Assessment of abdominal tissues viability


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Abstract

Topicality: Disruption of mesenteric circulation is one of the most severe pathologies in abdominal surgery. Intraoperative assessment of intestinal viability remains an unsolved surgical problem. Application of modern methods of ischemia and tissue necrosis determination is a promising direction in the objective diagnosis of these pathologies.
Purpose of the work. Development and introduction into the surgical practice of the operating field illumination methods improving visualization and objective assessment of microcirculation and intestinal wall viability.
Materials and methods. Clinically healthy laboratory rat of Wistar line was the object of investigation. To estimate the degree of the intestinal wall pathological changes in the midline laparotomy, staged ligation of the small intestine arcade vessels with the time intervals from 15 to 60 minutes was carried out. Tissue condition was assessed using RGB lamp, hyperspectral camera and diffuse reflectance spectroscopy method. An LED surgical illuminator with controllable color parameters was used in the study. Diffuse reflectance spectroscopy was used to assess ischemic changes, showing light absorption by different tissue chromophores. Radiation delivery from a broadband source to the tissue and collection of secondary optical radiation to the spectrometer were performed using an optical probe. An optical hyperspectral imaging system based on the principle of registration of diffuse light reflection from the tissue was used. A halogen source was used as a broadband radiation source, and a Specim hyperspectral camera as a detector. The study was completed by sending intestinal sections for pathomorphological examination.
Results. The obtained data were processed in the Matlab program using the mathematical method of image segmentation. Application of colors in the range of 500 and 593 nm (turquoise + orange) allowed to visualize and evaluate ischemic and necrotic intestinal areas better in comparison with the light repeating the radiation of the surgical lamp that was confirmed by histological study. Based on the data obtained by diffuse reflection spectroscopy and hyperspectral imaging methods, the values of blood flow and tissue saturation were calculated. Significant decrease of saturation and blood-filling in the ischemic regions of the intestine was observed.
Conclusions. Application of RGB lamp improves visualization of ischemic areas. Application of hyperspectral camera and diffuse reflection spectroscopy are objective methods of tissue viability assessment.
The study was supported by the Russian Science Foundation under Project No. 21-15-00325.

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Full Text

Topicality: Disruption of mesenteric circulation is one of the most severe pathologies in abdominal surgery. Intraoperative assessment of intestinal viability remains an unsolved surgical problem. Application of modern methods of ischemia and tissue necrosis determination is a promising direction in the objective diagnosis of these pathologies.
Purpose of the work. Development and introduction into the surgical practice of the operating field illumination methods improving visualization and objective assessment of microcirculation and intestinal wall viability.
Materials and methods. Clinically healthy laboratory rat of Wistar line was the object of investigation. To estimate the degree of the intestinal wall pathological changes in the midline laparotomy, staged ligation of the small intestine arcade vessels with the time intervals from 15 to 60 minutes was carried out. Tissue condition was assessed using RGB lamp, hyperspectral camera and diffuse reflectance spectroscopy method. An LED surgical illuminator with controllable color parameters was used in the study. Diffuse reflectance spectroscopy was used to assess ischemic changes, showing light absorption by different tissue chromophores. Radiation delivery from a broadband source to the tissue and collection of secondary optical radiation to the spectrometer were performed using an optical probe. An optical hyperspectral imaging system based on the principle of registration of diffuse light reflection from the tissue was used. A halogen source was used as a broadband radiation source, and a Specim hyperspectral camera as a detector. The study was completed by sending intestinal sections for pathomorphological examination.
Results. The obtained data were processed in the Matlab program using the mathematical method of image segmentation. Application of colors in the range of 500 and 593 nm (turquoise + orange) allowed to visualize and evaluate ischemic and necrotic intestinal areas better in comparison with the light repeating the radiation of the surgical lamp that was confirmed by histological study. Based on the data obtained by diffuse reflection spectroscopy and hyperspectral imaging methods, the values of blood flow and tissue saturation were calculated. Significant decrease of saturation and blood-filling in the ischemic regions of the intestine was observed.
Conclusions. Application of RGB lamp improves visualization of ischemic areas. Application of hyperspectral camera and diffuse reflection spectroscopy are objective methods of tissue viability assessment.
The study was supported by the Russian Science Foundation under Project No. 21-15-00325.


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About the authors

Nikita Alekseevich Adamenkov

Emergency Medical Care Hospital of Orel Region N.A. Semashko

Author for correspondence.
Email: nikita-ad@mail.ru
ORCID iD: 0000-0002-0238-2941
Russian Federation

Dmitriy Sergeevich Sumin

OOKB

Email: dm.s.sumin@gmail.ru
ORCID iD: 0000-0001-5937-2384
Russian Federation

Anastasiya Vladimirovna Vetrova

Emergency Medical Care Hospital of Orel Region N.A. Semashko

Email: boofee@yandex.ru
ORCID iD: 0000-0002-1031-3743
Russian Federation

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