Viability measurement of living tissue: The prevention and early detection of anastomotic leakage (DGT.6672)

Project nummer: dgt6672

Omschrijving van het onderzoek

Many patients still die every year as a result of leakage of esophagus, gastro-intestinal and hepatopancreatico-biliary anastomoses. An anastomosis is the surgical joining of parts of the bowel or of other organs to make them continuous and is an ongoing problem, showing a high morbidity and mortality and involving tremendous costs. In general, on average 3-12% of all abdominal anastomoses leak, with the highest occurrences for leakage being observed for rectum resection (10%), pancreas surgery (8%) and esophagus resection (5%). More specific, in the case of leakage of rectum (terminal part of the large intestine) anastomoses, statistics show a mortality of 10-20% and a morbidity of 30-50%. In conclusion, anastomotic leakage is the main, yet unsolved reason for the major lethal risk in abdominal surgery. To date there are limited tools available to the surgeons to assess the quality of the anastomosis during operation and during the post-operative phase. The medical world needs an aid to detect leakage both during the operation and during the critical recovery period. Considering the large number of complications this could lead to a major contribution to medicine. This project aims to bring together the engineering solutions and the medical research by combining the expertise of the Electronic Instrumentation Laboratory in Delft with the Department of Surgery in the Academic Hospital of the Erasmus University of Rotterdam. We propose a breakthrough by the development of a miniaturised measurement system able to detect adequate tissue oxygenation directly and continuously on the colon. The system should aid the surgeon during the operation to reduce the number of complications requiring a second operation (construction of an artificial anus/stoma) and further, in cases where there are still complications, to give a fast warning so that the problem can be tackled quickly to save the patient or prevent irreparable damage. A further aspect of this project will be a clinical study of the drain fluid performed on patients at the Erasmus Medical Centre in Rotterdam.
The sensor systems developed for preoperative use will forecast the start of the healing process. In the research stage, these sensors will be placed at the anastomotic site in a pig/rat model and will remain in place after the operation, for monitoring tissue oxygenation and local temperature to indicate infection and leakage. By using a novel transponder, there is no need for a battery to power the sensor system and the data can be transmitted wireless to outside the body. These sensors will remain at the anastomotic site in order to monitor the healing process for 4-7 days. Afterwards, the sensors will not be removed and therefore, it is important to perform long-term tests before these devices can be used in patients. Regarding the clinical study on drain fluids, in the research stage this will include PCR1 measurements, bacteria cultures, Raman spectroscopy, glucose and lactate levels. The role of this study is to identify the optimal measurement method for bacteria detection in the drain fluid. At a later stage, the most relevant combination of sensors should be incorporated into a bedside monitoring system.

Gebruikers

Six companies and one other university are involved in this project.

Projectleider

Prof.dr. P.J. French

Technische Universiteit Delft
Elektrotechniek, Wiskunde en Informatica
Lab. Elektronische Instrumentatie

Postbus 5031
2600 GA Delft

Status van het project

Gestart	: 01-06-2005
Einddatum	: 01-09-2008

Trefwoorden

Medische diagnostiek, Medische technologie, Sensor, Sensor technology, Sensortechnologie, Telemetrie.

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