Danique Heuvelings

159 Real-time quantification of LSCI during intestinal laparoscopic surgery estimation was performed to test the correlation between LSPUs and LCL-levels and plot a coefficient of determination, or R2. Inter-rate reliability was analyzed using Cohen’s Kappa 27. Differences were considered significant when P<0.05. Figures were produced with PRISM (PRISM version 10.1.0 (316), GraphPad Software LCC, Boston, Massachusetts, United States). Mann-Whitney U tests were conducted for non-normally distributed variables, while T-tests were employed for normally distributed variables. Numerical variables are presented as mean ± SD or median [IQR 25%-75%] where appropriate. RESULTS The surgical procedures were performed without complications or adverse events. The average weight of the landrace pigs was 39 kilogram (range 36-42). A total of 18 intestinal loops were created, ranging between three and five loops per animal. The operating surgeon was able to interpret all LSCI derived perfusion colourmaps in real-time on the surgical monitor and to place the ROIs (Figure 2). Systemic lactate levels ranged from 12 to 30 mmol/L, indicating that none of the pigs experienced ischemia during the experiment. LSPU values At T-1, there were no significant differences in mean LSPUs between the watershed, ischemic, and well-perfused areas, as presented in Figure 3A. At T0 (Figure 3B) LSPUs of the ROIs started to diverge. Mean ischemic LSPUs were not only significantly lower, compared to well-perfused areas (66.8 ± 19.4 versus 94.7 ± 18.7 AU, P≤.001), but also compared to the watershed areas (78.7 ± 18.3 AU, P=.038). This difference further increased at T60 and T120 in all measurements (P≤.004, Figure 3C-D). Temporally, all ROIs showed a decrease in perfusion levels (Figure 3E). Mean LSPUs decreased significantly over time from respectively 96.9 ± 8.0 AU at T-1 to 45.8 ± 6.4 AU at T120 in ischemic areas (P≤.001). In watershed, a decrease from 88.9 ± 7.6 to 64.8 ± 14.8 AU was seen (P≤.001). However, there was no significant change in well-perfused areas over a two-hour period. In ischemic areas, there was a significant decrease of LSPUs in the first hour (66.8 ± 19.4 at T0 versus 52.2 ± 12.6 at T60, P=.014). Between T60 and T120, the curve flattened out. Using a mixed model analysis, the interaction term between time and ROI was significant (P≤.001) 8

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