Display options
Share it on

Pilot Feasibility Stud. 2017 Nov 25;3:65. doi: 10.1186/s40814-017-0204-1. eCollection 2017.

Can we predict necrosis intra-operatively? Real-time optical quantitative perfusion imaging in surgery: study protocol for a prospective, observational, in vivo pilot study.

Pilot and feasibility studies

Sanne M Jansen, Daniel M de Bruin, Mark I van Berge Henegouwen, Simon D Strackee, Denise P Veelo, Ton G van Leeuwen, Suzanne S Gisbertz


  1. Academic Medical Center, University of Amsterdam, Dep. of Biomedical Engineering & Physics, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
  2. Academic Medical Center, University of Amsterdam, Dep. of Gastrointestinal Surgery, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
  3. Academic Medical Center, University of Amsterdam, Dep. of Plastic, Reconstructive and Handsurgery, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
  4. Academic Medical Center, University of Amsterdam, Dep. of Anesthesiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

PMID: 29209513 PMCID: PMC5702143 DOI: 10.1186/s40814-017-0204-1


BACKGROUND: Compromised perfusion as a result of surgical intervention causes a reduction of oxygen and nutrients in tissue and therefore decreased tissue vitality. Quantitative imaging of tissue perfusion during reconstructive surgery, therefore, may reduce the incidence of complications. Non-invasive optical techniques allow real-time tissue imaging, with high resolution and high contrast. The objectives of this study are, first, to assess the feasibility and accuracy of optical coherence tomography (OCT), sidestream darkfield microscopy (SDF), laser speckle contrast imaging (LSCI), and fluorescence imaging (FI) for quantitative perfusion imaging and, second, to identify/search for criteria that enable risk prediction of necrosis during gastric tube and free flap reconstruction.

METHODS: This prospective, multicenter, observational in vivo pilot study will assess tissue perfusion using four optical technologies: OCT, SDF, LSCI, and FI in 40 patients: 20 patients who will undergo gastric tube reconstruction after esophagectomy and 20 patients who will undergo free flap surgery. Intra-operative images of gastric perfusion will be obtained directly after reconstruction at four perfusion areas. Feasibility of perfusion imaging will be analyzed per technique. Quantitative parameters directly related to perfusion will be scored per perfusion area, and differences between biologically good versus reduced perfusion will be tested statistically. Patient outcome will be correlated to images and perfusion parameters. Differences in perfusion parameters before and after a bolus of ephedrine will be tested for significance.

DISCUSSION: This study will identify quantitative perfusion-related parameters for an objective assessment of tissue perfusion during surgery. This will likely allow early risk stratification of necrosis development, which will aid in achieving a reduction of complications in gastric tube reconstruction and free flap transplantation.

TRIAL REGISTRATION: Clinicaltrials.gov registration number NCT02902549. Dutch Central Committee on Research Involving Human Subjects registration number NL52377.018.15.

Keywords: Accuracy; Anastomotic leakage; Feasibility; Fluorescence imaging; Laser speckle contrast imaging; Monitoring; Necrosis; Optical coherence tomography; Optical technologies; Perfusion; Risk prediction; Sidestream darkfield microscopy


  1. Physiol Res. 2008;57(3):365-71 - PubMed
  2. Med Biol Eng Comput. 2008 Jul;46(7):659-70 - PubMed
  3. Opt Express. 2003 Dec 15;11(25):3490-7 - PubMed
  4. Crit Care. 2010;14(5):R193 - PubMed
  5. Appl Opt. 1977 Sep 1;16(9):2334-6 - PubMed
  6. Ann Surg. 2015 Jul;262(1):74-8 - PubMed
  7. Int J Surg. 2014 Dec;12(12):1500-24 - PubMed
  8. Cancer. 2013 Mar 15;119(6):1149-58 - PubMed
  9. Science. 1991 Nov 22;254(5035):1178-81 - PubMed
  10. Ann Surg. 2015 Aug;262(2):286-94 - PubMed
  11. Intensive Care Med. 2010 Nov;36(11):1813-25 - PubMed
  12. Curr Opin Chem Biol. 2003 Oct;7(5):626-34 - PubMed
  13. Medicine (Baltimore). 2016 Jun;95(25):e3875 - PubMed
  14. Lancet. 2009 Sep 26;374(9695):1105-12 - PubMed
  15. J Biomed Opt. 2013 Jun;18(6):066018 - PubMed
  16. Colorectal Dis. 2016 Mar;18(3):O103-10 - PubMed
  17. Anesthesiol Clin. 2008 Jun;26(2):293-304, vi - PubMed
  18. Opt Express. 2007 Nov 12;15(23):15101-14 - PubMed
  19. J Biomed Opt. 2017 Aug;22(8):1-9 - PubMed
  20. N Engl J Med. 2012 May 31;366(22):2074-84 - PubMed
  21. Ann Surg. 2010 Jun;251(6):1064-9 - PubMed
  22. Clin Chem. 2003 Jan;49(1):7-18 - PubMed
  23. IEEE Rev Biomed Eng. 2013;6:99-110 - PubMed
  24. Biometrics. 1977 Mar;33(1):159-74 - PubMed
  25. Anesth Analg. 2010 Feb 1;110(2):541-6 - PubMed
  26. Gastrointest Endosc. 2002 Jan;55(1):88-95 - PubMed
  27. BMC Med Imaging. 2010 Jul 13;10:15 - PubMed

Publication Types