Detection of inadequate anastomotic perfusion with handheld vital microscopy in two patients during colorectal surgery

Abstract

Introduction Anastomotic leakage is one of the most feared complications after gastrointestinal surgery. Assessment of anastomotic viability during surgery remains challenging. Sufficient bowel tissue perfusion is a requisite for anastomotic healing. Handheld vital microscopy (HVM) is a non-invasive technique that can directly visualize the intestinal microcirculation during surgery. Presentation of two cases Two patients underwent elective laparoscopic colorectal surgery. During surgery HVM was used to assess bowel perfusion prior to creation of a primary anastomosis. Although the bowel macroscopically appeared to be well perfused, HVM showed a severely compromised microcirculation. The colon was re-internalized and during the following minutes cyanosis of the bowel occurred which was visually determined by the surgeon. After dissection towards cranially, a new site for the primary anastomosis was chosen. The postoperative period was uncomplicated. Discussion Sufficient bowel tissue perfusion is often mentioned as key in the pathophysiology of anastomotic leakage. HVM is a technique that could potentially aid surgeons in the assessment of microcirculatory perfusion of the bowel during surgery. Conclusion We report two cases undergoing colorectal surgery in which HVM showed merit in detecting compromised bowel perfusion before creation of a primary anastomosis.

Indocyanine green fluorescence imaging during laparoscopic rectal cancer surgery could reduce the incidence of anastomotic leakage: a single institutional retrospective cohort study

“…Karliczek et al reported that the clinical judgment of surgeons appeared to have low sensitivity and specificity in predicting anastomotic leakage in colorectal anastomoses [22]. Recently, several techniques, such as oxygen spectrometry, laser speckle imaging, thermography, and handheld vital microscopy, have been developed to evaluate intestinal perfusion [23][24][25][26]. However, these techniques are not yet widely used due to their high cost and technical complexity.…”

Dye-free visualisation of intestinal perfusion using laser speckle contrast imaging in laparoscopic surgery: a prospective, observational multi-centre study

“…Insight in anastomotic perfusion has gained major interest in recent years. Enabling the surgeon to assess and—if necessary and possible—relocate the anastomosis to ensure adequate perfusion, which potentially may result in a decrease in anastomotic leakage [ 8 – 12 ].…”