Intra-operative optical monitoring of bowel tissue viability based on photoplethysmography and laser doppler flowmetry

Determination of bowel viability in patients undergoing bowel resection is essential in gastrointestinal surgery. One of the most common operations in gastrointestinal surgery is bowel resection for patients who have different kinds of bowel cancer or any other occlusion in which anastomosis has to be carried out following the removal of an unhealthy segment of the bowel. Monitoring blood flow in abdominal surgery especially intraoperatively would be a valuable tool for prevention of a postoperative anastomosis complication (e.g. anastomotic leak, which is the main complication after colorectal resection). The development of a continuous method for monitoring perfusion of bowel tissue would assist in early detection of inadequate blood supply which then help to reduce the occurrence of an anastomosis complication. Although various monitoring techniques have been proposed to assess intestinal viability intraoperatively, none of these techniques have proved to be reliable enough to replace visual observation. Therefore, to date there is no widely accepted and readily available intraoperative technique to reliably assess the viability of bowel tissue. The aim of this study was to combine the established techniques, laser Doppler flowmetry (LDF) and Photoplethysmography (PPG), into one probe intended for assessment of perfusion in abdominal tissue during bowel resection intraoperatively. In PPG, changes in transmission of light through tissue due to pulsation of small arteries can be monitored whereas in LDF microcirculatory blood cell velocity and flux can be studied. Such a probe could alert the surgeon immediately of any compromise in blood flow so further investigation and, if necessary, therapeutic steps can be applied immediately to prevent severe consequences. Therefore, custom reflectance PPG along with LDF sensor was designed and built in the form of a probe to investigate the changes in blood volume, blood flow and arterial oxygen saturation in patients undergoing bowel resection. The instrumentation was designed successfully and the data was saved for the further analysis. Twenty-four patients undergoing bowel resection were recruited for monitoring of perfusion and blood flowintraoperatively; twenty had undergone laparoscopy and the remainder had a laparotomy operation. Eight different measurements were performed during each trial. The results revealed that the probe could be an indicator of evaluating perfusion and blood flow changes at different stages of the surgery. The results also suggest that laser Doppler is more sensitive to artefact compared to PPG. Differences in amplitude of PPG between different measurements reveal that the sensor does detect changes in blood volume and flow confirming that it has the ability to verify that pulsatile flow is being preferentially preserved at the last step of the resection procedure (at the edges of the anastomosis sites after anastomosis is been constructed