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24.10.2017 | Dynamic Manuscript | Ausgabe 2/2018

Surgical Endoscopy 2/2018

Feasibility of real-time intestinal bloodstream evaluation using probe-based confocal laser endomicroscopy in a porcine intestinal ischemia model

Zeitschrift:
Surgical Endoscopy > Ausgabe 2/2018
Autoren:
Tsuyoshi Takahashi, Rie Nakatsuka, Hisashi Hara, Shigeyoshi Higashi, Kouji Tanaka, Yasuhiro Miyazaki, Tomoki Makino, Yukinori Kurokawa, Makoto Yamasaki, Shuji Takiguchi, Masaki Mori, Yuichiro Doki, Kiyokazu Nakajima
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00464-017-5914-1) contains supplementary material, which is available to authorized users.
This work was partially supported by the Japan NOTES Research Grant.

Abstract

Background

Intestinal ischemia can lead to fatal complications if left unrecognized during surgery. The current techniques of intraoperative microvascular assessment remain subjective. Probe-based confocal laser endomicroscopy (pCLE) has the potential to objectively evaluate microvascular blood flow in real-time setting. The present study evaluated the technical feasibility of real-time intestinal bloodstream evaluation using pCLE in a porcine intestinal ischemia model.

Methods

Seven pigs were used. The intestinal ischemia model was prepared by sequentially dividing the mesenteric blood vessels. The intestinal bloodstream was evaluated on its serosal surface using pCLE (Cellvizio 488 probe, Ultra Mini O) at every 1-cm segment from a vessel-preservation border (i.e., the cut end of the vessel). Images of the blood vessels and flow of red blood cells (RBCs) in each visualized vessel were semi-qualitatively assessed using a 3-scale scoring system. In addition, 25 surgeons blindly assessed the 10 movies recorded at 0, 1, 2, 3, and 5 cm from a vessel-preservation border using a 4-scale scoring system to confirm the consistency of the evaluation of the pCLE system.

Results

Images of the blood vessels were successfully obtained from the cut end of the vessel to the segment 4 cm away. Good unidirectional flow of RBCs was observed from the cut end to the 2-cm segment, whereas the flow became bidirectional between 2 and 3 cm segments. Beyond 4 cm, no flow images were obtained. The specimen obtained from the segment beyond 4 cm showed remarkable mucosal color change, which was confirmed as a necrotic change histologically. The evaluations from the cut end of the vessel to the segment 1 cm away by surgeons were excellent or good and it was almost consistent.

Conclusions

Real-time bloodstream evaluation using pCLE is feasible and potentially effective for predicting intestinal ischemia during surgery.

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Zusatzmaterial
The image of blood microvessels was obtained by pCLE on the normal intestine surface immediately after injecting FS, and the diameter was 10 µm. In the blood vessels, we clearly observed RBCs flowing in one direction (MP4 4252 KB)
pCLE images were obtained from the porcine ischemia model on − 5 cm. We get good contrast of vessels and detect RBCs flowing in one direction (MP4 2133 KB)
pCLE images were obtained from the porcine ischemia model on 0 cm. We get good contrast of vessels and detect RBCs flowing in one direction (MP4 1095 KB)
pCLE images were obtained from the porcine ischemia model on 1 cm. We get good contrast of vessels and detect RBCs flowing in one direction (MP4 3067 KB)
pCLE images were obtained from the porcine ischemia model on 2 cm. We get good contrast of vessels and detect RBCs flowing in bidirection (MP4 1835 KB)
pCLE images were obtained from the porcine ischemia model on 3 cm. We get fair contrast of vessels and detect RBCs flowing in bidirection (MP4 3188 KB)
pCLE images were obtained from the porcine ischemia model on 4 cm. We don’t get contrast of vessels and detect RBCs flowing (MP4 5650 KB)
pCLE images were obtained from the porcine ischemia model on 5 cm. We don’t get contrast of vessels and detect RBCs flowing (MP4 2787 KB)
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