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In vivo real-time assessment of the anastomotic blood supply in colorectal surgery using confocal laser endomicroscopy in an anastomotic model

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Abstract

Background and study aims

Anastomotic ischemia can affect healing and eventually lead to anastomotic leakage, and confocal laser endomicroscopy (CLE) can offer detailed observations at the subcellular level. We aimed to evaluate the anastomotic microcirculation in different anastomotic perfusion models using CLE.

Methods

Anastomotic perfusion models were established using twelve rabbits distributed into two groups: group A (good perfusion, n = 6) and group B (poor perfusion, n = 6). Afterward, intraoperative detection of anastomotic perfusion was carried out using CLE, and quantitative analysis of blood cells was performed. Rabbits that satisfied the criteria underwent a second exploratory operation and specimens were stained by hematoxylin and eosin.

Results

Enhanced with fluorescein sodium, capillaries were obviously highlighted in group A, while few capillaries were viewed in group B. Delayed development of fluorescence occurred in group B. The average flow of blood cells was 37.0 ± 5.93 per minute in group A and 6.33 ± 2.16 per minute in group B (p < 0.001). In addition, during the second exploratory surgery, rabbits with inadequate anastomotic perfusion exhibited more serious intestinal adhesion and ischemia. Anastomotic leakage and abdominal infection occurred in all rabbits in group B.

Conclusion

CLE can realize real-time imaging of the anastomotic microcirculation and is a feasible technique for performing intraoperative evaluation in different anastomotic perfusion situations. This animal experiment provides the groundwork for future in vivo research in humans.

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Acknowledgements

This work was supported by grants from the National Natural Science Foundation of China (81773117 and 81771881), the Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer (2020B121201004), the State’s Key Project of Research and Development Plan (2017YFC0108300, 2017YFC0108302 and 2019YFE0113700), the China Postdoctoral Science Foundation (2020M682789), the Special Fund for Guangdong Province Public Research and Capacity Building (2014B020215002), the Natural Science Foundation of Guangdong Province (2015A030308006), the Guangzhou Industry University Research Cooperative Innovation Major Project (201704020062), the Clinical Research Startup Program of Southern Medical University by High-level University Construction Funding of Guangdong Provincial Department of Education (LC2016PY010), the Scientific Research Foundation for High-Level Talents in Nanfang Hospital of Southern Medical University (201404280056), the Clinical Research Project of Nanfang Hospital (2018CR034), the President Funding of Nanfang Hospital (2019Z023), and the Training Program for Undergraduate Innovation and Entrepreneurship (201912121008, 202012121091 and 202012121277).

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Author notes

  1. Xiumin Liu, Yuting Tang, and Zhiming Li have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China

    Xiumin Liu, Yuting Tang, Zhiming Li, Jie Tan, Jixiang Zheng, Mingyuan Feng, Jinliang Wan, Shijie Wang, Kemao Qiu, Hongli Ji & Jun Yan

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  1. Xiumin Liu
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Correspondence to Jun Yan.

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Authors Xiumin Liu, Yuting Tang, Zhiming Li, Jie Tan, Jixiang Zheng, Mingyuan Feng, Jinliang Wan, Shijie Wang, Kemao Qiu, Hongli Ji, and Yan Jun have no conflicts of interest or financial ties to disclose.

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Liu, X., Tang, Y., Li, Z. et al. In vivo real-time assessment of the anastomotic blood supply in colorectal surgery using confocal laser endomicroscopy in an anastomotic model. Surg Endosc 36, 4136–4144 (2022). https://doi.org/10.1007/s00464-021-08738-x

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