330 Chapter 14 Parallel to and during the experiments in Chapter 7 and 8, we participated in the steps that were taken to optimize the LSCI device for intraoperative use, standardize LSCI protocols in research, and provide training for surgeons and healthcare professionals on interpreting LSCI data and integrating it into surgical workflows. In both our studies, we noticed that both observers with limited LSCI training and with more expertise can reliably select well-perfused and less perfused bowel tissue and the system seemed easy to use during surgery. This strengthened the believe that LSCI is a promising non-invasive technique for assessing tissue perfusion. It became clear that LSCI can influence decision making in an experimental setting; based on the LSCI images, surgeons were able to decide whether to create an anastomosis or not. Although we simulated an ischemic bowel model, the limitation of chapter 7 is the experimental setting, without performing a real surgical procedure. A recent prospective study imaged colonic perfusion using the same LSCI technique in 64 human participants 48. Post-operatively, surgeons were questioned if the additional visual feedback would have led to a change in clinical decision-making. Overall, 17% of operating surgeons reported that they would shift the location of anastomosis based on LSCI feedback. While LSCI produces an objective color map derived from quantitative data to depict perfusion variances, the interpretation of this color map remains subjective. Ideally, surgeons can make their anastomosis decision based in a more objective way, thereby enhancing informed clinical decision-making. As LSCI feedback represent flow rather than tissue viability, it is important to gain insight into correlation of these two parameters. A similar issue was recently addressed in the field of burn wound care for measuring wound healing potential 49. The research team created a LSCI color code in adult clinical burn patients and confirmed a good performance of the LSCI for prediction of wound healing potential. Its development was based on standard Laser Doppler Imaging (LDI) as a standard. Ideally, a similar model can be developed to estimate the potential of intestinal healing. As Chapter 8 described an initial threshold for LSPU to confirm tissue perfusion (with local lactate as a reference instead of LDI in the burn wound field), this information can be used to further develop such a quantitative real-time assessment model to discriminate between high and low AL risk regions. While LSCI shows promising results as a non-invasive technique to assess tissue perfusion as demonstrated in our porcine studies, its clinical utility in correlation with patient outcomes remains largely unexplored. For now, given the experimental and observational nature of current available evidence on LSCI, we can only yield speculative conclusions regarding the impact on AL. Stronger evidence derived from larger human cohorts is required to substantiate the effectiveness of LSCI in improving patients’ outcomes. By further improving real-time quantification of LSCI, concerns on the subjective aspect of LSCI will disappear and support its value compared to subjective white light assessment. Additionally, research that focus on the comparison with NIRF imaging might help to improve further clinical adoption of LSCI.
RkJQdWJsaXNoZXIy MTk4NDMw