Optical fiber probe spectroscopy for laparoscopic monitoring of tissue perfusion during esophagectomies

Anastomotic complication is a major morbidity associated

with esophagectomy. Gastric ischemia after conduit creation contributes

to anastomotic complications, but a reliable method to assess

oxygenation in the gastric conduit is lacking. We hypothesize that fiber

optic spectroscopy can reliably assess conduit oxygenation, and that

intraoperative gastric ischemia will correlate with the development of

anastomotic complications. A simple optical fiber probe spectrometer

is designed for nondestructive laparoscopic measurement of blood content

and hemoglobin oxygen saturation in the stomach tissue microvasculature

during human esophagectomies. In 22 patients, the probe measured

the light transport in stomach tissue between two fibers spaced

3-mm apart (500- to 650-nm wavelength range). The stomach tissue

site of measurement becomes the site of a gastroesophageal anastamosis

following excision of the cancerous esophagus and surgical ligation

of two of the three gastric arteries that provide blood perfusion to the

anastamosis. Measurements are made at each of five steps throughout

the surgery. The resting baseline saturation is 0.51±0.15 and decreases

to 0.35±0.20 with ligation. Seven patients develop anastomotic complications,

and a decreased saturation at either of the last two steps

(completion of conduit and completion of anastamosis) is predictive

of complication with a sensitivity of 0.71 when the specificity equaled

0.71.