Skip to main content

Advertisement

SpringerLink
Log in

Intra-abdominal laparoscopic assessment of organs perfusion using imaging photoplethysmography

  • New Technology
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

An objective evaluation of the functional state and viability of biological tissues during minimally invasive surgery remains unsolved task. Various non-contact methods for evaluating perfusion during laparoscopic surgery are discussed in the literature, but so far there have been no reports of their use in clinical settings.

Methods and patients

Imaging photoplethysmography (iPPG) is a new method for quantitative assessment of perfusion distribution along the tissue. This is the first study in which we demonstrate successful use of iPPG to assess perfusion of organs during laparoscopic surgery in an operation theater. We used a standard rigid laparoscope connected to a standard digital monochrome camera, and abdominal organs were illuminated by green light. A distinctive feature is the synchronous recording of video frames and electrocardiogram with subsequent correlation data processing. During the laparoscopically assisted surgeries in nine cancer patients, the gradient of perfusion of the affected organs was evaluated. In particular, measurements were carried out before preparing a part of the intestine or stomach for resection, after anastomosis, or during physiological tests.

Results

The spatial distribution of perfusion and its changes over time were successfully measured in all surgical cases. In particular, perfusion gradient of an intestine before resection was visualized and quantified by our iPPG laparoscope in all respective cases. It was also demonstrated that systemic administration of norepinephrine leads to a sharper gradient between well and poorly perfused areas of the colon. In four surgical cases, we have shown capability of the laparoscopic iPPG system for intra-abdominal assessment of perfusion in the anastomosed organs. Moreover, good repeatability of continuous long-term measurements of tissue perfusion inside the abdominal cavity was experimentally demonstrated.

Conclusion

Our study carried out in real clinical settings has shown that iPPG laparoscope is feasible for intra-abdominal visualization and quantitative assessment of perfusion distribution.

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
Fig. 7

Similar content being viewed by others

References

  1. Urbanavičius L, Pattyn P, de Putte D, Van VD (2011) How to assess intestinal viability during surgery: a review of techniques. World J Gastrointest Surg 3:59–69. https://doi.org/10.4240/wjgs.v3.i5.59

    Article  PubMed  PubMed Central  Google Scholar 

  2. Miyashiro I, Kishi K, Yano M, Tanaka K, Motoori M, Ohue M, Ohigashi H, Takenaka A, Tomita Y, Ishikawa O (2011) Laparoscopic detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging. Surg Endosc 25:1672–1676. https://doi.org/10.1007/s00464-010-1405-3

    Article  PubMed  Google Scholar 

  3. Park S-H, Park H-M, Baek K-R, Ahn H-M, Lee IY, Son GM (2020) Artificial intelligence based real-time microcirculation analysis system for laparoscopic colorectal surgery. World J Gastroenterol 26:6945–6962. https://doi.org/10.3748/wjg.v26.i44.6945

    Article  CAS  PubMed Central  Google Scholar 

  4. Hellan M, Spinoglio G, Pigazzi A, Lagares-Garcia JA (2014) The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery. Surg Endosc 28:1695–1702. https://doi.org/10.1007/s00464-013-3377-6

    Article  Google Scholar 

  5. Diana M, Agnus V, Halvax P, Liu Y-Y, Dallemagne B, Schlagowski A-I, Geny B, Diemunsch P, Lindner V, Marescaux J (2015) Intraoperative fluorescence-based enhanced reality laparoscopic real-time imaging to assess bowel perfusion at the anastomotic site in an experimental model. Br J Surg 102:e169–e176. https://doi.org/10.1002/bjs.9725

    Article  CAS  PubMed  Google Scholar 

  6. Chalopin C, Pfahl A, Köhler H, Knospe L, Maktabi M, Unger M, Jansen-Winkeln B, Thieme R, Moulla Y, Mehdorn M, Sucher R, Neumuth T, Gockel I, Melzer A (2022) Alternative intraoperative optical imaging modalities for fluorescence angiography in gastrointestinal surgery: spectral imaging and imaging photoplethysmography. Minim Invasive Ther Allied Technol 31:1–11. https://doi.org/10.1080/13645706.2022.2164469

    Article  Google Scholar 

  7. Schols RM, Bouvy ND, van Dam RM, Stassen LPS (2013) Advanced intraoperative imaging methods for laparoscopic anatomy navigation: an overview. Surg Endosc 27:1851–1859. https://doi.org/10.1007/s00464-012-2701-x

    Article  PubMed  Google Scholar 

  8. Han Z, Zhang A, Wang X, Sun Z, Wang MD, Xie T (2016) In vivo use of hyperspectral imaging to develop a noncontact endoscopic diagnosis support system for malignant colorectal tumors. J Biomed Opt 21:16001. https://doi.org/10.1117/1.JBO.21.1.016001

