Skip to main content

Advertisement

SpringerLink
Log in

Noninvasive assessment of bowel blood perfusion using intraoperative laser speckle flowgraphy

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Laser speckle flowgraphy (LSFG) is a noninvasive method for quantitative evaluation of blood flow using the mean blur rate (MBR) as the blood flow index. We investigated whether LSFG can intraoperatively detect the demarcation line after vessel dissection and reduce the incidence of anastomotic leakage (AL).

Methods

This study included 36 patients who underwent left-sided colorectal surgery. First, we compared the demarcation line (determined by LSFG) with the transection line (TL) at which the marginal vessels were divided. We then measured the MBR on both sides of the TL to determine where the MBR changed significantly. We investigated the presence or absence of significant differences between the MBR on the proximal side and that on the distal side of the TL. Finally, we retrospectively compared the patient characteristics and AL rates in the LSFG group (n = 36) and control group (n = 87).

Results

In total, 58.3% (21/36) of the demarcation lines determined by LSFG matched the TL. The median distance between the demarcation line determined by LSFG and the TL was 0.0 mm (0.0–12.1 mm). The MBR sharply decreased at the TL in 80.6% (29/36) of cases. The median MBR was significantly lower on the distal than proximal side. The AL rate was not significantly lower in the LSFG group than in the control group.

Conclusion

LSFG accurately detected the demarcation line during surgery. However, LSFG did not reduce the incidence of AL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Shogan BD, Carlisle EM, Alverdy JC, Umanskiy K (2013) Do we really know why colorectal anastomoses leak? J Gastrointest Surg 17:1698–1707. https://doi.org/10.1007/s11605-013-2227-0

    Article  PubMed  Google Scholar 

  2. Attard JA, Raval MJ, Martin GR, Kolb J, Afrouzian M, Buie WD, Sigalet DL (2005) The effects of systemic hypoxia on colon anastomotic healing: an animal model. Dis Colon Rectum 48:1460–1470. https://doi.org/10.1007/s10350-005-0047-3

    Article  PubMed  Google Scholar 

  3. James DR, Ris F, Yeung TM, Kraus R, Buchs NC, Mortensen NJ, Hompes RJ (2015) Fluorescence angiography in laparoscopic low rectal and anorectal anastomoses with pinpoint perfusion imaging--a critical appraisal with specific focus on leak risk reduction. Color Dis 17(Suppl 3):16–21. https://doi.org/10.1111/codi.13033

    Article  Google Scholar 

  4. Boyle NH, Manifold D, Jordan MH, Mason RC (2000) Intraoperative assessment of colonic perfusion using scanning laser Doppler flowmetry during colonic resection. J Am Coll Surg 191:504–510. https://doi.org/10.1016/s1072-7515(00)00709-2

    Article  CAS  PubMed  Google Scholar 

  5. Hirano Y, Omura K, Tatsuzawa Y, Shimizu J, Kawaura Y, Watanabe G (2006) Tissue oxygen saturation during colorectal surgery measured by near-infrared spectroscopy: pilot study to predict anastomotic complications. World J Surg 30:457–461. https://doi.org/10.1007/s00268-005-0271-y

    Article  PubMed  Google Scholar 

  6. Ambrosetti P, Robert J, Mathey P, Rohner A (1994) Left-sided colon and colorectal anastomoses: Doppler ultrasound as an aid to assess bowel vascularization. A prospective evaluation of 200 consecutive elective cases. Int J Color Dis 9:211–214. https://doi.org/10.1007/bf00292253

    Article  CAS  Google Scholar 

  7. Karliczek A, Benaron DA, Baas PC, Zeebregts CJ, Wiggers T, Van Dam GM (2010) Intraoperative assessment of microperfusion with visible light spectroscopy for prediction of anastomotic leakage in colorectal anastomoses. Color Dis 12:1018–1025. https://doi.org/10.1111/j.1463-1318.2009.01944.x

