Institute for Image Guided Surgery

Saint-Clément-de-la-Place, France

Institute for Image Guided Surgery

Saint-Clément-de-la-Place, France
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Beard K.,Providence Portland Comprehensive Cancer Center | Swanstrom L.L.,Institute for Image Guided Surgery
Journal of Thoracic Disease | Year: 2017

Zenker's diverticula (ZDs) are a relatively common cause of cervical dysphagia. Diagnosis is best by a good upper GI exam though upper endoscopy should be performed as well. Treatment is either by open, transcervical approaches or trans-oral. Over the past 20 years, transoral approach has mostly replace transcervical approaches due to less pain, no scarring and a rapid recovery. Transoral approaches are either using rigid access or flexible endoscopy. Today, the most common approach is transoral stapling using a 12 mm laparoscopic linear cutting stapler. This has the drawbacks of requiring extreme neck extension, the massive size of the stapler making visualization mostly impossible and the current staple design that does not cut/staple all the way to the end of the blades-resulting in a residual pouch. Flexible endoscopy allows a more tailored approach under direct vision, the myotomy can even be extended beyond the diverticulum and onto the esophageal wall to minimize the risk of incomplete myotomy. Experienced endoscopists report high technical success and low complication. Success rates are similar but maybe slightly higher than with ridged transoral approaches or open surgery. Today, flexible endoscopic Zenkers is our preferred initial approach- with open or ridged being reserved for special indications. © Journal of Thoracic Disease. All rights reserved.


Abdelmoaty W.F.,Providence Portland Medical Center | Swanstrom L.L.,The Oregon Clinic | Swanstrom L.L.,Institute for Image Guided Surgery
Current Gastroenterology Reports | Year: 2017

Purpose of Review: We aim to review the endoscopic evaluation of post-fundoplication anatomy and its role in assessment of fundoplication outcomes and in pre-operative planning for reoperation in failed procedures. Recent Findings: There is no universally accepted system for evaluating post-fundoplication anatomy endoscopically. However, multiple reports described the usefulness of post-operative endoscopy as a quality control measure and in the evaluation of complex cases such as repeat procedures and paraesophageal hernias (PEH). Summary: Endoscopic evaluation of post-fundoplication anatomy has an important role in assessing the outcomes of operative repair and pre-operative planning for failed fundoplications. Attempts have been made to characterize the appearance of the newly formed gastroesophageal valve after successful repairs and to standardize endoscopic reporting and classification of anatomic descriptions of failed fundoplications. However, there is no consensus. More studies are needed to evaluate the applicability and reproducibility of proposed endoscopic evaluation systems in order for such tools to become widely accepted. © 2017, Springer Science+Business Media, LLC.


Halvax P.,Institute for Image Guided Surgery | Diana M.,Institute for Image Guided Surgery | Diana M.,Research Institute Against Cancer of the Digestive System | Nagao Y.,Institute for Image Guided Surgery | And 3 more authors.
Surgical Innovation | Year: 2017

Background. The ability to perform reliable, secure endoluminal closure of the gastrointestinal tract wall, is a prerequisite to support the progress of the emerging field of endoluminal surgery. Along with advanced clipping systems, flexible endoscopic suturing devices are commercially available. Current systems can replicate traditional surgical suturing patterns in the endoluminal environment. The aim of this study was to evaluate the optimal endoluminal suturing technique using a flexible endoscopic suturing device. Materials and Methods. Procedures were performed on bench-top simulators containing 20 explanted porcine stomachs. A standardized 3-cm full-thickness incision was created on the anterior wall of each stomach using monopolar cautery. The gastrotomy was closed endoscopically using an over-the-scope suturing device (OverStitch, Apollo Endosurgery; Austin, TX). Three different techniques were used: single stitches, figure-of-8 pattern, and running suture. Material consumption and operation time were recorded and bursting pressure measurement of the closure was performed. Results. No statistically significant differences were identified in suturing time. Suturing time (minutes) was slightly shorter with the figure-of-8 technique (41.14 ± 4.6) versus interrupted (45.75 ± 1.1) versus continuous (51.44 ± 10.0), but the difference was not statistically significant. The number of sutures required was greater in the interrupted group. No significant difference was found in the burst pressure (mm Hg): figure-of-8 (45.85 ± 26.2) versus interrupted (30.5 ± 22.89) versus continuous (32.0 ± 26.5). In the figure-of-8 group, 85.5% of cases were leakproof above 30 mm Hg, while in the other groups only 50% of cases were so. Conclusion. A figure-of-8 suturing pattern seems to be the preferable suturing technique with the endoscopic suturing device. © The Author(s) 2017.


