Laser Speckle Contrast Imaging for Intraoperative Quantitative Assessment of Intestinal Blood Perfusion During Colorectal Surgery: A Prospective Pilot Study

• Published in: Surgical innovation 2019-06, Vol.26 (3), p.293-301
• Main Authors: Kojima, Shigehiro, Sakamoto, Tsuguo, Nagai, Yuko, Matsui, Yutaka, Nambu, Kyojiro, Masamune, Ken
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Blood Flow Velocity; Colorectal Neoplasms - surgery; Female; Humans; Image Interpretation, Computer-Assisted; Intestines - blood supply; Intraoperative Period; Laser-Doppler Flowmetry - methods; Male; Middle Aged; Optical Imaging - methods; Pilot Projects; Prospective Studies; Regional Blood Flow
• ISSN: 1553-3506; 1553-3514
• DOI: 10.1177/1553350618823426

Background. The main limitation of perfusion assessment with indocyanine green fluorescence angiography during colorectal surgery is that the surgeon assesses the quality of perfusion subjectively. The ideal intestinal viability test must be minimally invasive, objective, and reproducible. We evaluated the quantitativity and reproducibility of laser speckle contrast imaging for perfusion assessment during colorectal surgery. Methods. This was a prospective, nonrandomized, pilot study of 8 consecutive patients who underwent elective left-sided colorectal resection. Laser speckle perfusion images at the site of proximal transection of the bowel were obtained intraoperatively. We tested the hypothesis that laser speckle contrast imaging was able to quantitatively identify areas of diminished intestinal perfusion after devascularization and assessed the reproducibility of this method. Results. All surgical procedures were uneventful and blood flow measurements were successfully made in all patients. None of the patients developed postoperative complications related to the anastomosis and stoma. Data analyses were successfully optimized to perform quantitative regional perfusion assessments in all cases. The bowel tissue blood flows of the anal side region adjacent to the transection line were significantly lower than those of the oral side region adjacent to the transection line after ligation of marginal vessels (P = .012). Interrater reliability was high (intraclass correlation coefficients = 0.989), and a Bland-Altman plot showed few differences of mean flux data between 2 investigators. Conclusion. Laser speckle contrast imaging is feasible for real-time assessment of bowel perfusion with quantitativity and excellent reproducibility during colorectal surgery without administration of any contrast agents.