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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.


Graph summarizing 2-way ANOVA results of time points (T0, T1, and T2) for each region of interest (ROI) with laser speckle perfusion unit (LSPU) (flux data). ANOVA = analysis of variance.
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Figure 3: Graph summarizing 2-way ANOVA results of time points (T0, T1, and T2) for each region of interest (ROI) with laser speckle perfusion unit (LSPU) (flux data). ANOVA = analysis of variance.

Mentions: Figure 3 and Table 3 present the mean LSPU for each ROI during T0 to T2. There was a significant decrease in mean LSPU from LR2 and LR3 versus the cranial regions (i.e., RR1, RR2, and RR3) across all time points (Table 3). At all 3 time points, mean LSPU at the base of the stomach and GTR (i.e., RR3) was highest (688 [237], 519 [126], and 434 [125], respectively) in comparison with the ischemic most cranial point or anastomotic tip (LR3) (175 [66], 207 ([64], and 202 [61], respectively) (P < 0.01). Interestingly, a significant improvement in gastric perfusion was observed after GTR (T1), with a rise in mean LSPU around the watershed region (RR1 and LR1) that continued into LR2 (before fundus) (P < 0.01) compared with T0. After inclining the patients at a 20° reverse Trendelenburg (T2), all the ROIs mean LSPU decreased significantly (P < 0.05), except in the regions that already had <350 LSPU, that is, near fundus (LR2) and fundus (LR3). There were no differences in flux parameters between patients who received radiotherapy on the area of the upper part of the gastric tube (the fundus) as compared with patients who did not receive radiotherapy.


Laser speckle contrast imaging identifies ischemic areas on gastric tube reconstructions following esophagectomy
Graph summarizing 2-way ANOVA results of time points (T0, T1, and T2) for each region of interest (ROI) with laser speckle perfusion unit (LSPU) (flux data). ANOVA = analysis of variance.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Graph summarizing 2-way ANOVA results of time points (T0, T1, and T2) for each region of interest (ROI) with laser speckle perfusion unit (LSPU) (flux data). ANOVA = analysis of variance.
Mentions: Figure 3 and Table 3 present the mean LSPU for each ROI during T0 to T2. There was a significant decrease in mean LSPU from LR2 and LR3 versus the cranial regions (i.e., RR1, RR2, and RR3) across all time points (Table 3). At all 3 time points, mean LSPU at the base of the stomach and GTR (i.e., RR3) was highest (688 [237], 519 [126], and 434 [125], respectively) in comparison with the ischemic most cranial point or anastomotic tip (LR3) (175 [66], 207 ([64], and 202 [61], respectively) (P < 0.01). Interestingly, a significant improvement in gastric perfusion was observed after GTR (T1), with a rise in mean LSPU around the watershed region (RR1 and LR1) that continued into LR2 (before fundus) (P < 0.01) compared with T0. After inclining the patients at a 20° reverse Trendelenburg (T2), all the ROIs mean LSPU decreased significantly (P < 0.05), except in the regions that already had <350 LSPU, that is, near fundus (LR2) and fundus (LR3). There were no differences in flux parameters between patients who received radiotherapy on the area of the upper part of the gastric tube (the fundus) as compared with patients who did not receive radiotherapy.

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.