144 Chapter 7 Usability for intestinal perfusion assessment The collected data from the questionnaire were analyzed to assess the usability of PerfusiXImaging®. The questionnaire was filled in by five senior surgeons. No one disagreed on any of the questions. All surgeons (strongly) agreed on the minimal latency during the surgical procedure. Besides, 80% of the surgeons (n = 4) (strongly) agreed that the system was easy to use, easy to set up, able to visualize perfusion and able to visualize watershed areas. Two surgeons agreed and one strongly agreed (total of 60%) on the statement that the LSCI information reflected the expected pattern of blood flow. An additional 60% agreed on the good quality of the displayed data. The results from the survey are displayed in percentages in Figure 3. DISCUSSION In the current animal study, we successfully acquired laser speckle contrast images during intestinal surgery using laparoscopic LSCI setup, demonstrated the capability of indicating ischemic bowel regions with this technique, and demonstrated the usability of LSCI system for intestinal perfusion assessment. The use of LSCI feedback allowed us to visualize and detect differences of intestinal perfusion, which can serve as a critical indicator of tissue perfusion. The noticeable attributes of LSCI appear especially captivating when applied to the creation of intestinal anastomoses. In this context, it becomes imperative to conduct an intraoperative evaluation of intestinal microperfusion to confirm the vitality of the recently established anastomosis, aiming to avert complications stemming from insufficient blood supply, such as AL. The conventional approach of the surgeon relying on visual examination has demonstrated marked subjectivity and offers minimal predictive efficacy 12. The latter stimulated the advancement of perfusion imaging methods, especially near-infrared fluorescence imaging 22, 23. Fluorescence angiography has some distinct disadvantages compared to LSCI. These include the need for a fluorescence dye and the inability to repetitively and continuously assess bowel perfusion due to wash-out effects 24, 25. In contrast, we were able to detect the location of the intestinal watershed area in real time without the need to administer an exogenous dye with LSCI. Identifying the location of the intestinal watershed area with LSCI could serve as a socalled red flag technique in guiding surgeons towards an anastomosis created with better perfused tissue. The ability to assess anastomotic perfusion in real-time provides surgeons with important information that complements their conventional assessment methods. This additional feedback empowers surgeons to detect perfusion differences between tissue segments and identify the worst and best perfused tissue more accurately 16, 17, 18, 20.
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