Vascular Health and Risk Management (Nov 2020)
Laser Doppler Flowmetry and Visible Light Spectroscopy of the Gastric Tube During Minimally Invasive Esophagectomy
Abstract
Nathkai Safi,1,2 Hans-Olaf Johannessen,3 Asle Wilhelm Medhus,4 Tom Mala,2,3 Syed SH Kazmi1,2 1Department of Vascular Surgery, Heart, Lung and Vascular Clinic, Oslo University Hospital, Oslo, Norway; 2Faculty of Medicine, Oslo University, Oslo, Norway; 3Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway; 4Department of Gastroenterology, Oslo University Hospital, Oslo, NorwayCorrespondence: Nathkai SafiDepartment of Vascular Surgery, Heart, Lung and Vascular Clinic, Oslo University Hospital, Oslo University, Oslo 0586, NorwayTel +47 97407460Email [email protected]: Ischemia is considered as the main reason for thoracic gastroesophageal anastomotic leaks after esophagectomy. Microcirculatory monitoring with laser Doppler flowmetry and visible light spectroscopy may provide valuable intraoperative real-time information about the gastric tube’s tissue perfusion and circulation.Patients and Methods: Ten patients with esophageal cancer operated with minimally invasive esophagectomy participated in this single-center, prospective, observational pilot study. A single probe with laser Doppler flowmetry and visible light spectroscopy was used to perform transserosal microcirculation assessment of the gastric tube at predefined anatomical sites during different operation phases. Group comparison and changes were evaluated using the paired sample t-test.Results: A reduction in StO2 was found at all measuring sites after the gastric tube formation compared with the baseline measurements. The mean StO2 reduction from baseline to gastric tube formation and after anastomosis was 16% (range 4%– 28%) and 42% (range, 35%– 52%), respectively. A statistically significant increase in the rHb concentration, representing venous congestion, was detected at the most cranial part of the gastric tube (P = 0.04). Three patients developed anastomotic leaks.Conclusion: Intraoperative real-time laser Doppler flowmetry and visible light spectroscopy are feasible and may provide insight to microcirculatory changes in the gastric tube and at the anastomotic site. Patients with anastomotic leaks seem to have critical local tissue StO2 reduction and venous congestion that should be further evaluated in studies with larger sample sizes.Keywords: esophagectomy, gastric tube circulation, gastroesophageal anastomosis complications
