CC BY
6B-O-15
BIOMEDICAL PHOTONICS
Optical coherence angiography of the ischemic bowel in open and
laparoscopic surgery
M. Ryabkov, E. Kiseleva, P. Zarubenko, M. Sizov, M. Bagryantsev, N. Gladkova
FSBEI HE PRMUMOH Russia, 603005, Nizhny Novgorod, Minin and Pozharsky Square 10/1
maxim-ryabkov@yandex.ru
International and Russian guidelines «Management of acute mesenteric ischemia» include open and laparoscopic surgical operations [1]. Optical coherence angiography (OCA) has the potential to be able provide the surgeons with the data of blood circulation in the ischemic intestine [2]. However, to date the problem of high sensitivity of OCA to gastrointestinal peristalsis with OKA-images artifacts is not resolve [3,4]. Laparoscopic operation increasingly makes harder the colon fixation during the research.
The aim is to develop the device with the increasing of quality OCA-images of colon in open and laparoscopic surgery by the decreasing a number of peristalsis artifacts.
Materials and methods. We developed the device - nozzle on the detector of OCA. The device temporarily fixes the colon by the local controlled pressure deficit in open and laparoscopic surgery. The device tested in two series of the experiment with the approval of the Ethics Committee FSBEI HE PRMU MOH Russia. The first series of the experiment (mini-pigs, n=10) was organized in open surgery. We modeled an acute mesenteric ischemia and examined microstructure, microcirculation of the colon wall using an OCA-method. We compared the efficacy of the traditional method of hand colon fixation and the developed device. In the second series of the experiment (chinchilla, n=6) we research OCA of the colon with an acute mesenteric ischemia in laparoscopic surgery (fig. 1).
ALT'22
a b c d
Fig. 1: OCA of ischemic colon: a - a detector OCA on the colon, open surgery, b - a detector OCA on the colon, laparoscopic operation, c - traditional fixation of tissue, OCA-image, d - developed device, OCA-image.
Results. In the first series of the experiment the traditional method of the detectors fixation has proved to produce OCA-images without artifacts in 64% cases. It allowed to receive high-quality artefact-free 2D structural and angiographic images of the gastrointestinal tract in minipigs b 92 in 100 cases (p=0.001). In the second series of the experiment we got 24 small intestine OCA-images and 22 colon OCA-images. The number of informative OCA-images without artifacts of movement: 18 for small intestine and 21 for colon. Histological examination in two series confirmed the safety of device: there weren't hematoma or mechanical damage.
Conclusions. The traditional way of getting OCA-images of colon ended with non-artifacts images only in 64 % cases. The device has reduced artifacts of movement in OCA-images and increased informative angiograms before 92 % in open surgery (p=0.001) and before 84,7 % in laparoscopic surgery. The study was funded by the Russian Science Foundation #19-75-10096.
1. Bala, M.; Kashuk, J.; Moore, et al. Acute mesenteric ischemia: Guidelines of the World Society of Emergency Surgery. World J. Emerg. Surg. 2017, 12, 1-11.
2. Kiseleva E, Ryabkov M, Baleev M, et al. Prospects of Intraoperative Multimodal OCT Application in Patients with Acute Mesenteric Ischemia. Diagnostics. 2021; 11(4):705.
3. Spaide, R.F.; Fujimoto, J.G.; Waheed, N.K. Image artifacts in optical coherence angiography. Retina (Philadelphia, Pa.) 2015, 35, 2163.
4. Kiseleva E, Ryabkov M, Baleev M, et al. "Intestinal optical coherence tomography (angiography) imaging: a comparison between animal models and humans," Proc. SPIE 11949, Advanced Biomedical and Clinical Diagnostic and Surgical Guidance Systems XX, 1194908 (7 March 2022)
