A F J de Bruin1, A L M Tavy2, K van der Sloot3, A Smits4, C Ince5, E C Boerma6, P G Noordzij2, D Boerma4, M van Iterson2. 1. Department of Anesthesiology, Intensive Care and Pain Medicine, St Antonius Hospital, Postbus 2500, 3430 EM, Nieuwegein, The Netherlands. a.de.bruin@antoniusziekenhuis.nl. 2. Department of Anesthesiology, Intensive Care and Pain Medicine, St Antonius Hospital, Postbus 2500, 3430 EM, Nieuwegein, The Netherlands. 3. Department of Anesthesiologie and Pain Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands. 4. Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. 5. Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands. 6. Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
Abstract
BACKGROUND: Recognition of a non-viable bowel during colorectal surgery is a challenging task for surgeons. Identifying the turning point in serosal microcirculatory deterioration leading up to a non-viable bowel is crucial. The aim of the present study was to determine whether sidestream darkfield (SDF) imaging can detect subtle changes in serosal microcirculation of the sigmoid after vascular transection during colorectal surgery. METHODS: A prospective observational clinical study was performed at a single medical centre. All eligible participants underwent laparoscopic sigmoid resection and measurements were taken during the extra-abdominal phase. Microcirculation was measured at the transected bowel and 20 cm proximal to this point. Microcirculatory parameters such as Microvascular Flow Index (MFI), proportion of perfused vessels (PPV), perfused vessel density (PVD), total vessel density (TVD) and the Heterogeneity Index were determined. Data are presented as median (interquartile range) or mean ± standard deviation. RESULTS: A total of 60 SDF images were acquired for 10 patients. Perfusion parameters and perfused vessel density were significantly lower at the transected bowel compared with the non-transected measurements [MFI 2.29 (1.96-2.63) vs 2.96 (2.73-3.00), p = 0.007; PPV 74% (55-83) vs 94% (86-97), p = 0.007; and PVD 7.61 ± 2.99 mm/mm2 versus 10.67 ± 1.48 mm/mm2, p = 0.009]. Total vessel density was similar between the measurement locations. CONCLUSIONS: SDF imaging can identify changes of the bowel serosal microcirculation. Significantly lower serosal microcirculatory parameters of the vascular transected bowel was seen compared with the non-transected bowel. The ability of SDF imaging to detect subtle differences holds promise for future research on microvascular cut-off values leading to a non-viable bowel.
BACKGROUND: Recognition of a non-viable bowel during colorectal surgery is a challenging task for surgeons. Identifying the turning point in serosal microcirculatory deterioration leading up to a non-viable bowel is crucial. The aim of the present study was to determine whether sidestream darkfield (SDF) imaging can detect subtle changes in serosal microcirculation of the sigmoid after vascular transection during colorectal surgery. METHODS: A prospective observational clinical study was performed at a single medical centre. All eligible participants underwent laparoscopic sigmoid resection and measurements were taken during the extra-abdominal phase. Microcirculation was measured at the transected bowel and 20 cm proximal to this point. Microcirculatory parameters such as Microvascular Flow Index (MFI), proportion of perfused vessels (PPV), perfused vessel density (PVD), total vessel density (TVD) and the Heterogeneity Index were determined. Data are presented as median (interquartile range) or mean ± standard deviation. RESULTS: A total of 60 SDF images were acquired for 10 patients. Perfusion parameters and perfused vessel density were significantly lower at the transected bowel compared with the non-transected measurements [MFI 2.29 (1.96-2.63) vs 2.96 (2.73-3.00), p = 0.007; PPV 74% (55-83) vs 94% (86-97), p = 0.007; and PVD 7.61 ± 2.99 mm/mm2 versus 10.67 ± 1.48 mm/mm2, p = 0.009]. Total vessel density was similar between the measurement locations. CONCLUSIONS:SDF imaging can identify changes of the bowel serosal microcirculation. Significantly lower serosal microcirculatory parameters of the vascular transected bowel was seen compared with the non-transected bowel. The ability of SDF imaging to detect subtle differences holds promise for future research on microvascular cut-off values leading to a non-viable bowel.
Authors: I Mizrahi; M Abu-Gazala; A S Rickles; L M Fernandez; A Petrucci; J Wolf; D R Sands; S D Wexner Journal: Tech Coloproctol Date: 2018-08-10 Impact factor: 3.781
Authors: Mehraneh D Jafari; Steven D Wexner; Joseph E Martz; Elisabeth C McLemore; David A Margolin; Danny A Sherwinter; Sang W Lee; Anthony J Senagore; Michael J Phelan; Michael J Stamos Journal: J Am Coll Surg Date: 2014-09-28 Impact factor: 6.113
Authors: Anthonius F J de Bruin; Arthur Tavy; Koene van der Sloot; Anke Smits; Bert Van Ramshorst; Christiaan E Boerma; Peter Kars; Peter G Noordzij; Djamila Boerma; Mat van Iterson Journal: J Vasc Res Date: 2016-10-04 Impact factor: 1.934
Authors: Frederic Ris; Roel Hompes; Chris Cunningham; Ian Lindsey; Richard Guy; Oliver Jones; Bruce George; Ronan A Cahill; Neil J Mortensen Journal: Surg Endosc Date: 2014-02-25 Impact factor: 4.584
Authors: Daniel De Backer; Steven Hollenberg; Christiaan Boerma; Peter Goedhart; Gustavo Büchele; Gustavo Ospina-Tascon; Iwan Dobbe; Can Ince Journal: Crit Care Date: 2007 Impact factor: 9.097
Authors: Margot Fodor; Lukas Lanser; Julia Hofmann; Giorgi Otarashvili; Marlene Pühringer; Benno Cardini; Rupert Oberhuber; Thomas Resch; Annemarie Weissenbacher; Manuel Maglione; Christian Margreiter; Philipp Zelger; Johannes D Pallua; Dietmar Öfner; Robert Sucher; Theresa Hautz; Stefan Schneeberger Journal: Transpl Int Date: 2022-05-16 Impact factor: 3.842
Authors: E B Kiseleva; M G Ryabkov; M A Sizov; E L Bederina; A D Komarova; A A Moiseev; M V Bagryantsev; A N Vorobiev; N D Gladkova Journal: Sovrem Tekhnologii Med Date: 2021-08-28