Intraoperative assessment of anastomotic microcirculation during right hemicolectomy with real-time laser speckle contrast imaging is safe and feasible

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-07-16 DOI:10.1111/codi.70162

Rupan Paramasivam, Claudia Jaensch, Anders Husted Madsen, Mai-Britt Worm Ørntoft

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Abstract

Aim

Successful anastomotic healing is essential in colorectal surgery and depends on adequate microcirculation at the resection site to prevent anastomotic leakage (AL). Traditionally, surgeons subjectively assess this. Laser speckle contrast imaging (LSCI) provides an objective, dye-free, and non-contact method for measuring the bowel end microcirculation that could perioperatively support the surgeon's assessment. This study aimed to determine the feasibility of LSCI and evaluate surgeons' subjective opinions on its potential to assist in surgical decision-making.

Method

This feasibility trial was conducted within the IDEAL framework as a non-interventional multicentre study. Patients undergoing elective right hemicolectomy were included. LSCI measurements were conducted twice perioperatively: before and after anastomosis formation. Surgeons were blinded to all measurements. Postoperatively, LSCI images and a questionnaire were presented to the surgeon asking whether these images, if presented perioperatively, would have influenced the selection of the optimal anastomotic site.

Results

High-quality LSCI measurements were obtained in all 20 patients operated on by 17 different surgeons, with clear and interpretable perfusion images captured without compromising sterility or extending operating time significantly. The device was non-invasive and added an average of 2 minutes to the total operation time. Fifteen of the 17 surgeons indicated that measures could have influenced surgical decision-making. In 50% of the cases, the surgeon reported a change in the resection site, by an average of 1.2 cm, based on LSCI images.

Conclusion

This study demonstrated that LSCI effectively displays colonic perfusion in real-time without disrupting the surgical procedure. The potential clinical value of LSCI with additional visual feedback lies in assisting surgeons in selecting the most optimal anastomotic site, thereby potentially improving healing and surgical outcome.

Abstract Image

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实时激光散斑造影评价右半结肠切除术术中吻合口微循环安全可行

目的成功的吻合口愈合在结直肠手术中是至关重要的，它依赖于切除部位充足的微循环来防止吻合口漏。传统上，外科医生会主观地评估这一点。激光散斑对比成像（LSCI）提供了一种客观、无染料、非接触的方法来测量肠末端微循环，可以在围手术期支持外科医生的评估。本研究旨在确定LSCI的可行性，并评估外科医生对其协助手术决策的潜力的主观意见。方法在IDEAL框架下进行非介入性多中心研究。接受选择性右半结肠切除术的患者也包括在内。围手术期LSCI测量两次：吻合口形成前和吻合口形成后。外科医生不知道所有的测量结果。术后，向外科医生提供LSCI图像和一份调查问卷，询问如果围手术期提供这些图像，是否会影响最佳吻合部位的选择。结果所有20例患者均获得了高质量的LSCI测量结果，17位不同的外科医生进行了手术，获得了清晰可解释的灌注图像，没有影响不育或显着延长手术时间。该装置是非侵入性的，使总手术时间平均增加2分钟。17名外科医生中有15名表示措施可能影响手术决策。在50%的病例中，根据LSCI图像，外科医生报告切除部位发生了平均1.2厘米的变化。结论LSCI可以在不中断手术的情况下实时显示结肠灌注。具有附加视觉反馈的LSCI的潜在临床价值在于帮助外科医生选择最佳的吻合部位，从而有可能改善愈合和手术效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.