    Article  CAS  Google Scholar 

  8. Darwich I, Rustanto D, Friedberg R, Willeke F (2019) Spectrophotometric assessment of bowel perfusion during low anterior resection: a prospective study. Updates Surg 71(4):677–686. https://doi.org/10.1007/s13304-019-00682-9

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, Lee SW, Senagore AJ, Phelan MJ, Stamos MJ (2015) Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 220:82–92. https://doi.org/10.1016/j.jamcollsurg.2014.09.015

    Article  PubMed  Google Scholar 

  10. Kudszus S, Roesel C, Schachtrupp A, Höer JJ (2010) Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbeck’s Arch Surg 395:1025–1030. https://doi.org/10.1007/s00423-010-0699-x

    Article  Google Scholar 

  11. De Nardi P, Elmore U, Maggi G, Maggiore R, Boni L, Cassinotti E, Fumagalli U, Gardani M, De Pascale S, Parise P, Vignali A, Rosati R (2020) Intraoperative angiography with indocyanine green to assess anastomosis perfusion in patients undergoing laparoscopic colorectal resection: results of a multicenter randomized controlled trial. Surg Endosc 34(1):53–60. https://doi.org/10.1007/s00464-019-06730-0

    Article  PubMed  Google Scholar 

  12. Hayami S, Matsuda K, Iwamoto H, Ueno M, Kawai M, Hirono S, Okada K, Miyazawa M, Tamura K, Mitani Y, Kitahata Y, Mizumoto Y, Yamaue H (2019) Visualization and quantification of anastomotic perfusion in colorectal surgery using near-infrared fluorescence. Tech Coloproctol 23:973–980. https://doi.org/10.1007/s10151-019-02089-5

    Article  CAS  PubMed  Google Scholar 

  13. Bjerregaard J, Pandia MP, Jaffe RA (2013) Occurrence of severe hypotension after indocyanine green injection during the intraoperative period. A A Case Rep 1:26–30. https://doi.org/10.1097/ACC.0b013e3182933c12

    Article  PubMed  Google Scholar 

  14. Fujii H, Nohira K, Yamamoto Y, Ikawa H, Ohura T (1987) Evaluation of blood flow by laser speckle image sensing. Part 1. Appl Opt 26:5321–5325. https://doi.org/10.1364/AO.26.005321

    Article  CAS  PubMed  Google Scholar 

  15. Sugiyama T (2014) Basic technology and clinical applications of the updated model of laser speckle flowgraphy to ocular diseases. Photonics 1:220–234. https://doi.org/10.3390/photonics1030220

    Article  Google Scholar 

  16. Kikuchi S, Miyake K, Tada Y, Uchida D, Koya A, Saito Y, Ohura T, Azuma N (2019) Laser speckle flowgraphy can also be used to show dynamic changes in the blood flow of the skin of the foot after surgical revascularization. Vascular 27:242–251. https://doi.org/10.1177/1708538118810664

    Article  PubMed  Google Scholar 

  17. Rønn JH, Nerup N, Strandby RB, Svendsen MBS, Ambrus R, Svendsen LB, Achiam MP (2019) Laser speckle contrast imaging and quantitative fluorescence angiography for perfusion assessment. Langenbeck’s Arch Surg 404:505–515. https://doi.org/10.1007/s00423-019-01789-8

    Article  Google Scholar 

  18. Nagashima Y, Ohsugi Y, Niki Y, Maeda K, Okamoto T (2015) Assessment of laser speckle flowgraphy: development of novel cutaneous blood flow measurement technique. Proc. SPIE 9792, Biophotonics Japan 2015, 979218 (9 December 2015). https://doi.org/10.1117/12.2203712

  19. Japanese Society for Cancer of the Colon and Rectum (2019) Japanese classification of colorectal, appendiceal, and anal carcinoma: the 3d English Edition [Secondary Publication]. J Anus Rectum Colon 30;3(4):175–195. doi: https://doi.org/10.23922/jarc.2019-018. eCollection 2019

  20. Shiokawa H, Funahashi K, Kaneko H, Teramoto T (2018) Long-term assessment of anorectal function after extensive resection of the internal anal sphincter for treatment of low-lying rectal cancer near the anus. J Anus Rectum Colon 25;1(1):29-34. Doi: https://doi.org/10.23922/jarc.2016-002. eCollection

