Optical fiber probe spectroscopy for laparoscopic monitoring of tissue oxygenation during esophagectomies

Anastomotic complication is a major morbidity associated with esophagectomy. Gastric ischemia after conduit creation contributes to anastomotic complications, but a reliable method to assess oxygenation in the gastric conduit is lacking. We hypothesize that fiber optic spectroscopy can reliably asse...

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Bibliographic Details
Published in:Journal of Biomedical Optics 2010-11, Vol.15 (6), p.061712-061712
Main Authors: Gareau, Daniel S, Truffer, Frederic, Perry, Kyle, Pham, Thai, Enestvedt, C. Kristian, Dolan, James, Hunter, John G, Jacques, Steven L
Format: Article
Language:English
Subjects:
Conduits
Equipment Design
Equipment Failure Analysis
Esophagectomy - instrumentation
Esophagus - metabolism
Esophagus - surgery
Fiber Optic Technology - instrumentation
Humans
Ischemia
Laparoscopes
Optical fibers
Oximetry - instrumentation
Oxygen - analysis
Oxygenation
Patients
Saturation
Special Section on Optical Diagnostic and Biophotonic Methods from Bench to Bedside
Spectrophotometry, Infrared - instrumentation
Spectroscopy
Stomach
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Summary:Anastomotic complication is a major morbidity associated with esophagectomy. Gastric ischemia after conduit creation contributes to anastomotic complications, but a reliable method to assess oxygenation in the gastric conduit is lacking. We hypothesize that fiber optic spectroscopy can reliably assess conduit oxygenation, and that intraoperative gastric ischemia will correlate with the development of anastomotic complications. A simple optical fiber probe spectrometer is designed for nondestructive laparoscopic measurement of blood content and hemoglobin oxygen saturation in the stomach tissue microvasculature during human esophagectomies. In 22 patients, the probe measured the light transport in stomach tissue between two fibers spaced 3-mm apart (500- to 650-nm wavelength range). The stomach tissue site of measurement becomes the site of a gastroesophageal anastamosis following excision of the cancerous esophagus and surgical ligation of two of the three gastric arteries that provide blood perfusion to the anastamosis. Measurements are made at each of five steps throughout the surgery. The resting baseline saturation is 0.51±0.15 and decreases to 0.35±0.20 with ligation. Seven patients develop anastomotic complications, and a decreased saturation at either of the last two steps (completion of conduit and completion of anastamosis) is predictive of complication with a sensitivity of 0.71 when the specificity equaled 0.71.
ISSN:1083-3668
1560-2281
DOI:10.1117/1.3512149