Acute Cholecystitis, Colorectal Cancer, Diverticulitis, Colonic, Inflammatory Bowel Diseases, Obesity, Morbid
Conditions
Keywords
laparoscopic, robot assisted surgery, gastrointestinal anastomoses, cholecystectomy, colorectal surgery, bariatric surgery, vascularity, perfusion, ICG, laser speckle contrast imaging
Brief summary
ActivSightTM combines an innovative form factor and proprietary software to deliver precise, objective, real-time visualization of blood flow and tissue perfusion intraoperatively for laparoscope-based surgery. A small adaptor that fits between any existing laparoscope and camera systems and a separate light source placed along any current commercial system will deliver objective real-time tissue perfusion and blood flow information intraoperatively. Primary Objective: To determine safety and feasibility of ActivSightTM in displaying tissue perfusion in intestinal anastomoses including colorectal and bariatric surgery. Secondary Objective: To determine the efficacy of ActivSightTM in; (1) displaying tissue vascularity and perfusion in comparison to indocyanine green (ICG) during gastrointestinal anastomoses; and (2) displaying biliary tree during laparoscopic cholecystectomy using ICG-based intraoperative cholangiography (IOC).
Detailed description
Design: * This is a feasibility study designed to evaluate safety and feasibility of ActivSightTM in gastrointestinal anastomoses and cholecystectomy. * Safety will be determined through clinical assessments and evaluation of any adverse event. * Feasibility will be determined through technically successful completion of intended visualization. * Assessment of preliminary efficacy will be performed through analysis of any intraoperative decisions made based on visual display as compared to standard endoscopic approach, or non-inferiority to ICG-based visualization and usability. * Patients outcome and follow up to Postoperative day 28 will be monitored for clinical outcome. * Target enrollment for the assessment of 80 patients; 52 evaluating intestinal anastomoses cases (including bariatric and colorectal cases); and 28 evaluating laparoscopic cholecystectomy. Stopping rules are triggered following the first 6 patients and a comparison group 6 patients in ICG-based treatment.
Interventions
DEVICEActivSight
Use of ActivSight in patients undergoing laparoscopic or robot assisted intestinal anastomoses and patients undergoing laparoscopic or robot assisted cholecystectomy.
Sponsors
The University of Texas Health Science Center, Houston
University at Buffalo
Ohio State University
Activ Surgical
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DEVICE_FEASIBILITY
Masking
NONE
Intervention model description
Target enrollment is 80 patients. Feasibility will be studied under two categories of operations: feasibility in patients undergoing intestinal anastomoses for bariatric or colorectal surgery (n=52); and feasibility in patients undergoing cholecystectomy (n=28).
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* All patients age \>= 18 years old undergoing laparoscopic or robot assisted intestinal anastomoses, or all patients age \>= 18 years old who are planned for laparoscopic cholecystectomy; spoken command and literacy in the native language spoken at each participating center; ability to understand and follow study procedures; and having provided signed consent. * Diagnosis: * All patients with a clinical suspicion and diagnosis of benign or malignant, small or large bowel lesions requiring surgical resection. * All patients with clinical suspicion and diagnosis of symptomatic cholelithiasis or cholecystitis planned for cholecystectomy. * Typical imaging as per standard workup findings including US, CT and/or MRI. Plain radiographs and contrast imaging may be obtained by referring physicians and are helpful for confirming the clinical diagnosis. * Any bariatric patients undergoing gastric sleeve or bypass. * Any pediatric patient undergoing laparotomy for necrotizing enterocolitis * Location of pathology or resected segment: * Target lesions can be located in any fore-, mid- or hindgut segments requiring reconstruction and anastomoses. * Prior therapy: * Patients with prior surgery are eligible for enrollment. * Laboratory: * Hemoglobin \> 9 g/dL * Platelet count ≥75,000/μL (may receive transfusions) * Normal prothrombin time, tested prothrombin, and international normalized ratio \< 1.5 x upper limit of normal (ULN) (including patients on prophylactic anticoagulation) * Renal function: Age-adjusted normal serum creatinine derived from Schwartz formula for estimating glomerular filtration rate by the Centers for Disease Control (CDC) or a creatinine clearance ≥60 mL/min/1.73 m2 for safe * Adequate pulmonary function: Defined as no dyspnea at rest, and a pulse oximetry \>94% on room air if there is clinical indication for determination.
Exclusion criteria
* There is no
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Support personnel satisfaction with ActivSightTM, as quantified by Likert scale. | 1 day | Likert scale ratings will serve as an outcome for feasibility. Scale 1-5 question (1=strongly disagree, 2=slightly disagree, 3=neutral, 4=slightly agree, 5=strongly agree): ActivSightTM was easy to set up for the procedure. |
| Resolution of display of ActivSightTM. | 1 day | Rate on a scale of 1-5 (1 = Difficult to use or Unsatisfied - 5 = no training required or very satisfied): How was the display quality of ActivSight on the intended field and target tissue of interest? |
| Specificity of display of ActivSightTM. | 1 day | Specificity of display will serve as an outcome for feasibility. Yes/No question for surgeon: Does the perfusion information displayed by ActivSightTM reflect the expected pattern of blood flow interruption? |
| Usability of ActivSightTM by surgeon, as quantified by Likert scale. | 1 day | Likert scale ratings will serve as an outcome for feasibility. Scale 1-5 question (1=strongly disagree, 2=slightly disagree, 3=neutral, 4=slightly agree, 5=strongly agree): ActivSightTM was easy to use while operating. |
| Incidence of Adverse Events in 28 days following use of ActivSightTM | 28 days | To determine safety of ActivSightTM in patients undergoing intestinal anastomoses, as defined through clinical assessments and evaluation of use related adverse events intraoperatively and a routine follow up at 28 days following surgery. ActivSightTM will be deemed safe if hardware (adaptor or light source)-related major (serious) adverse event is encountered in the treated patients and if less than 2 hardware-related minor adverse events are encountered. Adverse events will be summarized descriptively and tabulations on the type, severity, and relationship to application will be performed and any changes of outcomes from baseline on follow up will be examined using the nonparametric Wilcoxon rank test. |
| Preparation time of ActivSightTM. | 1 day | Rate on a scale of 1-5 (1 = Difficult to use or Unsatisfied - 5 = no training required or very satisfied): How easy was ActivSight to set up? |
| Latency of display of ActivSightTM. | 1 day | Rate on a scale of 1-5 (1 = Difficult to use or Unsatisfied - 5 = no training required or very satisfied): How specifically did ActivSight display the intended field and the target tissue of interest? |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ability of ActivSightTM to display blood vessels. | 1 day | ActivSightTM ability to display blood vessels during gastrointestinal anastomoses is measured by the following Yes/No question for the surgeon: Does ActivSightTM display vascularity of the anatomy during anastomoses in comparison to ICG? |
| Ability of ActivSightTM to display biliary tree. | 1 day | The clinical metrics for displaying biliary tree will be evaluated using the following question: Which of the following biliary structures are you able to identify using ActivSightTM with ICG? (Select all that apply): common bile duct (CD), right hepatic duct (RHD), common hepatic duct (CHD), common bile duct (CBD), cystic common bile duct junction (CCBDJ), cystic gallbladder junction (CGJ), accessory ducts (AD). |
| Ability of ActivSightTM to display perfusion. | 1 day | ActivSightTM ability to display perfusion at a tissue level during gastrointestinal anastomoses is measured by the following Yes/No question for the surgeon: Does ActivSightTM display tissue perfusion of the anatomy during anastomoses in comparison to ICG? |
Countries
United States
Outcome results
None listed