Noninvasive assessment of bowel blood perfusion using intraoperative laser speckle flowgraphy
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ORIGINAL ARTICLE
Noninvasive assessment of bowel blood perfusion using intraoperative laser speckle flowgraphy Tomoaki Kaneko 1 & Kimihiko Funahashi 1 & Mitstunori Ushigome 1 & Satoru Kagami 1 & Kimihiko Yoshida 1 & Takamaru Koda 1 & Yasuo Nagashima 1 & Yasuyuki Miura 1 & Akiharu Kurihara 1 & Yoshitaka Murakami 2 Received: 25 January 2020 / Accepted: 9 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Laser speckle flowgraphy (LSFG) is a noninvasive method for quantitative evaluation of blood flow using the mean blur rate (MBR) as the blood flow index. We investigated whether LSFG can intraoperatively detect the demarcation line after vessel dissection and reduce the incidence of anastomotic leakage (AL). Methods This study included 36 patients who underwent left-sided colorectal surgery. First, we compared the demarcation line (determined by LSFG) with the transection line (TL) at which the marginal vessels were divided. We then measured the MBR on both sides of the TL to determine where the MBR changed significantly. We investigated the presence or absence of significant differences between the MBR on the proximal side and that on the distal side of the TL. Finally, we retrospectively compared the patient characteristics and AL rates in the LSFG group (n = 36) and control group (n = 87). Results In total, 58.3% (21/36) of the demarcation lines determined by LSFG matched the TL. The median distance between the demarcation line determined by LSFG and the TL was 0.0 mm (0.0–12.1 mm). The MBR sharply decreased at the TL in 80.6% (29/36) of cases. The median MBR was significantly lower on the distal than proximal side. The AL rate was not significantly lower in the LSFG group than in the control group. Conclusion LSFG accurately detected the demarcation line during surgery. However, LSFG did not reduce the incidence of AL. Keywords Bowel blood perfusion . Laser speckle flowgraphy . Laser speckle imaging . Anastomotic leakage
Introduction Anastomotic leakage (AL) is one of the major complications of gastrointestinal surgery, and ischemia at an anastomotic site is one of the most important risk factors for such leakage [1, 2]. To decrease AL, it is important to correctly interpret the state of blood perfusion at an intestinal anastomotic site. Surgeons usually assess intraoperative bowel blood perfusion based on several clinical signs including bowel serosal color, palpable pulsation, and active bleeding from marginal arteries
* Tomoaki Kaneko [email protected] 1
Department of Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ōta, Tokyo 143-8541, Japan
2
Department of Medical Statistics, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ōta, Tokyo 143-8540, Japan
[3]. However, such assessments depend on the surgeon’s subjective judgment. Laser Doppler flowmetry [4], near-infrared (NIR) spectroscopy [5], Doppler ultrasonography [6], visible light spectroscopy [7], and fluorescence imaging with indocyanine green (ICG) [
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