Abstract
Introduction
Anastomotic leakage after gastrointestinal surgery has a high impact on patient's
quality of life and its origin is associated with inadequate perfusion. Imaging photoplethysmography
(iPPG) is a noninvasive imaging technique that measures blood-volume changes in the
microvascular tissue bed and detects changes in tissue perfusion.
Materials and methods
Intraoperative iPPG imaging was performed in 29 patients undergoing an open segment
resection of the small intestine or colon. During each surgery, imaging was performed
on fully perfused (true positives) and ischemic intestines (true negatives) and the
anastomosis (unknowns). Imaging consisted of a 30-s video from which perfusion maps
were extracted, providing detailed information about blood flow within the intestine
microvasculature. To detect the predictive capabilities of iPPG, true positive and
true negative perfusion conditions were used to develop two different perfusion classification
methods.
Results
iPPG-derived perfusion parameters were highly correlated with perfusion—perfused or
ischemic—in intestinal tissues. A perfusion confidence map distinguished perfused
and ischemic intestinal tissues with 96% sensitivity and 86% specificity. Anastomosis
images were scored as adequately perfused in 86% of cases and 14% inconclusive. The
cubic-Support Vector Machine achieved 90.9% accuracy and an area under the curve of
96%. No anastomosis-related postoperative complications were encountered in this study.
Conclusions
This study shows that noninvasive intraoperative iPPG is suitable for the objective
assessment of small intestine and colon anastomotic perfusion. In addition, two perfusion
classification methods were developed, providing the first step in an intestinal perfusion
prediction model.
Keywords
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Article info
Publication history
Published online: November 30, 2022
Accepted:
October 29,
2022
Received in revised form:
October 24,
2022
Received:
June 29,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
