Quantitative indocyanine green fluorescence angiography for anastomotic perfusion assessment during thoracoscopic esophageal atresia repair: A two-phase study.
E A Breuking, H G M Vaassen, J E Hut, E M B P Reuling, J W Verweij, M J Witvliet, M Y A Lindeboom, S H A J Tytgat, J Ruiterkamp
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引用次数: 0
Abstract
Introduction: Thoracoscopic esophageal atresia (EA) repair is associated with high rates of anastomotic complications. Impaired perfusion may contribute to poor healing. Quantitative indocyanine green fluorescence angiography (ICG-FA) may enable objective anastomotic perfusion assessment. This study describes the implementation of quantitative ICG-FA during thoracoscopic EA repair and explores its association with anastomotic complications (leakage and/or stenosis).
Methods: A two-phase study was conducted, including patients undergoing fluorescence-guided thoracoscopic EA repair according to a standardized protocol between February 2024 and February 2026. Phase one consisted of retrospective qualitative and exploratory quantitative assessment. Phase two consisted of prospective quantitative assessment. Fluorescence recordings were postoperatively analyzed for time-to-peak (TTP), normalized peak slope (NPS) and hypoperfusion width.
Results: Twenty-nine patients underwent fluorescence-guided thoracoscopic EA repair. No ICG-related adverse events occurred. Anastomotic complications occurred in 17 patients (58.6%). Qualitative assessment demonstrated limited concordance with outcome (62.1%). In the prospective cohort, postoperative quantitative assessment was feasible in 13 patients (86.7%). Patients with anastomotic complications demonstrated a significantly larger hypoperfusion width at the anastomotic site (5 mm vs 2 mm, p = 0.019). No significant differences were observed in TTP and NPS.
Conclusion: Quantitative anastomotic perfusion assessment using ICG-FA is feasible in thoracoscopic EA repair. Quantitative analysis can provide objective, comparable and reproducible information beyond visual interpretation but requires strict adherence to standardized protocols. Anastomotic complications may be, at least partially, associated with (pre-existent) local perfusion deficits rather than mechanical factors (e.g. tension) only. Future research to validate quantitative parameters may contribute to optimized risk stratification and surgical decision-making.
简介：胸腔镜食管闭锁（EA）修复术与吻合口并发症的高发相关。灌注受损可能导致愈合不良。定量吲哚菁绿荧光血管造影（ICG-FA）可以客观地评估吻合口灌注。本研究描述了在胸腔镜下EA修复过程中定量ICG-FA的实施，并探讨了其与吻合口并发症（瘘和/或狭窄）的关系。方法：采用两期研究，纳入2024年2月至2026年2月间按照标准化方案进行荧光引导胸腔镜EA修复的患者。第一阶段包括回顾性定性和探索性定量评估。第二阶段包括前瞻性定量评估。术后分析荧光记录的峰前时间（TTP）、归一化峰斜率（NPS）和低灌注宽度。结果：29例患者行荧光引导胸腔镜EA修复术。未发生与icg相关的不良事件。吻合口并发症17例（58.6%）。定性评估显示与结果的一致性有限（62.1%）。在前瞻性队列中，13例（86.7%）患者的术后定量评估是可行的。吻合口并发症患者吻合口低灌注宽度明显增大（5mm vs 2mm, p = 0.019）。TTP和NPS无显著差异。结论：应用ICG-FA定量评价吻合口血流灌注在胸腔镜EA修复中是可行的。定量分析可以提供超越视觉解释的客观、可比和可重复的信息，但需要严格遵守标准化协议。吻合口并发症可能（至少部分地）与（预先存在的）局部灌注缺陷有关，而不仅仅是机械因素（如张力）。未来对定量参数的验证研究可能有助于优化风险分层和手术决策。
期刊介绍：
The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.
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