Wido Heeman1,2,3, Aurelia C L Wildeboer4,5, Mahdi Al-Taher6,7, Joost E M Calon8, Laurents P S Stassen9,10, Michele Diana11, Joep P M Derikx12, Gooitzen M van Dam13, E Christiaan Boerma14, Nicole D Bouvy9,10. 1. Faculty Campus Fryslân, University of Groningen, Leeuwarden, 8911 CE, The Netherlands. w.t.heeman@umcg.nl. 2. Department of Surgery, Optical Molecular Imaging Groningen, University Medical Centre Groningen, Groningen, 9713 GZ, The Netherlands. w.t.heeman@umcg.nl. 3. LIMIS Development BV, Leeuwarden, 8934 AD, The Netherlands. w.t.heeman@umcg.nl. 4. Department of Pediatric Surgery, Amsterdam UMC, 1105 AZ, Amsterdam UMC, The Netherlands. a.wildeboer@maastrichtuniversity.nl. 5. GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht, 6229 ER, The Netherlands. a.wildeboer@maastrichtuniversity.nl. 6. IRCAD, Research Institute Againstgainst Digestive Cancer, 67000, Strasbourg, France. mahdi.altaher@mumc.nl. 7. Department of Surgery, Maastricht University Medical Center, Maastricht, 6200 MD, The Netherlands. mahdi.altaher@mumc.nl. 8. ZiuZ Visual Intelligence BV, Gorredijk, 8401 DK, The Netherlands. 9. Department of Surgery, Maastricht University Medical Center, Maastricht, 6200 MD, The Netherlands. 10. NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, 6229 HX, The Netherlands. 11. IRCAD, Research Institute Againstgainst Digestive Cancer, 67000, Strasbourg, France. 12. Department of Pediatric Surgery, Amsterdam UMC, 1105 AZ, Amsterdam UMC, The Netherlands. 13. Department of Surgery, Optical Molecular Imaging Groningen, University Medical Centre Groningen, Groningen, 9713 GZ, The Netherlands. 14. Medical Centre Leeuwarden, Department of Intensive Care, Leeuwarden, 8934 AD, The Netherlands.
Abstract
BACKGROUND: Ischemia at the site of an intestinal anastomosis is one of the most important risk factors for anastomotic leakage (AL). Consequently, adequate intestinal microperfusion is essential for optimal tissue oxygenation and anastomotic healing. As visual inspection of tissue viability does not guarantee an adequate objective evaluation of intestinal microperfusion, surgeons are in dire need of supportive tools to decrease anastomotic leakage after colorectal surgery. METHODS: In this feasibility study, laparoscopic laser speckle contrast imaging (LSCI) was used to evaluate intestinal microperfusion in an experimental ischemic bowel loop model. Both large and small ischemic loops were created from the small intestine of a pig; each loop was divided into 5 regions of interest (ROI) with varying levels of ischemia. Speckle contrast and local capillary lactate (LCL) was measured in all ROIs. RESULTS: Both real-time visualization of intestinal microperfusion and induced perfusion deficits was achieved in all bowel loops. As a result, the emergence of regions of intestinal ischemia could be predicted directly after iatrogenic perfusion limitation, whereas without LSCI signs of decreased intestinal viability could only be seen after 30 minutes. Additionally, a significant relation was found between LCL and LSCI. CONCLUSION: In conclusion, LSCI can achieve real-time intraoperative visualization of intestinal microperfusion deficits, allowing for accurate prediction of long-term postoperative ischemic complications. With this revealing capacity, LSCI could potentially facilitate surgical decision-making when constructing intestinal anastomoses in order to mitigate ischemia-related complications such as AL.
BACKGROUND: Ischemia at the site of an intestinal anastomosis is one of the most important risk factors for anastomotic leakage (AL). Consequently, adequate intestinal microperfusion is essential for optimal tissue oxygenation and anastomotic healing. As visual inspection of tissue viability does not guarantee an adequate objective evaluation of intestinal microperfusion, surgeons are in dire need of supportive tools to decrease anastomotic leakage after colorectal surgery. METHODS: In this feasibility study, laparoscopic laser speckle contrast imaging (LSCI) was used to evaluate intestinal microperfusion in an experimental ischemic bowel loop model. Both large and small ischemic loops were created from the small intestine of a pig; each loop was divided into 5 regions of interest (ROI) with varying levels of ischemia. Speckle contrast and local capillary lactate (LCL) was measured in all ROIs. RESULTS: Both real-time visualization of intestinal microperfusion and induced perfusion deficits was achieved in all bowel loops. As a result, the emergence of regions of intestinal ischemia could be predicted directly after iatrogenic perfusion limitation, whereas without LSCI signs of decreased intestinal viability could only be seen after 30 minutes. Additionally, a significant relation was found between LCL and LSCI. CONCLUSION: In conclusion, LSCI can achieve real-time intraoperative visualization of intestinal microperfusion deficits, allowing for accurate prediction of long-term postoperative ischemic complications. With this revealing capacity, LSCI could potentially facilitate surgical decision-making when constructing intestinal anastomoses in order to mitigate ischemia-related complications such as AL.
Authors: Zaid Al-Difaie; Nariaki Okamoto; Max H M C Scheepers; Didier Mutter; Laurents P S Stassen; Nicole D Bouvy; Jacques Marescaux; Bernard Dallemagne; Michele Diana; Mahdi Al-Taher Journal: Surg Endosc Date: 2022-10-18 Impact factor: 3.453