Intraoperative video-fluorescence navigation and tissue saturation control of gastric malignant tumor
Kustov D.M.1, Yakovlev D.V.1,2, Moskalev A.S.1, Kozlikina E.I.1,3, Loshchenov M.V.1,3, Kalyagina N.A.1,3, Blondel W.4, Daul C.4, Amouroux M.4, Levkin V.V.5, Kharnas S.S.5, Shiryaev A.A.5, Loschenov V.B.1,3; 1 Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia, 2 Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Science, IBCh RAS, Moscow, Russia, 3 National Research Nuclear University MEPhI, Moscow, Russia, 4 Université de Lorraine, Lorraine, France, 5 I.M. Sechenov First Moscow State Medical University, Moscow, Russia
Abstract
Purpose
The main purpose of the work was to implement an complex approach to diagnostics by using video-fluorescence navigation with spectroscopic control of tissue saturation (StO2) of stomach malignant tumor.
Materials and methods
Video fluorescence navigation was performed by two-channel video-fluorescence system consists of white light source and laser source with 635 nm wavelength, a system of light filters, and a rigid endoscope. Tissue saturation was analyzed by using a spectroscopic setup, which consisted of a source of visible broadband light, a spectrometer with a fiber optic input, a fiber optic probe, and a PC with special software for recording and processing spectra. The study was conducted on the basis of the Faculty Surgical Clinic No. N.N. Burdenko of the First Moscow State Medical University named after I.M. Sechenov on 5 volunteers diagnosed with a malignant tumor of the stomach cardia. The photosensitizer used was protoporphyrin 9, induced 5-aminolevulinic acid (PpIX), which was administered to patients sublingually 4 hours before diagnostics at a concentration of 20 mg/kg.
Results
After data processing, the accumulation of PpIX in the tumor tissue was determined: in each case PpIX concentration was in the range 3 to 5 mg/kg. Resection with following anastomosis was performed for each patient. StO2 at study points after anastomosis was comparable to values before mobilization at the operation beginning.
Conclusion
This approach was made it possible to carry out fluorescent navigation inside the stomach by the PS accumulation in the tumor tissue and to identify fluorescent areas that were not visible during visual gastroscopic examination. At the same time, the monitoring of tissue saturation at the studied points was made it possible to avoid anastomosis failure.
Acknowledgments
The reported study was funded by RFBR and CNRS, project number 21-58-15005.
Speaker
Kustov Daniil
GPI RAS
Russia
Discussion
Ask question
