Novel oxygen saturation imaging endoscopy to assess anastomotic integrity in a porcine ischemia model
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Novel oxygen saturation imaging endoscopy to assess anastomotic integrity in a porcine ischemia model Hiro Hasegawa1,2, Nobuyoshi Takeshita1,2 and Masaaki Ito1,2*
Abstract Background: Establishing anastomotic integrity is crucial for avoiding anastomotic complications in colorectal surgery. This study aimed to evaluate the safety and feasibility of assessing anastomotic integrity using novel oxygen saturation imaging endoscopy in a porcine ischemia model. Methods: In three pigs, a new endoscope system was used to check the mechanical completeness of the anastomosis and capture the tissue oxygen saturation (StO2) images. This technology can derive the StO2 images from the differences in the absorption coefficient in the visible light region between oxy- and deoxy-hemoglobin. Bowel perfusion at the proximal rectum was assessed before and after the anastomosis, and 1 min and 30 min after the ligation of the cranial rectal artery (CRA). Results: The completeness of the anastomoses was confirmed by the absence of air leakage. Intraluminal oxygen saturation imaging was successfully performed in all animals. There was no significant difference in the S tO2 level before and after the anastomosis (52.6 ± 2.0 vs. 52.0 ± 2.6; p = 0.76, respectively). The StO2 level of the intestine on the oral side of the anastomosis one minute after the CRA ligation was significantly lower than immediately after the anastomosis (15.9 ± 6.0 vs. 52.0 ± 2.6; p = 0.006, respectively). There was no significant difference in the StO2 level between 1 min after and 30 min after the CRA ligation (15.9 ± 6.0 vs. 12.1 ± 5.3; p = 0.41, respectively). Conclusion: Novel oxygen saturation imaging endoscopy was safe and feasible to assess the anastomotic integrity in the experimental model. Keywords: Anastomotic integrity, Endoscopy, Perfusion assessment, Tissue oxygen saturation Background Despite advances in surgical techniques and medical devices, anastomotic leakage and stricture remain one of the most dreaded complications in colorectal surgery. Anastomotic complications, such as postoperative morbidity and mortality, have a negative impact on short-term outcomes [1, 2]. In addition, they also affect
*Correspondence: [email protected] 1 Department of Colorectal Surgery, National Cancer Center Hospital East, 6‑5‑1 Kashiwanoha, Kashiwa, Chiba 277‑8577, Japan Full list of author information is available at the end of the article
long-term outcomes, such as survival in cancer patients [3] and quality of life [4]. Various risk factors have been reported to be associated with anastomotic leakage in colorectal surgery [1, 5]. Male sex, low anastomotic level (within 5 cm from the anal verge), and multiple firings with a linear stapler are the important factors for anastomotic leakage. Macroscopic intraluminal assessment of anastomotic completeness using an intraoperative colonoscopy and the air leakage test have been broadly used to check the incompleteness of the anastomosis during surgery [6–9]. It is also a v
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