Abstract
AIM: Successful anastomotic healing is essential in colorectal surgery and depends on adequate microcirculation at the resection site to prevent anastomotic leakage (AL). Traditionally, surgeons subjectively assess this. Laser speckle contrast imaging (LSCI) provides an objective, dye-free, and non-contact method for measuring the bowel end microcirculation that could perioperatively support the surgeon's assessment. This study aimed to determine the feasibility of LSCI and evaluate surgeons' subjective opinions on its potential to assist in surgical decision-making. METHOD: This feasibility trial was conducted within the IDEAL framework as a non-interventional multicentre study. Patients undergoing elective right hemicolectomy were included. LSCI measurements were conducted twice perioperatively: before and after anastomosis formation. Surgeons were blinded to all measurements. Postoperatively, LSCI images and a questionnaire were presented to the surgeon asking whether these images, if presented perioperatively, would have influenced the selection of the optimal anastomotic site. RESULTS: High-quality LSCI measurements were obtained in all 20 patients operated on by 17 different surgeons, with clear and interpretable perfusion images captured without compromising sterility or extending operating time significantly. The device was non-invasive and added an average of 2 minutes to the total operation time. Fifteen of the 17 surgeons indicated that measures could have influenced surgical decision-making. In 50% of the cases, the surgeon reported a change in the resection site, by an average of 1.2 cm, based on LSCI images. CONCLUSION: This study demonstrated that LSCI effectively displays colonic perfusion in real-time without disrupting the surgical procedure. The potential clinical value of LSCI with additional visual feedback lies in assisting surgeons in selecting the most optimal anastomotic site, thereby potentially improving healing and surgical outcome.