  21. Kawada K, Hasegawa S, Hida K, Hirai K, Okoshi K, Nomura A, Kawamura J, Nagayama S, Sakai Y (2014) Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc 28:2988–2995. https://doi.org/10.1007/s00464-014-3564-0

    Article  PubMed  PubMed Central  Google Scholar 

  22. Luft N, Wozniak PA, Aschinger GC, Fondi K, Bata AM, Werkmeister RM, Schmidl D, Witkowska KJ, Bolz M, Garhöfer G, Schmetterer L (2016) Ocular blood flow measurements in healthy white subjects using laser speckle flowgraphy. PLoS One 11:e0168190. https://doi.org/10.1371/journal.pone.0168190

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Sugiyama T, Araie M, Riva CE, Schmetterer L, Orgul S (2010) Use of laser speckle flowgraphy in ocular blood flow research. Acta Ophthalmol 88:723–729. https://doi.org/10.1111/j.1755-3768.2009.01586.x

    Article  PubMed  Google Scholar 

  24. Takahashi H, Sugiyama T, Tokushige H, Maeno T, Nakazawa T, Ikeda T, Araie M (2013) Comparison of CCD-equipped laser speckle flowgraphy with hydrogen gas clearance method in the measurement of optic nerve head microcirculation in rabbits. Exp Eye Res 108:10–15. https://doi.org/10.1016/j.exer.2012.12.003

    Article  CAS  PubMed  Google Scholar 

  25. Wang L, Cull GA, Piper C, Burgoyne CF, Fortune B (2012) Anterior and posterior optic nerve head blood flow in nonhuman primate experimental glaucoma model measured by laser speckle imaging technique and microsphere method. Invest Ophthalmol Vis Sci 53:8303–8309. https://doi.org/10.1167/iovs.12-10911

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kojima S, Sakamoto T, Matsui Y, Nambu K, Masamune K (2019) Clinical efficacy of bowel perfusion assessment during laparoscopic colorectal resection using laser speckle contrast imaging: a matched case-control study. Asian J Endosc Surg 13:329–335. https://doi.org/10.1111/ases.12759

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Angela Morben, DVM, ELS, from Edanz Group (https://en-author-services.edanzgroup.com/), for editing a draft of this manuscript.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ōta, Tokyo, 143-8541, Japan

    Tomoaki Kaneko, Kimihiko Funahashi, Mitstunori Ushigome, Satoru Kagami, Kimihiko Yoshida, Takamaru Koda, Yasuo Nagashima, Yasuyuki Miura & Akiharu Kurihara

  2. Department of Medical Statistics, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ōta, Tokyo, 143-8540, Japan

    Yoshitaka Murakami

Authors
  1. Tomoaki Kaneko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kimihiko Funahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mitstunori Ushigome
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Satoru Kagami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kimihiko Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takamaru Koda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasuo Nagashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yasuyuki Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Akiharu Kurihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yoshitaka Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: Tomoaki Kaneko, Kimihiko Funahashi. Acquisition of data: Mitstunori Ushigome, Kimihiko Yoshida, Yasuyuki Miura, Akiharu Kurihara. Analysis and interpretation of data: Satoru Kagami, Takamaru Koda, Yoshitaka Murakami. Drafting of the manuscript: Tomoaki Kaneko. Critical revision of the manuscript: Kimihiko Funahashi.

Corresponding author

Correspondence to Tomoaki Kaneko.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was approved by the Ethics Committee of Toho University Omori Hospital (M17229).

Informed consent

All patients provided informed consent to undergo the procedures described in this report.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kaneko, T., Funahashi, K., Ushigome, M. et al. Noninvasive assessment of bowel blood perfusion using intraoperative laser speckle flowgraphy. Langenbecks Arch Surg 405, 817–826 (2020). https://doi.org/10.1007/s00423-020-01933-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-020-01933-9

Keywords

Search

Navigation