Feasibility and comparison of laparoscopic laser speckle contrast imaging to near-infrared display of indocyanine green in intraoperative tissue blood flow/tissue perfusion in preclinical porcine models

• Published in: Surgical endoscopy Vol. 37; no. 2; pp. 1086 - 1095
• Main Authors: Nwaiwu, Chibueze A., Buharin, Vasiliy E., Mach, Anderson, Grandl, Robin, King, Matthew L., Dechert, Alyson F., O’Shea, Liam, Schwaitzberg, Steven D., Kim, Peter C. W.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2023; Springer Nature B.V
• Subjects: Abdominal Surgery; Animals; Blood; Contrast agents; Feasibility Studies; Gastroenterology; Gastrointestinal surgery; Gynecology; Hepatology; Indocyanine Green; Laparoscopy; Laparoscopy - methods; Laser Speckle Contrast Imaging; Medical imaging; Medicine; Medicine & Public Health; Original Article; Perfusion; Proctology; Surgeons; Surgery; Surgical anastomosis; Swine; Dye-less real-time perfusion; Indocyanine green; Anastomosis; Laser speckle contrast imaging; Near-infrared fluorescence
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-022-09583-2

Objective To determine if laser speckle contrast imaging (LSCI) mitigates variations and subjectivity in the use and interpretation of indocyanine green (ICG) fluorescence in the current visualization paradigm of real-time intraoperative tissue blood flow/perfusion in clinically relevant scenarios. Methods De novo laparoscopic imaging form-factor detecting real-time blood flow using LSCI and blood volume by near-infrared fluorescence (NIRF) of ICG was compared to ICG NIRF alone, for dye-less real-time visualization of tissue blood flow/perfusion. Experienced surgeons examined LSCI and ICG in segmentally devascularized intestine, partial gastrectomy, and the renal hilum across six porcine models. Precision and accuracy of identifying demarcating lines of ischemia/perfusion in tissues were determined in blinded subjects with varying levels of surgical experience. Results Unlike ICG, LSCI perfusion detection was real time (latency < 150 ms: p <  0.01), repeatable and on-demand without fluorophore injection. Operating surgeons ( n =  6) precisely and accurately identified concordant demarcating lines in white light, LSCI, and ICG modes immediately. Blinded subjects ( n =  21) demonstrated similar spatial–temporal precision and accuracy with all three modes ≤ 2 min after ICG injection, and discordance in ICG mode at ≥ 5 min in devascularized small intestine ( p <  0.0001) and in partial gastrectomy ( p <  0.0001). Conclusions Combining LSCI for near real-time blood flow detection with ICG fluorescence for blood volume detection significantly improves precision and accuracy of perfusion detection in tissue locations over time, in real time, and repeatably on-demand than ICG alone. Graphical abstract