    Article  PubMed  Google Scholar 

  9. Wakabayashi T, Barberio M, Urade T, Pop R, Seyller E, Pizzicannella M, Mascagni P, Charles A-L, Abe Y, Geny B, Baiocchini A, Kitagawa Y, Marescaux J, Felli E, Diana M (2021) Intraoperative perfusion assessment in enhanced reality using quantitative optical imaging: an experimental study in a pancreatic partial ischemia model. Diagnostics 11:93. https://doi.org/10.3390/diagnostics11010093

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Clancy NT, Soares AS, Bano S, Lovat LB, Chand M, Stoyanov D (2021) Intraoperative colon perfusion assessment using multispectral imaging. Biomed Opt Express 12:7556–7567. https://doi.org/10.1364/BOE.435118

    Article  PubMed  PubMed Central  Google Scholar 

  11. Pfahl A, Köhler H, Thomaßen MT, Maktabi M, Bloße AM, Mehdorn M, Lyros O, Moulla Y, Niebisch S, Jansen-Winkeln B, Chalopin C, Gockel I (2022) Video: clinical evaluation of a laparoscopic hyperspectral imaging system. Surg Endosc 36:7794–7799. https://doi.org/10.1007/s00464-022-09282-y

    Article  PubMed  PubMed Central  Google Scholar 

  12. Thomaßen MT, Köhler H, Pfahl A, Stelzner S, Mehdorn M, Thieme R, Jansen-Winkeln B, Gockel I, Chalopin C, Moulla Y (2023) In vivo evaluation of a hyperspectral imaging system for minimally invasive surgery (HSI-MIS). Surg Endosc 37:3691–3700. https://doi.org/10.1007/s00464-023-09874-2

    Article  PubMed  PubMed Central  Google Scholar 

  13. Urade T, Felli E, Barberio M, Al-Taher M, Felli E, Goffin L, Agnus V, Ettorre GM, Marescaux J, Mutter D, Diana M (2021) Hyperspectral enhanced reality (HYPER) for anatomical liver resection. Surg Endosc 35:1844–1850. https://doi.org/10.1007/s00464-020-07586-5

    Article  PubMed  Google Scholar 

  14. Zheng C, Lau LW, Cha J (2018) Dual-display laparoscopic laser speckle contrast imaging for real-time surgical assistance. Biomed Opt Express 9:5962–5981. https://doi.org/10.1364/BOE.9.005962

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Heeman W, Dijkstra K, Hoff C, Koopal S, Pierie J-P, Bouma H, Boerma EC (2019) Application of laser speckle contrast imaging in laparoscopic surgery. Biomed Opt Express 10:2010–2019. https://doi.org/10.1364/BOE.10.002010

    Article  PubMed  PubMed Central  Google Scholar 

  16. Potapova EV, Seryogina ES, Dremin VV, Stavtsev DD, Kozlov IO, Zherebtsov EA, Mamoshin AV, Ivanov YV, Dunaev AV (2020) Laser speckle contrast imaging of blood microcirculation in pancreatic tissues during laparoscopic interventions. Quantum Electron 50:33–40. https://doi.org/10.1070/qel17207

    Article  CAS  Google Scholar 

  17. Guo Y, Weng Y, Zhang Y, Tong S, Liu Y, Lu Z, Miao P (2023) Random matrix-based laser speckle contrast imaging enables quasi-3D blood flow imaging in laparoscopic surgery. Biomed Opt Express 14:1480–1493. https://doi.org/10.1364/BOE.483655

    Article  PubMed  PubMed Central  Google Scholar 

  18. Heeman W, Wildeboer ACL, Al-Taher M, Calon JEM, Stassen LPS, Diana M, Derikx JPM, van Dam GM, Boerma EC, Bouvy ND (2023) Experimental evaluation of laparoscopic laser speckle contrast imaging to visualize perfusion deficits during intestinal surgery. Surg Endosc 37:950–957. https://doi.org/10.1007/s00464-022-09536-9

    Article  Google Scholar 

  19. Kazmi SMS, Faraji E, Davis MA, Huang Y-Y, Zhang X, Dunn AK (2018) Flux or speed? Examining speckle contrast imaging of vascular flows. Biomed Opt Express 6:2588–2608. https://doi.org/10.1364/BOE.6.002588

    Article  Google Scholar 

  20. Mamontov OV, Shcherbinin AV, Romashko RV, Kamshilin AA (2020) Intraoperative imaging of cortical blood flow by camera-based photoplethysmography at green light. Appl Sci 10:6192. https://doi.org/10.3390/app10186192

    Article  CAS  Google Scholar 

  21. Kukel I, Trumpp A, Plötze K, Rost A, Zaunseder S, Matschke KE, Rasche S (2020) Contact-free optical assessment of changes in the chest wall perfusion after coronary artery bypass grafting by imaging photoplethysmography. Appl Sci 10:6537. https://doi.org/10.3390/app10186537

