title: Visual enhancement of laparoscopic partial nephrectomy with 3-charge coupled device camera: assessing intraoperative tissue perfusion and vascular anatomy by visible hemoglobin spectral response.
abstract: OBJECTIVE
  We report the novel use of 3-charge coupled device camera technology to infer tissue oxygenation. The technique can aid surgeons to reliably differentiate vascular structures and noninvasively assess laparoscopic intraoperative changes in renal tissue perfusion during and after warm ischemia.
  
  
  METHODS
  We analyzed select digital video images from 10 laparoscopic partial nephrectomies for their individual 3-charge coupled device response. We enhanced surgical images by subtracting the red charge coupled device response from the blue response and overlaying the calculated image on the original image. Mean intensity values for regions of interest were compared and used to differentiate arterial and venous vasculature, and ischemic and nonischemic renal parenchyma.
  
  
  RESULTS
  The 3-charge coupled device enhanced images clearly delineated the vessels in all cases. Arteries were indicated by an intense red color while veins were shown in blue. Differences in mean region of interest intensity values for arteries and veins were statistically significant (p >0.0001). Three-charge coupled device analysis of pre-clamp and post-clamp renal images revealed visible, dramatic color enhancement for ischemic vs nonischemic kidneys. Differences in the mean region of interest intensity values were also significant (p <0.05).
  
  
  CONCLUSIONS
  We present a simple use of conventional 3-charge coupled device camera technology in a way that may provide urological surgeons with the ability to reliably distinguish vascular structures during hilar dissection, and detect and monitor changes in renal tissue perfusion during and after warm ischemia.
authors: Department of Regenerative Medicine, Combat Casualty Care, Naval Medical Research Center, Uniformed Services University, Silver Spring, Maryland 20910, USA.
authors: Nicole J
authors: NJ
authors: Crane
authors: Suzanne M
authors: SM
authors: Gillern
authors: Kambiz
authors: K
authors: Tajkarimi
authors: Ira W
authors: IW
authors: Levin
authors: Peter A
authors: PA
authors: Pinto
authors: Eric A
authors: EA
authors: Elster
mesh_terms: D004867:Equipment Design; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D007432:Intraoperative Period; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D012039:Regional Blood Flow; D020535:Video-Assisted Surgery / Q000295:instrumentation*
chemical_list: D006454:Hemoglobins