Real-time intestinal perfusion assessment for anastomotic site selection using laser speckle contrast imaging: Verification in a porcine model

Introduction: Adequate blood perfusion is widely recognized as a crucial factor for successful healing of an anastomosis and avoid anastomotic leakage. This study aimed to determine if laparoscopic laser speckle contrast imaging, can provide valuable feedback for identifying the state of tissue perfusion. Therefore, we explored the efficacy and feasibility of a new laser speckle contrast imaging system to assess real-time intestinal perfusion. Methods: Three gradually perfused porcine small bowel loops were created, and five senior surgeons were asked to assess the perfusion differences based on laser speckle contrast images using PerfusiX-Imaging (R). Subsequently, the study evaluated the impact of laser speckle contrast imaging on decision-making for anastomosis creation. Afterwards, a questionnaire was completed by all surgeons to assess the usability of the device. Results: Results demonstrated a high accuracy (100 %) in identifying compromised perfusion and detecting perfusion differences between loops using the imaging system. In case of compromised perfusion, all surgeons recommended against creating an anastomosis based on the visual feedback. The questionnaire revealed that the senior surgeons were satisfied with the perfusion imager, particularly in terms of minimal latency, ease of use and set up, and ability to accurately represent blood flow patterns as these questions showed a (very) strong agreement in 80 %. Conclusion: Laser speckle contrast imaging can provide valuable real-time feedback on intestinal tissue perfusion during surgery, enabling surgeons to select optimal tissue segments for a well-perfused anastomosis. However, further research is required to validate the efficacy in clinical settings and its potential impact on surgical outcomes in patients.