Use of an Image Acquisition Stabilizer Improves Sidestream Dark Field Imaging of the Serosa during Open Gastrointestinal Surgery

Abstract

Aim: To investigate whether an image acquisition stabilizer (IAS) mounted on the sidestream dark field camera (SDF) during gastrointestinal surgery improves image stability and acquisition. Methods: Serosal SDF imaging was compared with SDF imaging combined with an IAS (SDF + IAS) during gastrointestinal surgery. Stability was assessed as the image drift in pixels and the time to obtain stable images. The success rate was determined as the percentage of analyzable images after recording. The effect of negative pressure from the IAS was determined during single-spot measurements and by comparing microvascular parameters between groups. Data are presented as mean ± SD. Results: Sixty serosal measurements were performed per group; 87% were successful in the SDF group and 100% in the SDF + IAS group (p = 0.003). Image drift in the SDF group was 148 ± 36 versus 55 ± 15 pixels in the SDF + IAS group; p < 0.001. Time to stable image was 96 ± 60 s in the SDF group versus 57 ± 31 s in the SDF + IAS group; p = 0.03. No effect of negative pressure was seen. Conclusion: The use of an IAS mounted on an SDF camera during serosal microvascular assessment improves the success rate of image acquisition and stability and reduces the time to stable image with no effect on the microcirculation.

Intraoperative Incident Dark Field Imaging of the Human Peritoneal Microcirculation

“…The difficulty that determined the time to acquire a peritoneal image was pressure artifacts. Use of an image or surface contact stabilizer, described previously by Balestra et al [30] and validated by de Bruin et al [31], could help to avoid such pressure artifacts. This contact stabilizer is attached to the tip of the device as a ring and adheres to the region of interest by applying a mild negative pressure.…”

Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine

“…From the results it became clear that microcirculatory alterations were significantly correlated with the progress of human sepsis and predictive of organ failure and mortality [5][6][7][8][9][10]. Although most microcirculatory measurements using HVM were carried out in the sublingual area, several investigations of the microcirculation were carried out directly on organ surfaces during surgery [2,[11][12][13][14][15]. Indeed, sublingual microcirculatory alterations have been identified using HVM in a wide range of disease states other than sepsis and shock [16][17][18][19][20][21][22][23][24][25][26] and in different age groups including critically ill newborns [27].…”

“…Space-time diagrams (STDs) are the gold standard for quantitative measurements of RBC velocity. It should be noted that not all microvessels contain the physical characteristics (clear visualization of particular nature of the RBCs) that make them suitable for STD analysis, creating potential bias in the analysis15. Alterations in the sublingual microcirculation have previously been used mainly to describe changes observed in patients associated with sepsis.…”

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

“…Although, practical difficulties in acquiring stable image have largely been overcome with the use of an IAS with an average imaging time per organ site of 3 min, still limitations of HVM remain [5]. Firstly, direct access to the bowel is necessary, making applicability limited to open procedures or surgery, where the bowel is externalized as in the cases described.…”

“…The serosal microcirculation was visualized with Sidestream dark field imaging in case 1 and with Cytocam-IDF imaging (Braedius Medical, Huizen, The Netherlands) in case 2. An image acquisition stabilizer was used [5]. Images were acquired by a trained researcher and according to international consensus, as recommended three unique HVM images were acquired per measurement [6].…”