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. 2023 Mar;37(3):2395-2403.
doi: 10.1007/s00464-022-09764-z. Epub 2022 Nov 28.

Quantification of bowel ischaemia using real-time multispectral Single Snapshot Imaging of Optical Properties (SSOP)

María Rita Rodríguez-Luna  1   2 , Nariaki Okamoto  3   4 , Lorenzo Cinelli  3   5 , Luca Baratelli  6 , Silvère Ségaud  4 , Adriana Rodríguez-Gómez  7 , Deborah S Keller  8 , Elham Zonoobi  9   10 , Elisa Bannone  3   11 , Jacques Marescaux  3 , Michele Diana  3   4 , Sylvain Gioux  4   6
Affiliations

Quantification of bowel ischaemia using real-time multispectral Single Snapshot Imaging of Optical Properties (SSOP)

María Rita Rodríguez-Luna et al. Surg Endosc. 2023 Mar.

Abstract

Background: Single snapshot imaging of optical properties (SSOP) is a relatively new non-invasive, real-time, contrast-free optical imaging technology, which allows for the real-time quantitative assessment of physiological properties, including tissue oxygenation (StO2). This study evaluates the accuracy of multispectral SSOP in quantifying bowel ischaemia in a preclinical experimental model.

Methods: In six pigs, an ischaemic bowel segment was created by dividing the arcade branches. Five regions of interest (ROIs) were identified on the bowel loop, as follows: ROI 1: central ischaemic; ROI 2: left marginal; ROI 3: left vascularised; ROI 4: right marginal; and ROI 5: right vascularised. The Trident imaging system, specifically developed for real-time tissue oxygenation imaging using SSOP, was used to image before (T0) and after ischaemia induction. Capillary and systemic lactates were measured at each time point (T0, T15, T30, T45, T60), as well as StO2 values acquired by means of SSOP (SSOP-StO2).

Results: The mean value of SSOP-StO2 in ROI 1 was 30.08 ± 6.963 and was significantly lower when compared to marginal ROIs (ROI 2 + ROI 4: 45.67 ± 10.02 p = < 0.0001), and to vascularised ROIs (ROI 3 + ROI 5: 48.08 ± 7.083 p = < 0.0001). SSOP-StO2 was significantly correlated with normalised lactates r = - 0.5892 p < 0.0001 and with histology r =- 0.6251 p = 0.0002.

Conclusion: Multispectral SSOP allows for a contrast-free accurate assessment of small bowel perfusion identifying physiological tissue oxygenation as confirmed with perfusion biomarkers.

Keywords: Anastomotic leak; Diffuse optical imaging; Image-guided surgery; Single snapshot imaging of optical properties; Tissue perfusion.

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Conflict of interest statement

Sylvain Gioux and Luca Baratelli are employees of Intuitive Surgical Sàrl. Jacques Marescaux is the President of the IRCAD, which is partly funded by KARL STORZ and Medtronic. María Rita Rodríguez-Luna was supported by the following project grant: European Union’s Horizon 2020 research and innovation programme, under the Marie Skłodowska-Curie grant agreement No. 857894 – CAST. Drs. Nariaki Okamoto, Lorenzo Cinelli, Silvère Ségaud, Adriana Rodríguez-Gómez, Deborah S. Keller, Elisa Bannone, Michele Diana, and Ms. Elham Zonoobi have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
SSOP images showing StO2% during the full ischaemic period in the small bowel loop from baseline to T60, and corresponding true colour (RGB) images
Fig. 2
Fig. 2
A. SSOP-StO2 values during 1 h of ischaemia: the mean value of SSOP-StO2 in ROI 1 was 30.08 ± 6.963 and significantly lower when compared to marginal ROIs (ROI 2 + ROI 4: 45.67 ± 10.02 p =  < 0.0001), and to vascularised ROIs (ROI 3 + ROI 5: 48.08 ± 7.083, p =  < 0.0001). Although SSOP-StO2 was higher in vascularised ROIs, it did not show any statistically significant difference (p = 0.1298). B. Kinetics of StO2 cartography in each ROI. C. Normalised lactates (mmol/L) during 1 h of ischaemia: the mean value of normalised lactates in ROI 1 was 4.804  ± 2.591 and significantly higher when compared to marginal ROIs (ROI 2 + ROI 4: 1.026 ± 0.472, p < 0,0001), and to vascularised ROIs (ROI 3 + ROI 5: 0.749 ± 0.246, p < 0.0001). The difference between marginal and vascularised ROIs also showed a statistically significant difference p < 0.0001. D. Kinetics of normalised lactates (mmol/L). E. Pearson’s correlation analysis between normalised lactates and SSOP-StO2 in correspondence to all ROIs. F. Histopathological report: the mean Park/Chiu’s score at ROI 1 was 4.500 ± 0.8367 and significantly higher than marginal zones (ROI 2 and ROI 4: 1.583 ± 1.097, p < 0,0001) and vascularised (ROI 3 and ROI 5: 0.667 ± 0.650, p < 0.0001)
Fig. 3
Fig. 3
SSOP images showing SSOP-StO2% in the ischaemia/reperfusion small bowel model at baseline, occlusion, and release with the corresponding true colour (RGB) images (Color figure online)
Fig. 4
Fig. 4
The graph shows the overtime evolution of the SSOP-StO2 parameter at baseline, occlusion, and reperfusion phases on ROI 1. Red bars represent clamping (T0) and declampling (T10), respectively. The SSOP-StO2 could precisely discriminate when the ischaemia started with a more evident decrease in 50% appreciated after 2 min of occlusion. Once the surgical clamp was released (second red bar), an improvement in saturation occurred
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