The intraoperative assessment of intestinal tissue viability with modern optical technologies

Purpose. To improve the accuracy of diagnosing microcirculation disorders in the intestinal wall tissues in small laboratory animals by introducing hyperspectral imaging in combination with a controlled polychrome LED light source.

Materials and methods. 10 clinically healthy Wistar rats were used in the study. Intestinal ischemia was modeled by the ligation of mesenteric vessels after laparotomy under inhalation anesthesia. Relaparotomy was performed in 1, 6 and 12 hours. The viability of intestinal tissues and the identifi cation of secondary pathological changes were assessed with the visual Kerte method and a polychrome LED light source providing contrast visualization of biological tissues. Intestinal wall perfusion was assessed by the hyperspectral imaging system. Intestinal resection followed by the sampling for morphological examination was made according to time intervals established by the examination protocol.

Results. Spectral composition of the light source, which reliably detects the intestinal wall necrosis, includes two spectral lines with maxima of λpeak = 503 nm and λpeak = 594 nm at 2:1 intensity ratio. Hyperspectral imaging allowed to get two-dimensional maps of tissue saturation with the following values: 66 ± 2 % (intact tissue), 42 ± 5 % (1 hour), 26 ± 3 % (6 hours) and 21 ± 3 % (12 hours). The performed morphological analysis revealed three key ischemic intervals: 1 hour (ischemia onset), 6 hours (reversible ischemia) and 12 hours (irreversible necrosis). The obtained data confi rm the signifi cant decrease in saturation which correlates with morphological changes, and the effectiveness of the discussed technique for assessing the viability of intestinal tissues.

Conclusion. In the course of the study, the authors have developed a technology for optimizing the lighting during surgery so as to improve contrast imaging of ischemic and necrotic tissue changes. Hyperspectral imaging promotes non-invasive and objective intraoperative assessment of the ischemic damage in the intestinal wall without any exogenous fl uorescent drugs. The obtained results also demonstrate the prospects of introducing optimized lighting and hyperspectral imaging into clinical practice so as to improve diagnosis and surgical treatment of ischemic intestinal lesions.

1. Zachariah S.K. Adult necrotizing enterocolitis and non occlusive mesenteric ischemia. J. Emergencies, Trauma Shock. 2011; 4 (3): 430–432. DOI: 10.4103/0974-2700.83881

2. Yaroshhuk S.A., Baranov A.I., Katasheva L.Yu., Leshhishin Ya.M. Ostraya mezenterial’naya ishemiya: podxody’ k diagnostike i operativnomu lecheniyu. Medicina v Kuzbasse. 2018; 17 (2): 35–42. (In Russ.).

3. Maev I.V., Vojnovskij E.A., Lucevich O.E., V`yuchnova E.S., Urbanovich A.S., Dicheva D.T., Lebedeva E.G., Andreev D.N., Morozova A.V., Surkova O.A., Veryugina N.I. Acute intestinal obstruction (the guidelines). Russian Journal of EvidenceBased Gastroenterology. 2013; (1): 36–51. (In Russ.).

4. Rukovodstvo po neotlozhnoj xirurgii organov bryushnoj polosti. Rukovodstvo dlya vrachej. 2-e izdanie. Pod. red. VS Savel’eva. Moscow: MIA; 2020. (In Russ.).

5. Urbanavičius L., Pattyn P., Putte DV., Venskutonis D. How to assess intestinal viability during surgery: A review of techniques. World J Gastrointest Surg. 2011; 3(5): 59–69. DOI: 10.4240/wjgs.v3.i5.59

6. Bryski M.G., Frenzel Sulyok L.G., Kaplan L., Singhal S., Keating J.J. Techniques for intraoperative evaluation of bowel viability in mesenteric ischemia: A review. Am. J. Surg. 2020; 220 (2): 309–315. DOI: 10.1016/j.amjsurg.2020.01.042

7. Rodin A.V., Pleshkov V.G. Intraoperacionnaya ocenka zhiznesposobnosti kishki pri ostroj kishechnoj neproxodimosti. Vestnik Smolenskoi gosudarstvennoi meditsinskoi akademii. 2016; 15 (1): 75–82. (In Russ.).

8. Shapovalyants S.G., Larichev S.E., Sazhin A.V., Shchegolev A.A., Gulyaev A.A., Beburishvili A.G., Prutkov M.I., Shulutko A.M., Darwin V.V. National clinical recommendations “Acute non-tumour intestinal obstruction”. Adopted at the XII Congress of Surgeons of Russia “Topical issues of surgery”, Rostov-on-Don, 7–9 Oct. Rostov-na-Donu; 2015. 36 p. (In Russ.).

