Near-infrared (NIR) imaging with indocyanine green (ICG) has proven to be useful in general, visceral, and transplant surgery. However, most studies have performed only qualitative assessments. Therefore, a systematic overview of all studies performing quantitative indocyanine green evaluation in general, visceral, and transplant surgeries should be conducted. Free term and medical subject heading (MeSH) term searches were performed in the Medline and Cochrane databases until October 2022. The main categories of ICG quantification were esophageal surgery (24.6%), reconstructive surgery (24.6%), and colorectal surgery (21.3%). Concordantly, anastomotic leak (41%) was the main endpoint, followed by the assessment of flap perfusion (23%) and the identification of structures and organs (14.8%). Most studies examined open surgery (67.6%) or laparoscopic surgery (23.1%). The analysis was mainly carried out using manufacturer software (44.3%) and open-source software (15.6%). The most frequently analyzed parameter was intensity over time for blood flow assessment, followed by intensity alone or intensity-to-background ratios for structure and organ identification. Intraoperative ICG quantification could become more important with the increasing impact of robotic surgery and machine learning algorithms for image and video analysis.

This retrospective analysis aimed to assess and compare the short-term perioperative outcomes and morbidity of hybrid and full-Robotic-Assisted Minimally Invasive Esophagectomy (RAMIE) surgical techniques. A total of 168 robotic-assisted Ivor Lewis esophagectomy procedures performed at Muenster University Hospital were included in the study, with 63 cases in the hybrid group and 105 cases in the full-robotic group. Demographic factors, comorbidities, and tumor stages showed no significant differences between the two groups. However, the full-RAMIE technique demonstrated superiority in terms of overall operative time, postoperative pain levels, and patient morphine consumption. Additionally, the full-RAMIE group exhibited better perioperative outcomes, with significantly shorter ICU stays and fewer occurrences of pneumonias and severe complications. While there was a trend favoring the full-RAMIE technique in terms of severe postoperative complications and anastomotic insufficiencies, further research is required to establish it as the gold standard surgical technique for Ivor Lewis esophagectomy.

In vivo tissue engineering (TE) techniques like the AV loop model provide an isolated and well-defined microenvironment to study angiogenesis-related cell interactions. Functional visualization of the microvascular network within these artificial tissue constructs is crucial for the fundamental understanding of vessel network formation and to identify the underlying key regulatory mechanisms. To facilitate microvascular tracking advanced fluorescence imaging techniques are required. We studied the suitability of microporous polylactic acid (PLA) scaffolds with known low autofluorescence to form axial vascularized tissue constructs in the AV loop model and to validate these scaffolds for fluorescence-based perfusion imaging. Compared to commonly used collagen elastin (CE) scaffolds, the total number of vessels and cells in PLA scaffolds was lower. In detail, CE-based constructs exhibited significantly higher vessel numbers on day 14 and 28 (d14: 316 ± 53; d28: 610 ± 74) compared to the respective time points in PLA-based constructs (d14: 144 ± 18; d28: 327 ± 34; each p < 0.05). Analogously, cell counts in CE scaffolds were higher compared to corresponding PLA constructs (d14: 7661.25 ± 505.93 and 5804.04 ± 716.59; d28: 11211.75 + 1278.97 and 6045.71 ± 572.72, p < 0.05). CE scaffolds showed significantly higher vessel densities in proximity to the main vessel axis compared to PLA scaffolds (200–400 µm and 600–800 µm on day 14; 400–1000 µm and 1400–1600 µm on day 28). CE scaffolds had significantly higher cell counts on day 14 at distances from 800 to 2000 µm and at distances from 400 to 1600 µm on day 28. While the total number of vessels and cells in PLA scaffolds were lower, both scaffold types were ideally suited for axial vascularization techniques. The intravascular perfusion of PLA-based constructs with fluorescence dye MHI148-PEI demonstrated dye specificity against vascular walls of low- and high-order branches as well as capillaries and facilitated the fluorescence-based visualization of microcirculatory networks. Fluorophore tracking may contribute to the development of automated quantification methods after 3D reconstruction and image segmentation. These technologies may facilitate the characterization of key regulators within specific subdomains and add to the current understanding of vessel formation in axially vascularized tissue constructs.

