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Laser speckle contrast imaging identifies ischemic areas on gastric tube reconstructions following esophagectomy

View Article: PubMed Central - PubMed

ABSTRACT

S: Gastric tube reconstruction (GTR) is a high-risk surgical procedure with substantial perioperative morbidity. Compromised arterial blood supply and venous congestion are believed to be the main etiologic factors associated with early and late anastomotic complications. Identifying low blood perfusion areas may provide information on the risk of future anastomotic leakage and could be essential for improving surgical techniques. The aim of this study was to generate a method for gastric microvascular perfusion analysis using laser speckle contrast imaging (LSCI) and to test the hypothesis that LSCI is able to identify ischemic regions on GTRs.

Patients requiring elective laparoscopy-assisted GTR participated in this single-center observational investigation. A method for intraoperative evaluation of blood perfusion and postoperative analysis was generated and validated for reproducibility. Laser speckle measurements were performed at 3 different time pointes, baseline (devascularized) stomach (T0), after GTR (T1), and GTR at 20° reverse Trendelenburg (T2).

-: Blood perfusion analysis interrater reliability was high, with intraclass correlation coefficients for each time point approximating 1 (P < 0.0001). Baseline (T0) and GTR (T1) mean blood perfusion profiles were highest at the base of the stomach and then progressively declined towards significant ischemia at the most cranial point or anastomotic tip (P < 0.01). After GTR, a statistically significant improvement in mean blood perfusion was observed in the cranial gastric regions of interest (P < 0.05). A generalized significant decrease in mean blood perfusion was observed across all GTR regions of interest during 20° reverse Trendelenburg (P < 0.05).

It was feasible to implement LSCI intraoperatively to produce blood perfusion assessments on intact and reconstructed whole stomachs. The analytical design presented in this study resulted in good reproducibility of gastric perfusion measurements between different investigators. LSCI provides spatial and temporal information on the location of adequate tissue perfusion and may thus be an important aid in optimizing surgical and anesthesiological procedures for strategically selecting anastomotic site in patients undergoing esophagectomy with GTR.

No MeSH data available.


Related in: MedlinePlus

ICC (A) and Bland–Altman (B) analyses for all speckle datasets (i.e., T0, T1, and T2) between investigators 1 and 2. ICC = intraclass correlation coefficient.
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Figure 2: ICC (A) and Bland–Altman (B) analyses for all speckle datasets (i.e., T0, T1, and T2) between investigators 1 and 2. ICC = intraclass correlation coefficient.

Mentions: Repeated intraoperative applications of LSCI successfully generated an overview or map of whole organ microvascular perfusion revealing ischemic and nonischemic regions instantaneously (Fig. 1). The setup of the LSCI in the theater was easy to perform and sterility of the operating field remained intact. The speckle imager produced high-quality images (total of 5 frames per time point) with excellent resolution for analysis offline. Inter-rater reliability in the acquired results (mean LSPU for each ROI and time point) was high, with an average ICC approximating 1 for all time points (P < 0.0001, respectively) (Fig. 2A). Bland–Altman plot shows low mean percentage differences between the 2 investigators (Fig. 2B).


Laser speckle contrast imaging identifies ischemic areas on gastric tube reconstructions following esophagectomy
ICC (A) and Bland–Altman (B) analyses for all speckle datasets (i.e., T0, T1, and T2) between investigators 1 and 2. ICC = intraclass correlation coefficient.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998312&req=5

Figure 2: ICC (A) and Bland–Altman (B) analyses for all speckle datasets (i.e., T0, T1, and T2) between investigators 1 and 2. ICC = intraclass correlation coefficient.
Mentions: Repeated intraoperative applications of LSCI successfully generated an overview or map of whole organ microvascular perfusion revealing ischemic and nonischemic regions instantaneously (Fig. 1). The setup of the LSCI in the theater was easy to perform and sterility of the operating field remained intact. The speckle imager produced high-quality images (total of 5 frames per time point) with excellent resolution for analysis offline. Inter-rater reliability in the acquired results (mean LSPU for each ROI and time point) was high, with an average ICC approximating 1 for all time points (P < 0.0001, respectively) (Fig. 2A). Bland–Altman plot shows low mean percentage differences between the 2 investigators (Fig. 2B).

View Article: PubMed Central - PubMed

ABSTRACT

S: Gastric tube reconstruction (GTR) is a high-risk surgical procedure with substantial perioperative morbidity. Compromised arterial blood supply and venous congestion are believed to be the main etiologic factors associated with early and late anastomotic complications. Identifying low blood perfusion areas may provide information on the risk of future anastomotic leakage and could be essential for improving surgical techniques. The aim of this study was to generate a method for gastric microvascular perfusion analysis using laser speckle contrast imaging (LSCI) and to test the hypothesis that LSCI is able to identify ischemic regions on GTRs.

Patients requiring elective laparoscopy-assisted GTR participated in this single-center observational investigation. A method for intraoperative evaluation of blood perfusion and postoperative analysis was generated and validated for reproducibility. Laser speckle measurements were performed at 3 different time pointes, baseline (devascularized) stomach (T0), after GTR (T1), and GTR at 20&deg; reverse Trendelenburg (T2).

-: Blood perfusion analysis interrater reliability was high, with intraclass correlation coefficients for each time point approximating 1 (P&#8202;&lt;&#8202;0.0001). Baseline (T0) and GTR (T1) mean blood perfusion profiles were highest at the base of the stomach and then progressively declined towards significant ischemia at the most cranial point or anastomotic tip (P&#8202;&lt;&#8202;0.01). After GTR, a statistically significant improvement in mean blood perfusion was observed in the cranial gastric regions of interest (P&#8202;&lt;&#8202;0.05). A generalized significant decrease in mean blood perfusion was observed across all GTR regions of interest during 20&deg; reverse Trendelenburg (P&#8202;&lt;&#8202;0.05).

It was feasible to implement LSCI intraoperatively to produce blood perfusion assessments on intact and reconstructed whole stomachs. The analytical design presented in this study resulted in good reproducibility of gastric perfusion measurements between different investigators. LSCI provides spatial and temporal information on the location of adequate tissue perfusion and may thus be an important aid in optimizing surgical and anesthesiological procedures for strategically selecting anastomotic site in patients undergoing esophagectomy with GTR.

No MeSH data available.


Related in: MedlinePlus