|
Back to 2016 Annual Meeting
Clinical Application of Thermal Imaging Systems for Simulation of Gastric Tube Formation in Esophageal Reconstruction After Esophagectomy
Katsunori Nishikawa*, Masami Yuda, Akira Matsumoto, Yujiro Tanaka, Yuichiro Tanishima, Se-ryung Yamamoto, Fumiaki Yano, Katsuhiko Yanaga
Sugery, Jikei University, Tokyo, Japan
(Background) Image-guided surgery has revolutionized traditional surgical techniques, especially in neurosurgery and breast cancer treatment. As with other clinical application, image-guided surgery is now accepted in some gastrointestinal operation such as sentinel node navigation for gastric cancer surgery. However, these advances image-guided surgery are still limited.
(Aim) A poor vascularization of esophageal substitute is considered as a main cause of anastomotic impairment. To secure anastomosis at a well-vascularized area, we have been using thermal imaging systems (TIS) to simulate the construction of a gastric tube (GT) as well as to navigate suitable anastomotic site. The aim of study is to evaluate the clinical signifcance of TIS in esophageal reconstruction.
(Method) After esophagectomy, distribution of vascular/blood flow of the devascularized stomach was assessed by TIS images. Actual GT was constructed along the line of simulation, which was drawn on the devascularized stomach based on appropriate length and viability of the GT set by the simulation. TIS images of GT was also used to calculate anastomotic viability index (AVI), based on the length of right gastric epiploic artery (RGEA) and temperature change on the proximal GT. The best site for anastomosis of the GT was navigated by AVIs after GT was pulled up to the cervical space.
（Results）Since we have used TIS for GT reconstruction following esophagectomy in 199 cases of esophageal neoplasms so far. TIS can clearly demonstrated vascular distribution of both devascularized stomach and GT by surface temperature. Approximate required time for GT simulation and AVI calculation were 2min. and 3min., respectively. TIS images of devacularized stomach revealed existence of vascular arcade between RGEA and LGEA in 68%, and blood supply to proximal GT region from right gastric artery in 17%, which were associated with construction of viable GT. Anastomotic leakage occurred 0.8% in GT with AVI≥0.63, as compared to 27% with those with AVI＜0.63. For GT with AVI＜0.5, additional supercharge and/or drainage were added.
(Conclusion) TIS support precise designing of GT by allowing secure construction of GT with fair vascularization, and can be integrated into a navigation systems for esophageal surgery to optimize GT construction in patients undergoing esophagectomy and reconstruction by a GT for cancer.
 Represented TIS image of devascularized and tubularized stomach.
Back to 2016 Annual Meeting
|