Caponero M.A.,ENEA | Polimadei A.,ENEA | Ariano M.,Biomedical University of Rome | Schena E.,Biomedical University of Rome | And 3 more authors.
I2MTC 2017 - 2017 IEEE International Instrumentation and Measurement Technology Conference, Proceedings | Year: 2017

Minimally invasive thermal techniques are gaining acceptance in cancer removal. These approaches aim at destroying the tumour while minimizing the damage of surrounding healthy structures. Several solutions have already proved their effectiveness in improving treatment outcomes and in minimizing adverse events. However, it is still challenging to selectively remove the cancer. To help tackle this challenge, several groups of research are focusing on the use of thermometry for monitoring the effects on biological tissue of hyperthermal treatments, since the irreversible damage of tissue depends on temperature and time of application. Given the rising complexity of treatment settings, a temperature feedback may be useful to improve the clinical outcome by minimizing the thermal damage of surrounding healthy tissue. Fiber Bragg grating (FBG) sensors are used in this scenario thanks to several advantages, such as the small size, Magnetic Resonance (MR) compatibility and the possibility to perform spatially distributed measurements; moreover, with the use of specific coating their thermal sensitivity may be increased. However, they are fragile and their insertion within the organ can be challenging and time consuming. In this paper we describe the fabrication of three thermal probes embedding FBG sensors. Each probe consists of a MR-compatible needle which embeds a FBG sensor glued with epoxy adhesive. The three probes showed a sensitivity of about 24 pm/°C, which his higher than the one showed by non-encapsulated FBG (about 10 pm/°C). Moreover, the output of the three probes showed a negligible output drift and a negligible sensitivity drift after 4 thermal cycles in a wide range of temperature (i.e., from environmental temperature up to about 80 °C). The investigated solution shows some advantages considering the specific field of application: it allows an easy insertion within the organ being embedded within a needle; the probes' sensitivity is better than non-encapsulated FBGs; it can be used also during MR-guided procedures since both the needle and the FBG are MR-compatible. Future testing will assess the feasibility for temperature monitoring during thermal ablation treatment of the probes in ex vivo and in vivo animal model. © 2017 IEEE.


Saccomandi P.,Institute for Image guided Surgery | Zollo L.,Biomedical University of Rome | Ciancio A.L.,Biomedical University of Rome | Schena E.,Biomedical University of Rome | And 4 more authors.
I2MTC 2017 - 2017 IEEE International Instrumentation and Measurement Technology Conference, Proceedings | Year: 2017

Microfabricated tactile sensors gain importance for their application in bio-robotics. They are useful for the measurement of contact properties, in particular force and pressure, in three main fields, i.e., prosthetics and artificial skin, minimal access surgery and collaborative robotics. Among the different technological solutions, piezoresistive materials proved to be suitable for such an application. These materials show a change of electrical resistivity as a function of the applied strain. This work describes the design of a 2×2 array of piezoresistive elements and the experimental setup arranged for the array characterization, intended to be embedded within an artificial fingertip. The size of the bare array is 1.5×1.5×0.65 mm3. The finger has been designed to bio-mimic the behaviour of a human finger tip, thanks to the external layer of dragon skin. The static calibration of the sensors has been carried out by applying quasistatic normal loads on the mesa of each sensor of the array in two configurations (i.e., bare array and the array embedded in a fingertip). The sensors showed a linear response; the sensitivity ranges from 34 mV/N to 65 mV/N for the bare array, and from 16 mV/N to 39 mV/N for the array in the fingertip. No significant cross-talk (∼2%) has been observed during the test on the bare array. Further tests will be designed to characterize the response to tangential loads and assess the dynamic response of the sensors, as well as additional features which can be crucial for bio-robotic applications. © 2017 IEEE.


