title: Evaluation of intestinal viability using 3-charge coupled device image enhancement technology in a pediatric laparoscopic appendectomy model.
abstract: BACKGROUND
  Intraoperative laparoscopic determination of intestinal viability is currently limited to subjective visible cues. Adjunctive modalities are neither widely available nor practical. Three-charge coupled device (3-CCD) imaging directly correlates the amount of light detected by CCDs to tissue oxygenation. We hypothesize that application of 3-CCD image enhancement detects bowel ischemia in a pediatric laparoscopic appendectomy model.
  
  
  METHODS
  We recorded 10 laparoscopic appendectomies for appendicitis. Offline analysis involved selecting regions of interest (ROIs) in the appendix, adjacent colon, and nonappendiceal fat and calculating mean intensity values in selected images before and after division of the mesoappendix. The colon was used as a control, and the intensity values were normalized to fat.
  
  
  RESULTS
  As an indicator of decreased perfusion, the mean appendix ROI intensity values decreased over time (R(2) = 0.92) compared with the colon mean ROI intensity values, which remained stable. There was a statistically significant difference between fat-normalized intensity values for ischemic and nonischemic appendix after 1 minute.
  
  
  CONCLUSIONS
  We have demonstrated proof of principle for the determination of bowel ischemia using 3-CCD image enhancement. By quantitatively identifying areas of ischemia, this technique has the potential to significantly change the management of ischemic bowel in the future.
authors.affiliation: Walter Reed National Military Medical Center, Department of Surgery, Bethesda, MD 20889, USA.
authors.forename: Maridelle B
authors.initials: MB
authors.lastname: Millendez
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Crane
authors.forename: Eric A
authors.initials: EA
authors.lastname: Elster
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Safford
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007089:Image Enhancement; D007422:Intestines / Q000098:blood supply*; D007430:Intraoperative Care / Q000379:methods*; D007511:Ischemia / Q000175:diagnosis*; D010535:Laparoscopy