Intraoperative indocyanine green imaging has emerged as a powerful tool for assessing gastric conduit perfusion during open and minimally invasive esophagectomy. Although delayed perfusion correlates with the development of anastomotic leakage, indocyanine green assessments have high surgeon-dependent interuser variability. Therefore, quantitative indocyanine green analysis is recommended. We present a quantitative indocyanine green analysis using an unsupervised, self-organizing map cluster network during robotic-assisted minimally invasive esophagectomy. In total, 70 patients treated with robotic-assisted minimally invasive esophagectomy, intraoperative indocyanine green imaging, and prophylactic endoluminal vacuum therapy were included in the study. The occurrence of anastomotic leakage, cycles of endoluminal vacuum therapy, patient comorbidities, and arteriosclerosis shown on preoperative computed tomography scans was recorded. The recorded videos of intraoperative indocyanine green imaging were clustered using an unsupervised, self-organizing map network, and an indocyanine green perfusion score was determined. The indocyanine green perfusion score, as well as patient age and body mass index, correlated with an increased risk of anastomotic leakage in the univariate analysis. Other comorbidities and the extent of arteriosclerosis in preoperative computed tomography scans did not differ in patients with and without anastomotic leakage. An unsupervised learning approach to quantify intraoperative indocyanine green imaging could aid the prediction of anastomotic leakage after robotic-assisted minimally invasive esophagectomy in future treatments. However, the value of this approach needs to be clarified in a randomized, controlled prospective study.

Purpose: Peritoneal dialysis has been demonstrated to be a cost-effective modality of dialysis treatment, providing a greater quality of life in comparison to hemodialysis. However, complications associated with the peritoneal dialysis catheter (PD catheter) can lead to increased patient morbidity and thus the necessity of PD catheter removal. While prior studies have identified patient-related risk factors, the impact of various surgical risk factors on technical survival is yet to be elucidated. Methods: A retrospective, monocentric cohort study was conducted including all patients who underwent PD catheter implantation through an open surgical technique utilizing a small surgical incision above the rectus abdominis muscle from January 2010 to March 2022. The technical survival of PD catheters was observed retrospectively over a period of three years and the reasons for PD catheter removal were summarized. Furthermore, Cox regression analysis was conducted to evaluate potential risk factors for a reduced technical survival. Results: A total of 340 patients were included, and a median PD catheter functionality of 980 days was presented in this study. The main reasons for PD catheter removal included infectious complications and mechanical malfunctions. Postoperative revision was identified as a significant risk factor for a reduced technical survival. Conclusion: PD catheter implantation through a small surgical incision showed a high long-term functionality regardless of prior abdominal surgery, prior PD catheter implantation, or the necessity of adhesiolysis. Only postoperative revision was identified as a significant risk factor for PD catheter removal. Trial registration: The study was registered in the German clinical trial database (Application number DRKS00036575, registration date 19.05.2025). Graphical

Purpose: Proton pump inhibitors (PPIs) are indispensable in the treatment of gastro-esophageal reflux disease and peptic ulcers or for the prevention of stress ulcers after major abdominal surgery. However, long-term PPI therapy leads to several side effects such as delayed gastric emptying and distinct changes in mucosal histology. Therefore, this retrospective study aims to evaluate the impact of preoperative PPI therapy on the anastomotic leak rate after esophagectomy. Methods: A retrospective, single-center analysis was conducted for all patients treated with esophagectomy and gastric conduit reconstruction between January 2016 and November 2024. Preoperative treatment with PPIs, as well as patient comorbidities, histopathological findings and surgical techniques were noted. Subsequently, a group-wise comparison was carried out for the differences in anastomotic leak rate and postoperative complications in patients with and without preoperative PPI therapy. Finally, a multivariate logistic regression analysis was conducted for the occurrence of anastomotic leak. Results: A total of 229 patients were included in the study. The group-wise comparison revealed a significantly higher rate of anastomotic leaks and postoperative complications in patients with preoperative PPI therapy compared to those without. The multivariate logistic regression analysis indicated a 2.5-fold increased risk of anastomotic leaks in patients with preoperative PPI therapy compared to patients without. Conclusion: Preoperative PPI therapy may represent a modifiable risk factor for the development of anastomotic leaks after esophagectomy. Further prospective, interventional studies are necessary to verify the results. Trial registration: The study was retrospectively registered in the German clinical trial database (Application number DRKS00035536, Registration date 03.12.2024). Graphical