Diana M.,Institute for Image Guided Surgery
Progress in Biomedical Optics and Imaging - Proceedings of SPIE | Year: 2016

Pre-anastomotic bowel perfusion is a key factor for a successful healing process. Clinical judgment has limited accuracy to evaluate intestinal microperfusion. Fluorescence videography is a promising tool for image-guided intraoperative assessment of the bowel perfusion at the future anastomotic site in the setting of minimally invasive procedures. The standard configuration for fluorescence videography includes a Near-Infrared endoscope able to detect the signal emitted by a fluorescent dye, more frequently Indocyanine Green (ICG), which is administered by intravenous injection. Fluorescence intensity is proportional to the amount of fluorescent dye diffusing in the tissue and consequently is a surrogate marker of tissue perfusion. However, fluorescence intensity alone remains a subjective approach and an integrated computer-based analysis of the over-time evolution of the fluorescence signal is required to obtain quantitative data. We have developed a solution integrating computer-based analysis for intra-operative evaluation of the optimal resection site, based on the bowel perfusion as determined by the dynamic fluorescence intensity. The software can generate a "virtual perfusion cartography", based on the "fluorescence time-to-peak". The virtual perfusion cartography can be overlapped onto real-time laparoscopic images to obtain the Enhanced Reality effect. We have defined this approach FLuorescence-based Enhanced Reality (FLER). This manuscript describes the stepwise development of the FLER concept. © 2016 SPIE.


Liu Y.-Y.,Research Institute Against Cancer of the Digestive System | Liu Y.-Y.,Chang Gung University | Pop R.,Institute for Image Guided Surgery | Diana M.,Research Institute Against Cancer of the Digestive System | And 6 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2016

Background: Despite intensive preoperative localization workouts, intraoperative localization of the bleeding source in case of obscure gastrointestinal bleeding (OGIB) can be cumbersome and time-consuming. Our aim was to assess the feasibility of image-guided laparoscopic identification of the small bowel loop containing the bleeding source with and without near-infrared angiographic enhancement. Materials and methods: Angiography of superior mesenteric artery (SMA) branches was performed in 11 pigs using a right femoral artery approach, followed by a three-port laparoscopy, using a near-infrared-equipped laparoscope. Two pigs were used to identify the optimal intra-arterial indocyanine green (ICG) dose. Eight pigs were divided into two groups: ICG near-infrared angiography-assisted laparoscopy (n = 4) and fluoroscopic-assisted laparoscopy (n = 4). Finally, in one pig, a novel OGIB model was created and used to evaluate the ICG enhancement pattern in the presence of active bleeding. Results: Mean time to identify the fluorescence signal from the small bowel segment fed by the catheterized SMA branch was 13.75 ± 7.8 s, which was statistically significantly shorter than the time required to identify the tip of the catheter by fluoroscopic guidance, i.e., 243.25 ± 107 s (p = 0.02). Conclusions: Near-infrared fluorescence angiography using intra-arterial ICG injection provides a fast image-guided intraoperative localization of the small bowel loop fed by the arterial territory identified as bleeding by digital subtraction angiography and could help target the bleeding source during OGIB surgery. © 2015, Springer Science+Business Media New York.


Diana M.,Institute for Research Against Cancer of the Digestive System | Diana M.,Institute for Image Guided Surgery | Usmaan H.,Institute for Image Guided Surgery | Legner A.,Institute for Image Guided Surgery | And 8 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2016

