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Optimization of anastomotic technique and gastric conduit perfusion with hyperspectral imaging in an experimental model for minimally invasive esophagectomy

Nickel, F. and Studier-Fischer, A. and Özdemir, B. and Odenthal, J. and Müller, L. R. and Knödler, S. and Kowalewski, K. F. and Camplisson, I. and Allers, M. M. and Dietrich, M. and Schmidt, K. and Salg, G. A. and Kenngott, H. G. and Billeter, A. T. and Gockel, I. and Sagiv, C. and Hadar, O. E. and Gildenblat, J. and Ayala, L. and Seidlitz, S. and Maier-Hein, L. and Müller-Stich, B. P. (2021) Optimization of anastomotic technique and gastric conduit perfusion with hyperspectral imaging in an experimental model for minimally invasive esophagectomy. . (Unpublished)

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Objective: To optimize anastomotic technique and gastric conduit perfusion with hyperspectral imaging (HSI) for total minimally invasive esophagectomy (MIE) with linear stapled anastomosis. Summary Background Data: Esophagectomy is the mainstay of esophageal cancer treatment but anastomotic insufficiency related morbidity and mortality remain challenging for patient outcome. Methods: A live porcine model (n=50) for MIE was used with gastric conduit formation and linear stapled side-to-side esophagogastrostomy. Four main experimental groups differed in stapling length (3 vs. 6 cm) and anastomotic position on the conduit (cranial vs. caudal). Tissue oxygenation around the anastomotic site was evaluated using HSI and was validated with histopathology. Results: The tissue oxygenation (ΔStO2) after the anastomosis remained constant only for the short stapler in caudal position (-0.4±4.4%, n.s.) while it dropped markedly in the other groups (short-cranial: -15.6±11.5%, p=0.0002; long-cranial: -20.4±7.6%, p=0.0126; long-caudal: -16.1±9.4%, p<0.0001) Tissue samples from deoxygenated stomach as measured by HSI showed correspondent eosinophilic pre-necrotic changes in 35.7±9.7% of the surface area. Conclusions: Tissue oxygenation at the anastomotic site of the gastric conduit during MIE is influenced by stapling technique. Optimal oxygenation was achieved with a short stapler (3 cm) and sufficient distance of the anastomosis to the cranial end of the gastric conduit. HSI tissue deoxygenation corresponded to histopathologic necrotic tissue changes. These findings allow for optimization of gastric conduit perfusion and anastomotic technique in MIE.

Item Type:Report or Paper (Discussion Paper)
Related URLs:
URLURL TypeDescription Paper
Nickel, F.0000-0001-6066-8238
Studier-Fischer, A.0000-0001-8682-9300
Müller, L. R.0000-0001-5312-9551
Kowalewski, K. F.0000-0003-2931-6247
Camplisson, I.0000-0001-9653-2789
Dietrich, M.0000-0003-0960-038X
Schmidt, K.0000-0001-8373-9406
Salg, G. A.0000-0002-3964-3527
Kenngott, H. G.0000-0003-1123-346X
Billeter, A. T.0000-0001-8724-4793
Gockel, I.0000-0001-7423-713X
Gildenblat, J.0000-0002-1291-2520
Ayala, L.0000-0002-3574-2085
Seidlitz, S.0000-0002-1122-4793
Maier-Hein, L.0000-0003-4910-9368
Müller-Stich, B. P.0000-0002-8552-8538
Additional Information:The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license. This version posted October 4, 2021. The authors gratefully acknowledge the data storage service SDS@hd supported by the Ministry of Science, Research and the Arts Baden-Württemberg (MWK) and the German Research Foundation (DFG) through grant INST 35/1314-1 FUGG and INST 35/1503-1 FUGG. Furthermore, the authors gratefully acknowledge the support from the Willy Robert Pitzer Foundation and the Heidelberg Foundation of Surgery. There was financial support from the Willy Robert Pitzer Foundation and the Heidelberg Foundation of Surgery for this project. Authors state no conflict of interest. Felix Nickel reports support for courses and travel from Johnson and Johnson, Medtronic, Intuitive Surgical, Cambridge Medical Robotics and KARL STORZ as well as consultancy fees from KARL STORZ. We acknowledge support from Medtronic for providing the stapling devices. Published data will be made available upon reasonable request to the corresponding author. Author contribution: ASF, FN and BPM had the original idea for the project. ASF and FN developed the project. ASF coordinated the whole project. ASF, FN, GS and KS performed the initial review of existing literature and the planning. ASF, KFK, BÖ, BPM and FN performed the surgeries. ASF and GS did the casting and the SEM recordings. ASF, IC, BÖ and JO developed the Python codes for data structure and annotation. ASF, SK, MMA, MD and KS annotated data. Image processing was performed by LRM, ASF, SK, SS, LA and LMH. ASF, MMA, GS, BÖ, JO, SK, KS, SS, LA, LRM and LMH analyzed and interpreted data. Statistical analysis was performed by ASF, KFK and FN. CS, OEH and JG supported the pathohistological analysis. ASF and FN drafted the figures and wrote the manuscript. SS, LRM, BPM, HK, IG, AB, CS, OEH and LMH revised the manuscript. All authors have read and approved the final manuscript. Registration of research studies: Not applicable.
Funding AgencyGrant Number
Willy Robert Pitzer FoundationUNSPECIFIED
Heidelberg Foundation of SurgeryUNSPECIFIED
Ministry of Science, Research and the Arts (Baden-Württemberg)UNSPECIFIED
Deutsche Forschungsgemeinschaft (DFG)35/1314-1
Deutsche Forschungsgemeinschaft (DFG)35/1503-1
Subject Keywords:hyperspectral imaging, minimally invasive esophagectomy, anastomotic insufficiency, gastric conduit, linear stapling, linear stapled anastomosis, esophagogastric anastomosis, translational research, porcine model, tissue perfusion
Record Number:CaltechAUTHORS:20211005-195331731
Persistent URL:
Official Citation:Optimization of anastomotic technique and gastric conduit perfusion with hyperspectral imaging in an experimental model for minimally invasive esophagectomy. Felix Nickel, Alexander Studier-Fischer, Berkin Oezdemir, Jan Odenthal, Lucas-Raphael Mueller, Samuel Knoedler, Karl-Friedrich Kowalewski, Isabella Camplisson, Michael Martin Allers, Maximilian Dietrich, Karsten Schmidt, Gabriel Alexander Salg, Hannes Goetz Kenngott, Adrian Billeter, Ines Gockel, Chen Sagiv, Ofir Etz-Hadar, Jacob Gildenblat, Leonardo Ayala, Silvia Seidlitz, Lena Maier-Hein, Beat Peter Mueller-Stich. bioRxiv 2021.10.03.462901; doi:
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:111220
Deposited By: Tony Diaz
Deposited On:05 Oct 2021 20:16
Last Modified:16 Nov 2021 19:43

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