Techniques in Coloproctology

, Volume 22, Issue 10, pp 793–800 | Cite as

Can sidestream dark field (SDF) imaging identify subtle microvascular changes of the bowel during colorectal surgery?

  • A. F. J. de BruinEmail author
  • A. L. M. Tavy
  • K. van der Sloot
  • A. Smits
  • C. Ince
  • E. C. Boerma
  • P. G. Noordzij
  • D. Boerma
  • M. van Iterson
Original Article



Recognition of a non-viable bowel during colorectal surgery is a challenging task for surgeons. Identifying the turning point in serosal microcirculatory deterioration leading up to a non-viable bowel is crucial. The aim of the present study was to determine whether sidestream darkfield (SDF) imaging can detect subtle changes in serosal microcirculation of the sigmoid after vascular transection during colorectal surgery.


A prospective observational clinical study was performed at a single medical centre. All eligible participants underwent laparoscopic sigmoid resection and measurements were taken during the extra-abdominal phase. Microcirculation was measured at the transected bowel and 20 cm proximal to this point. Microcirculatory parameters such as Microvascular Flow Index (MFI), proportion of perfused vessels (PPV), perfused vessel density (PVD), total vessel density (TVD) and the Heterogeneity Index were determined. Data are presented as median (interquartile range) or mean ± standard deviation.


A total of 60 SDF images were acquired for 10 patients. Perfusion parameters and perfused vessel density were significantly lower at the transected bowel compared with the non-transected measurements [MFI 2.29 (1.96–2.63) vs 2.96 (2.73–3.00), p = 0.007; PPV 74% (55–83) vs 94% (86–97), p = 0.007; and PVD 7.61 ± 2.99 mm/mm2 versus 10.67 ± 1.48 mm/mm2, p = 0.009]. Total vessel density was similar between the measurement locations.


SDF imaging can identify changes of the bowel serosal microcirculation. Significantly lower serosal microcirculatory parameters of the vascular transected bowel was seen compared with the non-transected bowel. The ability of SDF imaging to detect subtle differences holds promise for future research on microvascular cut-off values leading to a non-viable bowel.


Sidestream darkfield imaging Microcirculation Diagnostic imaging Colon resection Blood supply Intestinal ischemia 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was performed at a tertiary teaching hospital (St Antonius Hospital, Nieuwegein, the Netherlands) after approval from the united medical ethics committees (NL48332.100.14/R14.005).

Informed consent

All patients gave their written informed consent as per the applicable laws.

Supplementary material

Supplementary material 1 (AVI 12458 KB)


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • A. F. J. de Bruin
    • 1
    Email author
  • A. L. M. Tavy
    • 1
  • K. van der Sloot
    • 2
  • A. Smits
    • 3
  • C. Ince
    • 5
  • E. C. Boerma
    • 4
  • P. G. Noordzij
    • 1
  • D. Boerma
    • 3
  • M. van Iterson
    • 1
  1. 1.Department of Anesthesiology, Intensive Care and Pain MedicineSt Antonius HospitalNieuwegeinThe Netherlands
  2. 2.Department of Anesthesiologie and Pain MedicineHaaglanden Medisch CentrumThe HagueThe Netherlands
  3. 3.Department of SurgerySt Antonius HospitalNieuwegeinThe Netherlands
  4. 4.Department of Intensive CareMedical Center LeeuwardenLeeuwardenThe Netherlands
  5. 5.Department of Intensive CareErasmus MCRotterdamThe Netherlands

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