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Real-time quantification of intestinal perfusion and arterial versus venous occlusion using laser speckle contrast imaging in porcine model

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Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Real-time intraoperative perfusion assessment may reduce anastomotic leaks. Laser speckle contrast imaging (LSCI) provides dye-free visualization of perfusion by capturing coherent laser light scatter from red blood cells and displays perfusion as a colormap. Herein, we report a novel method to precisely quantify intestinal perfusion using LSCI.

Methods

ActivSight™ is an FDA-cleared multi-modal visualization system that can detect and display perfusion via both indocyanine green imaging (ICG) and LSCI in minimally invasive surgery. An experimental prototype LSCI perfusion quantification algorithm was evaluated in porcine models. Porcine small bowel was selectively devascularized to create regions of perfused/watershed/ischemic bowel, and progressive aortic inflow/portal vein outflow clamping was performed to study arterial vs. venous ischemia. Continuous arterial pressure was monitored via femoral line.

Results

LSCI perfusion colormaps and quantification distinguished between perfused, watershed, and ischemic bowel in all vascular control settings: no vascular occlusion (p < 0.001), aortic occlusion (p < 0.001), and portal venous occlusion (p < 0.001). LSCI quantification demonstrated similar levels of ischemia induced both by states of arterial inflow and venous outflow occlusion. LSCI-quantified perfusion values correlated positively with higher mean arterial pressure and with increasing distance from ischemic bowel.

Conclusion

LSCI relative perfusion quantification may provide more objective real-time assessment of intestinal perfusion compared to conventional naked eye assessment by quantifying currently subjective gradients of bowel ischemia and identifying both arterial/venous etiologies of ischemia.

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Data Availability

The data that support the findings of this study are available from the corresponding author, Peter CW Kim, upon reasonable request.

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Acknowledgements

We acknowledge Robin Grandl, PhD, Activ Surgical for review and editing.

Author information

Authors and Affiliations

  1. Department of Surgery, Brown University, Providence, RI, USA

    Yao Z. Liu, Chibueze A. Nwaiwu & Peter C. W. Kim

  2. Activ Surgical, 30 Thomson Pl, 2nd Floor, Boston, MA, 02210, USA

    Yao Z. Liu, Saloni Mehrotra, Chibueze A. Nwaiwu, Vasiliy E. Buharin, John Oberlin, Roman Stolyarov & Peter C. W. Kim

  3. Department of Surgery, University of Buffalo, Buffalo, NY, USA

    Saloni Mehrotra & Steven D. Schwaitzberg

Authors
  1. Yao Z. Liu
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  2. Saloni Mehrotra
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  3. Chibueze A. Nwaiwu
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  5. John Oberlin
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  8. Peter C. W. Kim
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Contributions

• Study conception and design: Yao Z Liu, Saloni Mehrotra, Chibueze A Nwaiwu, Vasiliy E Buharin, Steven D Schwaitzberg, and Peter CW Kim. • Acquisition of data: Yao Z Liu, Saloni Mehrotra, Vasiliy E Buharin, John Oberlin, Roman Stolyarov, and Peter CW Kim. • Analysis and interpretation of data: Yao Z Liu, Saloni Mehrotra, Vasiliy E Buharin, Roman Stolyarov, and Peter CW Kim. • Drafting of the manuscript: Yao Z Liu, Saloni Mehrotra, Chibueze A Nwaiwu, and Peter CW Kim. • Critical revision of the manuscript: All authors.

Corresponding author

Correspondence to Peter C. W. Kim.

Ethics declarations

This study was funded by Activ Surgical, Inc. Authors Yao Z Liu, Saloni Mehrotra, Chibueze A Nwaiwu, Vasiliy E Buharin, John Oberlin, Roman Stolaryov, and Peter CW Kim are employees of Activ Surgical. Author Steven D Schwaitzberg is on the advisory board of Activ Surgical, Human Extensions, New View Surgical, HAI Technology, Levitra Magnetics, and Arch Therapeutics.

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Liu, Y.Z., Mehrotra, S., Nwaiwu, C.A. et al. Real-time quantification of intestinal perfusion and arterial versus venous occlusion using laser speckle contrast imaging in porcine model. Langenbecks Arch Surg 408, 114 (2023). https://doi.org/10.1007/s00423-023-02845-0

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