskalaki D, Fernandes E, Wang X , et al. Indocyanine green (ICG) fluorescent cholangiography during robotic cholecystectomy: results of 184 consecutive cases in a single institution. Surg Innov 2014; 21 (6) 615-621
• 9 Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ ; ALA-Glioma Study Group. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 2006; 7 (5) 392-401
• 10 Kato S, Kawamura J, Kawada K, Hasegawa S, Sakai Y. Fluorescence diagnosis of metastatic lymph nodes using 5-aminolevulinic acid (5-ALA) in a mouse model of colon cancer. J Surg Res 2012; 176 (2) 430-436
• 11 Murayama Y, Harada Y, Imaizumi K , et al. Precise detection of lymph node metastases in mouse rectal cancer by using 5-aminolevulinic acid. Int J Cancer 2009; 125 (10) 2256-2263
• 12 Kondo Y, Murayama Y, Konishi H , et al. Fluorescent detection of peritoneal metastasis in human colorectal cancer using 5-aminolevulinic acid. Int J Oncol 2014; 45 (1) 41-46
• 13 van Dam GM, Themelis G, Crane LM , et al. Intraoperative tumor-specific fluorescence imaging in ovarian cancer by folate receptor-α targeting: first in-human results. Nat Med 2011; 17 (10) 1315-1319
• 14 Bird-Lieberman EL, Neves AA, Lao-Sirieix P , et al. Molecular imaging using fluorescent lectins permits rapid endoscopic identification of dysplasia in Barrett's esophagus. Nat Med 2012; 18 (2) 315-321
• 15 Vignali A, Gianotti L, Braga M, Radaelli G, Malvezzi L, Di Carlo V. Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum 2000; 43 (1) 76-82
• 16 Ishii M, Tanaka E, Imaizumi T , et al. Local VEGF administration enhances healing of colonic anastomoses in a rabbit model. Eur Surg Res 2009; 42 (4) 249-257
• 17 Attard JA, Raval MJ, Martin GR , et al. The effects of systemic hypoxia on colon anastomotic healing: an animal model. Dis Colon Rectum 2005; 48 (7) 1460-1470
• 18 Grommes J, Binnebösel M, Klink CD , et al. Comparison of intestinal microcirculation and wound healing in a rat model. J Invest Surg 2013; 26 (1) 46-52
• 19 Bertelsen CA, Andreasen AH, Jørgensen T, Harling H ; Danish Colorectal Cancer Group. Anastomotic leakage after anterior resection for rectal cancer: risk factors. Colorectal Dis 2010; 12 (1) 37-43
• 20 Allison AS, Bloor C, Faux W , et al. The angiographic anatomy of the small arteries and their collaterals in colorectal resections: some insights into anastomotic perfusion. Ann Surg 2010; 251 (6) 1092-1097
• 21 Sherwinter DA, Gallagher J, Donkar T. Intra-operative transanal near infrared imaging of colorectal anastomotic perfusion: a feasibility study. Colorectal Dis 2013; 15 (1) 91-96
• 22 Jafari MD, Lee KH, Halabi WJ , et al. The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc 2013; 27 (8) 3003-3008
• 23 Hellan M, Spinoglio G, Pigazzi A, Lagares-Garcia JA. The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery. Surg Endosc 2014; 28 (5) 1695-1702
• 24 Ris F, Hompes R, Lindsey I, Cunningham C, Mortensen NJ, Cahill RA. Near Infra-Red (NIR) Laparoscopic Assessment of the Adequacy of Blood Perfusion of Intestinal Anastomosis. Colorect Dis 2014; 16 (8) 646-647
• 25 Killeen S, Mannion M, Devaney A, Winter DC. Complete Mesocolic Resection and Extended Lymphadenectomy for Colon Cancer: A Systematic Review. Colorect Dis 2014; 16 (8) 577-594
• 26 Hashiguchi Y, Hase K, Ueno H, Mochizuki H, Shinto E, Yamamoto J. Optimal margins and lymphadenectomy in colonic cancer surgery. Br J Surg 2011; 98 (8) 1171-1178
• 27 Cahill RA, Anderson M, Wang LM, Lindsey I, Cunningham C, Mortensen NJ. Near-infrared (NIR) laparoscopy for intraoperative lymphatic road-mapping and sentinel node identification during definitive surgical resection of early-stage colorectal neoplasia. Surg Endosc 2012; 26 (1) 197-204
• 28 Leaper DJ. Angiography as an index of healing in experimental laparotomy wounds and colonic anastomoses. Ann R Coll Surg Engl 1983; 65 (1) 20-23
• 29 Phillips JP, Kyriacou PA, Jones DP, Shelley KH, Langford RM. Pulse oximetry and photoplethysmographic waveform analysis of the esophagus and bowel. Curr Opin Anaesthesiol 2008; 21 (6) 779-783
• 30 Sheridan WG, Lowndes RH, Williams GT, Young HL. Determination of a critical level of tissue oxygenation in acute intestinal ischaemia. Gut 1992; 33 (6) 762-766
• 31 Sheridan WG, Lowndes RH, Young HL. Tissue oxygen tension as a predictor of colonic anastomotic healing. Dis Colon Rectum 1987; 30 (11) 867-871
• 32 Boerma EC, Mathura KR, van der Voort PH, Spronk PE, Ince C. Quantifying bedside-derived imaging of microcirculatory abnormalities in septic patients: a prospective validation study. Crit Care 2005; 9 (6) R601-R606
• 33 Carter MS, Fantini GA, Sammartano RJ, Mitsudo S, Silverman DG, Boley SJ. Qualitative and quantitative fluorescein fluorescence in determining intestinal viability. Am J Surg 1984; 147 (1) 117-123