164 Chapter 8 centimeter range, this percentage increased to 89%. An inter-rater reliability analysis was conducted comparing the group of experts with the operating surgeon, yielding a substantial Kappa of 0.66 (95% CI 0.58-0.74). The comparison between physicians and the surgeon showed a moderate Kappa of 0.56 (95% CI 0.47-0.65). The comparison between the whole observer group and the surgeon showed a moderate Kappa of 0.52 (95% CI 0.44-0.61, P=.764). Figure 6. Intra Class Correlation (ICC) dot plot of all assessors per watershed region in all intestinal loops. Distances are measured from the Region of Interest (ROI) placed by the operating surgeon to the ROI placed by a different observer. Negative values are measured from the operating surgeon towards well-perfused tissue. Positive numbers are measured from the operating surgeon towards ischemic tissue. Within each loop, T0, T60 and T120 are shown from left to right, with two ROIs per timepoint (left and right watershed). A more detailed example of how ROI distances are calculated can be found in Supplemental 1. Ex = expert observer; Px = Physician, Lx = loop number. DISCUSSION To our knowledge, this is the first study to correlate quantitative LSPUs to lactate levels and providing a cut-off value for well-perfused tissue, thus adding to the increasing evidence that LSCI may serve as a suitable tool to guide the surgeon in the construction of an optimal anastomosis during laparoscopic surgery 13, 28-32. Inter-observer agreement among physicians and experts was moderate to substantial, indicating that interpreting LSCI images is feasible even without extensive experience. A distinct contrast in LSPUs between ROIs was seen at all timepoints following the creation of an ischemic segment. This underscores PerfusiX-Imaging®’s efficacy in visualizing perfusion
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