Evaluation of tissue blood supply during esophagectomy using fluorescent diagnostics and diffuse scattering spectroscopy in visible region.

BACKGROUND: The success of the surgical treatment of a tumor or obstruction of the esophagus with subsequent anastomosis application depends on the level of blood supply to the stitched tissues. Intraoperative assessment of blood flow is widely used in medicine and can be used as a diagnostic method that affects the outcome of surgery and reduces the frequency of postoperative complications for the patient. METHODS: In this work, the assessment of blood supply during esophageal resection operations was carried out using two techniques sequentially: fluorescent diagnostics with indocyanine green and measurement of hemoglobin oxygen saturation by diffuse scattering spectroscopy in the visible wavelength range. The first method was used to assess the integrity of the vascular network structure in the area of anastomosis and blood flow through the sutured tissues, the second one - for local assessment of hemoglobin oxygen saturation in the investigated area. RESULTS: Conducted clinical study involved the participation of nine patients with malignant neoplasms (six cases) or esophageal obstruction (three cases). The presence of postoperative complications was compared with the measurement results. Anastomosis failure was observed in only one patient. According to the results of the study, with the use of the investigated method of assessing blood supply, there is a tendency towards a decrease in the frequency of anastomosis leaks (11.1 % compared with 21.4 %). CONCLUSIONS: Therefore, fluorescent diagnostics with indocyanine green and measurement of hemoglobin oxygen saturation using diffuse scattering spectroscopy were affirmed as methods that allow increasing the safety of surgical procedures by assessing the risk of postoperative complications, including anastomosis failures.

Attenuation correction technique for fluorescence analysis of biological tissues with significantly different optical properties.

During intraoperative fluorescence navigation to remove various neoplasms and during pharmacokinetic studies of photosensitizers in laboratory animals, in many cases, the ratio of photosensitizer accumulation in the tumor and normal tissue can reach ⩾ 10-fold, which inevitably changes their optical properties. At the same time, the tumor formation process causes various metabolic and structural changes at cellular and tissue levels, which lead to changes in optical properties. A hardware-software complex for the spectral-fluorescence studies of the content of fluorochromes in biological tissues with significantly different optical properties was developed, and it was tested on optical phantoms with various concentrations of photosensitizers, absorbers, and scatterers. To correct the influence of optical properties on the photosensitizer concentration analysis by fluorescence spectroscopy, we propose the spectrum-processing algorithm, which combines empirical and theory-based approaches.