    Article  CAS  Google Scholar 

  22. Kamshilin AA, Zaytsev VV, Lodygin AA, Kashchenko VA (2022) Imaging photoplethysmography as an easy-to-use tool for monitoring changes in tissue blood perfusion during abdominal surgery. Sci Rep 12:1143. https://doi.org/10.1038/s41598-022-05080-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Kashchenko VA, Zaytsev VV, Ratnikov VA, Kamshilin AA (2022) Intraoperative visualization and quantitative assessment of tissue perfusion by imaging photoplethysmography: comparison with ICG fluorescence angiography. Biomed Opt Express 13:3954–3966. https://doi.org/10.1364/BOE.462694

    Article  PubMed  PubMed Central  Google Scholar 

  24. Krasnoselsky KY, Salnikov VG, Shirinbekov NR, Aleksandrovich YS (2019) TIVA manager—component of control of general anesthesia. In: Abstracts of the XVIII International Euroasian Congress of Surgery and Hepatogastroenterology. 11–14 Sept 2019, Baku, Azerbaijan, pp. 330–331

  25. Kamshilin AA, Krasnikova TV, Volynsky MA, Miridonov SV, Mamontov OV (2018) Alterations of blood pulsations parameters in carotid basin due to body position change. Sci Rep 8:13663. https://doi.org/10.1038/s41598-018-32036-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Lyubashina OA, Mamontov OV, Volynsky MA, Zaytsev VV, Kamshilin AA (2019) Contactless assessment of cerebral autoregulation by photoplethysmographic imaging at green illumination. Front Neurosci 13:1235. https://doi.org/10.3389/fnins.2019.01235

    Article  PubMed Central  Google Scholar 

  27. Volynsky MA, Mamontov OV, Osipchuk AV, Zaytsev VV, Sokolov AY, Kamshilin AA (2022) Study of cerebrovascular reactivity to hypercapnia by imaging photoplethysmography to develop a method for intraoperative assessment of the brain functional reserve. Biomed Opt Express 13:184–196. https://doi.org/10.1364/BOE.443477

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors like to thank Mr. Vladimir Artemov from the EFA Medica Ltd for the fruitful discussions and his crucial notes.

Funding

The study was carried out with the financial support of the Russian Science Foundation (Grant No. 21-15-00265) in terms of the manufacture of the experimental equipment, software development, and data processing and analysis. Research planning, patient preparation, and surgical interventions were carried out with the financial support of the Government of the Russian Federation for the state support of scientific research carried out under the supervision of leading scientists (Agreement No. 075-15-2022-1110).

Author information

Authors and Affiliations

  1. First Surgical Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291

    Victor A. Kashchenko, Alexander V. Lodygin & Konstantin Yu. Krasnoselsky

  2. Department of Faculty Surgery, St. Petersburg State University, Saint Petersburg, Russia, 199106

    Victor A. Kashchenko & Alexander V. Lodygin

  3. Department of Anesthesiology-Resuscitation and Emergency Pediatrics, St. Petersburg State Pediatric Medical University, Saint Petersburg, Russia, 194100

    Konstantin Yu. Krasnoselsky

  4. Laboratory of New Functional Materials for Photonics, Institute of Automation and Control Processes of the Far Eastern Branch of the Russian Academy of Sciences, Vladivostok, Russia, 690041

    Valeriy V. Zaytsev & Alexei A. Kamshilin

  5. Organizational and Methodological Department, North-Western District Scientific and Clinical Center Named After L.G. Sokolov of the Federal Medical and Biological Agency, Saint Petersburg, Russia, 194291

    Valeriy V. Zaytsev & Alexei A. Kamshilin

Authors
  1. Victor A. Kashchenko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander V. Lodygin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Konstantin Yu. Krasnoselsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Valeriy V. Zaytsev
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexei A. Kamshilin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VK and AK drafted the study plan. AK and VZ developed the conceptual framework for iPPG video analyses, designed and manufactured the technical setup as well as developed the data processing software. VK and AL carried out the surgical interventions. CK provided anesthesia for patients and physiological tests. AK and VK analyzed the experimental data. AK drafted the manuscript. VZ and AK prepared the figures. All authors critically reviewed and approved the manuscript.

Corresponding author

Correspondence to Alexei A. Kamshilin.

Ethics declarations

Disclosures

Dr. Victor A. Kashchenko, Dr. Alexander V. Lodygin, Dr. Konstantin Yu. Krasnoselsky, Valery V. Zaytsev, and Dr. Alexei A. Kamshilin have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

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

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 789 KB)

Supplementary file1 (MP4 320219 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kashchenko, V.A., Lodygin, A.V., Krasnoselsky, K.Y. et al. Intra-abdominal laparoscopic assessment of organs perfusion using imaging photoplethysmography. Surg Endosc 37, 8919–8929 (2023). https://doi.org/10.1007/s00464-023-10506-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-023-10506-y

Keywords

Search

Navigation