Introduction: Bile leakage is a serious complication occurring in up to 10 % of hepatic resections. Intraoperative detection of bile leakage is challenging, and concomitant blood oozing can mask the presence of bile. Intraductal dye injection [methylene blue or indocyanine green (ICG)] is a validated technique to detect bile leakage. However, this method is time-consuming, particularly in the laparoscopic setting. A novel narrow band imaging (NBI) modality (SPECTRA-A; Karl Storz, Tuttlingen, Germany) allows easy discrimination of the presence of bile, which appears in clear orange, by image processing. The aim of this experimental study was to evaluate SPECTRA-A ability to detect bile leakage. Methods: Twelve laparoscopic partial hepatectomies were performed in seven pigs. The common bile duct was clipped distally and dissected, and a catheter was inserted and secured with a suture or a clip. Liver dissection was achieved with an ultrasonic cutting device. Dissection surfaces were checked by frequently switching on the SPECTRA filter to identify the presence of bile leakage. Intraductal ICG injection through the catheter was performed to confirm SPECTRA findings. Results: Three active bile leakages were obtained out of 12 hepatectomies and successfully detected intraoperatively by the SPECTRA. There was complete concordance between NBI and ICG fluorescence detection. No active leaks were found in the remaining cases with both techniques. The leaking area identified was sutured, and SPECTRA was used to assess the success of the repair. Conclusions: The SPECTRA laparoscopic image processing system allows for rapid detection of bile leaks following hepatectomy without any contrast injection. © 2015, Springer Science+Business Media New York.


PubMed | Institute for Image Guided Surgery and Research Institute Against Cancer of the Digestive System
Type: Journal Article | Journal: Surgical endoscopy | Year: 2016

Despite intensive preoperative localization workouts, intraoperative localization of the bleeding source in case of obscure gastrointestinal bleeding (OGIB) can be cumbersome and time-consuming. Our aim was to assess the feasibility of image-guided laparoscopic identification of the small bowel loop containing the bleeding source with and without near-infrared angiographic enhancement.Angiography of superior mesenteric artery (SMA) branches was performed in 11 pigs using a right femoral artery approach, followed by a three-port laparoscopy, using a near-infrared-equipped laparoscope. Two pigs were used to identify the optimal intra-arterial indocyanine green (ICG) dose. Eight pigs were divided into two groups: ICG near-infrared angiography-assisted laparoscopy (n=4) and fluoroscopic-assisted laparoscopy (n=4). Finally, in one pig, a novel OGIB model was created and used to evaluate the ICG enhancement pattern in the presence of active bleeding.Mean time to identify the fluorescence signal from the small bowel segment fed by the catheterized SMA branch was 13.757.8s, which was statistically significantly shorter than the time required to identify the tip of the catheter by fluoroscopic guidance, i.e., 243.25107s (p=0.02).Near-infrared fluorescence angiography using intra-arterial ICG injection provides a fast image-guided intraoperative localization of the small bowel loop fed by the arterial territory identified as bleeding by digital subtraction angiography and could help target the bleeding source during OGIB surgery.


PubMed | Institute for Research Against Cancer of the Digestive System and Institute for Image Guided Surgery
Type: Journal Article | Journal: Surgical endoscopy | Year: 2016

Bile leakage is a serious complication occurring in up to 10% of hepatic resections. Intraoperative detection of bile leakage is challenging, and concomitant blood oozing can mask the presence of bile. Intraductal dye injection [methylene blue or indocyanine green (ICG)] is a validated technique to detect bile leakage. However, this method is time-consuming, particularly in the laparoscopic setting. A novel narrow band imaging (NBI) modality (SPECTRA-A; Karl Storz, Tuttlingen, Germany) allows easy discrimination of the presence of bile, which appears in clear orange, by image processing. The aim of this experimental study was to evaluate SPECTRA-A ability to detect bile leakage.Twelve laparoscopic partial hepatectomies were performed in seven pigs. The common bile duct was clipped distally and dissected, and a catheter was inserted and secured with a suture or a clip. Liver dissection was achieved with an ultrasonic cutting device. Dissection surfaces were checked by frequently switching on the SPECTRA filter to identify the presence of bile leakage. Intraductal ICG injection through the catheter was performed to confirm SPECTRA findings.Three active bile leakages were obtained out of 12 hepatectomies and successfully detected intraoperatively by the SPECTRA. There was complete concordance between NBI and ICG fluorescence detection. No active leaks were found in the remaining cases with both techniques. The leaking area identified was sutured, and SPECTRA was used to assess the success of the repair.The SPECTRA laparoscopic image processing system allows for rapid detection of bile leaks following hepatectomy without any contrast injection.

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