9. Karliczek A., Harlaar N.J., Zeebregts C.J., Wiggers T., Baas P.C., van Dam G.M. Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis. 2009; 24 (5): 569–76. DOI: 10.1007/s00384009-0658-6

10. Adamenkov N.A., Mamoshin A.V., Dremin V.V., Potapova E.V., Shupleczov V.V., Goryunov I.A., Palalov A.A., Dunaev A.V. Assessment of intestinal wall perfusion under ischemic conditions using hyperspectral imaging. Russian Journal of Operative Surgery and Clinical Anatomy. 2024;8(1):5-13. (In Russ.). DOI: 10.17116/operhirurg202480115

11. Dunaev A.V. Multimodalnaya opticheskaya diagnostika mikrocirkulyatorno-tkanevyh sistem organizma cheloveka: monografi ya. Staryj Oskol: TNT; 2022. [440] (In Russ.).

12. Aladov A.V., Valyukhov V.P., Zakgeim A.L., Kuptsov V.D., Mamoshin A.V., Potapova E.V., Chernyakov A.E., Fotiadi A.E. Optimization of surgical fi eld illumination to maximize the contrast when biological objects being visualized, St. Petersburg Polytechnical State University Journal. Physics and Mathematics. 2019; 12 (4): 79–88. (In Russ.). DOI: 10.18721/ JPM.12408

13. Mamoshin A.V., Alyanov A.L., Seryogina E.S., Potapova E.V., Dunaev A.V., Ivanov A.V., Aladov A.V. Possibilities of using dynamically controlled semiconductor light sources during surgical operations. EEE International Conference on Electrical Engineering and Photonics. 2018; 22: 288–291. DOI: 10.1109/EExPolytech.2018.8564383

14. Аладов А.В., Валюхов В.П., Закгейм А.Л., Купцов В.Д., Мамошин А.В., Потапова Е.В., Черняков А.Е., Фотиади А.Э. Оптимизация освещения операционного поля с целью получения максимального контраста при визуализации биологических объектов // Научно-технические ведомости СПбГПУ. Физико-математические науки. 2019. 12 (4): 79–88. (In Russ.). DOI: 10.18721/JPM.12408

15. Kurabuchi Y., Nakano K., Ohnishi T., Nakahuchi T., Hauta-Kasari M., Haneishi H. Optimization of Surgical Illuminant Spectra for Organ Microstructure Visualization. IEEE Access. 2019; 7: 70733–70741. DOI: 10.1109/AC-CESS.2019.2919451

16. Dremin V.V., Zherebtsov E.A., Popov A.P., Meglinski I.V., Bykov A.V. Hyperspectral imaging of diabetes mellitus skin complications. In Biomedical Photonics for Diabetes Research. 2022; 177–195.

17. Dremin V.V, Marcinkevics Z., Zherebtsov E.A., Popov A.P., Grabovskis A., Kronberga H., Geldnere K., Doronin A.A., Meglinski I.V., Bykov A.V. Skin complications of diabetes mellitus revealed by polarized hyperspectral imaging and machine learning. IEEE Transactions on Medical Imaging. 2021; 40 (4): 1207–1216. DOI: 10.1109/TMI.2021.3049591

18. Zherebtsov E.А., Dremin V.V., Popov A.P., Doronin A.A., Kurakina D., Kirillin M., Meglinski I.V., Bykov A.V. Hyperspectral imaging of human skin aided by artifi cial neural networks. Biomedical optics express. 2019; 10 (7): 3545–3559.

19. Zimmermann A. The role of intraoperative hyperspectral imaging (HSI) in colon interposition after esophagectomy. BMC surgery. 2023; 2 (23): 47. DOI: 10.1186/s12893-023-01946-3

20. Potapova E.V., Dremin V.V., Zherebtsov E.A., Makovik I.N., Zherebtsova A.I., Dunaev A.V., Muradyan V.F. Evaluation of microcirculatory disturbances in patients with rheumatic diseases by the method of diffuse refl ectance spectroscopy. Hum Physiol. 2017; 43: 222–228. DOI: 10.1134/S036211971702013X

21. Bertacco A., Dehner C.A., Caturegli G., D’Amico F., Morotti R., Rodriguez M.I., Mulligan D.C., Kriegel M.A., Geibel J.P. Modulation of Intestinal Microbiome Prevents Intestinal Ischemic Injury. Front. Physiol. 2017; 8: 1064. DOI: 10.3389/fphys.2017.01064

22. Canceco J., Winokur E.J. Mesenteric Ischemia: Concepts of Care for the Bedside Nurse. Gastroenterol Nurs. 2018; 41 (4): 305–311. DOI: 10.1097/SGA.0000000000000329

23. Zherebtsov E.A., Dremin V.V., Popov A.P., Doronin A.A., Kurakina D., Kirillin M., Bykov A.V. Hyperspectral imaging of human skin aided by artifi cial neural networks. Biomedical optics express. 2019; 10 (7): 3545–3559.