Organ perfusion has been of interest to surgeons unremittingly as it is generally understood that adequate tissue perfusion prevents morbidity and mortality. A promising objective imaging method that can provide objective and reproducible perfusion imaging is called laser speckle contrast imaging. For this study, a dye-free, instantaneous, continuous and real-time laparoscopic perfusion imaging device called PerfusiX-Imaging was developed. The technology was validated in multiple pre-clinical models as well as a multi-centre study in colorectal surgery. The basic and fundamental (pre-)clinical studies provide evidence that laparoscopic laser speckle contrast imaging is capable of measuring the slightest of perfusion differences in real-time.
Esophageal cancer is one of the most common types of cancer. Surgical treatment is associated with high morbidity and mortality due to the high incidence of anastomotic leakage (AL). Hypoperfusion of the gastric conduit plays an important role in developing AL. Per-operative perfusion quantification methods are currently lacking. The laparoscopic Laser Speckle Contrast Imaging device PerfusiX-Imaging could be a promising alternative to the surgical eye and ICG, showing real-time imminent perfusion differences.
Significance: Intraoperative parameters of renal cortical microperfusion (RCM) have been associated with postoperative ischemia/reperfusion injury. Laser speckle contrast imaging (LSCI) could provide valuable information in this regard with the advantage over the current standard of care of being a non-contact and full-field imaging technique.
Aim: Our study aims to validate the use of LSCI for the visualization of RCM on ex vivo perfused human-sized porcine kidneys in various models of hemodynamic changes.
Approach: A comparison was made between three renal perfusion measures: LSCI, the total arterial renal blood flow (RBF), and sidestream dark-field (SDF) imaging in different settings of ischemia/reperfusion.
Results: LSCI showed a good correlation with RBF for the reperfusion experiment (0.94 ± 0.02; p < 0.0001) and short- and long-lasting local ischemia (0.90 ± 0.03; p < 0.0001 and 0.81 ± 0.08; p < 0.0001, respectively). The correlation decreased for low flow situations due to RBF redistribution. The correlation between LSCI and SDF (0.81 ± 0.10; p < 0.0001) showed superiority over RBF (0.54 ± 0.22; p < 0.0001).
Conclusions: LSCI is capable of imaging RCM with high spatial and temporal resolutions. It can instantaneously detect local perfusion deficits, which is not possible with the current standard of care. Further development of LSCI in transplant surgery could help with clinical decision making.
Monitoring the renal cortical microperfusion (RCM) can aid in the determination of an adequate treatment plan to eventually improve transplantation outcome and improve patient care. In this paper we report on a feasibility study on the use of LSCI to monitor RCM in human sized porcine kidneys using an isolated perfusion model and a Lapvas-Imaging speckle imager. Our data shows that there is a discrepancy between overall- and RCM perfusion indicating that the implementation of LSCI during transplant surgery could help with the establishment of an appropriate treatment plan possibly decreasing the chance of renal allograft rejection.
When a biological tissue is illuminated with coherent light, an interference pattern will be formed at the detector, the so-called speckle pattern. Laser speckle contrast imaging (LSCI) is a technique based on the dynamic change in this backscattered light as a result of interaction with red blood cells. It can be used to visualize perfusion in various tissues and, even though this technique has been extensively described in the literature, the actual clinical implementation lags behind. We provide an overview of LSCI as a tool to image tissue perfusion. We present a brief introduction to the theory, review clinical studies from various medical fields, and discuss current limitations impeding clinical acceptance.
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