Wildeboer Aurelia, Heeman Wido, van der Bilt Arne, Hoff Christiaan, Calon Joost, Boerma E Christiaan, Al-Taher Mahdi, Bouvy Nicole
Department of Surgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands.
University Campus Fryslân, University of Groningen, 8911 CE Leeuwarden, The Netherlands.
Life (Basel). 2022 Aug 16;12(8):1251. doi: 10.3390/life12081251.
Intestinal resection causes inevitable vascular damage, which cannot always be seen during an intraoperative clinical assessment of local intestinal perfusion. If left unaltered, impaired perfusion can lead to complications, such as anastomotic leakage (AL). Therefore, we demonstrate the use of a novel laparoscopic laser speckle contrast imaging (LSCI)-based approach in order to assess local intestinal perfusion during the construction of intestinal anastomoses.
Three segments were isolated from the small intestine of a pig, while the perfusion of each was compromised by coagulating 7-8 mesenteric arteries. Both clinical assessments and LSCI were used to detect the induced perfusion deficits and to subsequently guide a transection in either a well perfused, marginally perfused, or poorly perfused tissue area within the segment. Bowel ends were then utilized for the creation of three differently perfused anastomoses: well perfused/well perfused (anastomosis segment 1), well perfused/poorly perfused (anastomosis segment 2), and poorly perfused/poorly perfused (anastomosis segment 3). After construction of the anastomoses, a final perfusion assessment using both clinical assessment and LSCI was executed in order to evaluate the vascular viability of the anastomosis.
Laparoscopic LSCI enabled continuous assessment of local intestinal perfusion and allowed for detection of perfusion deficits in real time. The imaging feedback precisely guided the surgical procedure, and, when evaluating the final anastomotic perfusion, LSCI was able to visualize the varying degrees of perfusion, whereas standard clinical assessment yielded only minor differences in visual appearance of the tissue.
In this technical note, we demonstrate a novel LSCI-based approach for intraoperative perfusion assessment. With its ability to continuously visualize perfusion in real time, laparoscopic LSCI has significant potential for the optimization of anastomotic surgery in the near future.
肠道切除术会不可避免地造成血管损伤，而在术中对局部肠道灌注进行临床评估时，这种损伤并非总能被发现。如果不加以处理，灌注受损可能会导致诸如吻合口漏（AL）等并发症。因此，我们展示了一种基于新型腹腔镜激光散斑对比成像（LSCI）的方法，用于在肠道吻合术构建过程中评估局部肠道灌注。
从猪的小肠中分离出三段，通过凝固7 - 8条肠系膜动脉来损害每一段的灌注。临床评估和LSCI都用于检测诱导的灌注不足，并随后指导在该段内灌注良好、灌注边缘或灌注不良的组织区域进行横切。然后将肠端用于创建三种不同灌注情况的吻合口：灌注良好/灌注良好（吻合口段1）、灌注良好/灌注不良（吻合口段2）和灌注不良/灌注不良（吻合口段3）。在构建吻合口后，使用临床评估和LSCI进行最终的灌注评估，以评估吻合口的血管活力。
腹腔镜LSCI能够持续评估局部肠道灌注，并实时检测灌注不足。成像反馈精确地指导了手术过程，并且在评估最终吻合口灌注时，LSCI能够可视化不同程度的灌注，而标准临床评估仅显示组织外观的微小差异。
在本技术说明中，我们展示了一种基于LSCI的新型术中灌注评估方法。腹腔镜LSCI能够实时持续可视化灌注，在不久的将来，其在优化吻合手术方面具有巨大潜力。
