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Surgical Procedure, UnspecifiedNCT06637176

Examination of the Blood Supply of the Intestine Before Suturing the Ends of the Intestine.

An observational study of Surgical Procedure, Unspecified, run by University of Aarhus at 3 sites in Denmark.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

In this non-interventional, multicenter study in the Central Denmark Region, the potential of assessing blood supply during colorectal surgery will be explored using a recognized and reliable laser technique called Laser Speckle Contrast Imaging. Read more about this study

Who is it for?
Ages 19 years and older
Conditions the study is for
Surgical Procedure, Unspecified
What is being tested?
Laser speckle contrast imaging
Type of treatment
Medical device
How many people
20 participants
Where
3 sitesDenmark
Study dates
1 Apr 2024to 10 Sep 2024
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 19 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Patients will be identified and included from the Regional Hospital Gødstrup, Viborg, and Randers.

Who may be able to join

  • All patients undergoing any elective colorectal surgery with the potential formation of an extracorporeal anastomosis as part of the surgical procedure are eligible for inclusion, irrespective of the indication for surgery. Patients will be consecutively included, after informed consent.

Who cannot join

  • In this clinical feasibility trial, exclusion criteria apply only in cases where the inclusion criteria are not met or if performing an extracorporeal anastomosis is not feasible during surgery. Otherwise, patients meeting the inclusion criteria will be considered eligible for participation in the trial.

Trial locations and contacts

3 sites in 1 country.

Denmark3 sites
  • Region hospital Gødstrup

    Herning, 7400

  • Region Hospital Randers

    Randers, 8900

  • Region Hospital Viborg

    Viborg, 8800

Other trials in Denmark

About this study

Official title: Laser Speckle Contrast Imaging for Intraoperative Assessment of Anastomotic Perfusion

In this non-interventional, multicenter study in the Central Denmark Region, the potential of assessing blood supply during colorectal surgery will be explored using a recognized and reliable laser technique called Laser Speckle Contrast Imaging. The study aims to evaluate whether surgeons find this tool valuable in the decision-making process regarding where to perform the anastomosis during the operation.

Read the detailed description

Anastomotic leakage (AL) is among the most severe and feared postoperative complications of colorectal surgery as it is directly associated with an increase in mortality and morbidity. AL increases risk of local recurrence, decreases the 5-year survival rate, and impairs the patient's quality of life. Despite improvements in the surgical technique, AL continues to occur with high frequency. The cause of AL is considered multifactorial and several factors have shown association with increased risk of AL, although the complete pathogenesis is still unclear; It is recognized that one of the most important risk factors is inadequate blood supply to the anastomotic site, since optimal perfusion is essential for the healing of the anastomosis.

Currently, the assessment of the perfusion at the anastomotic site is based on a subjective clinical estimate by the surgeon (e.g., palpable pulsation of the arteries in the mesenterium, normal color of the intestine, bleeding from the surgical edges, and/or pulsatile bleeding from marginal arteries). However, these assessments are shown to lack objectivity, quantifiability, and predictive accuracy - even experienced surgeons underestimate the risk of AL.

Preventing AL is crucial for improving the outcomes of colorectal surgery. Studies have shown that understanding the state of microcirculation can help reduce the rate of AL. Therefore, having an accurate evaluation of local intestinal microcirculation is the first step in aiding surgeons to make informed decisions on the optimal anastomotic side.

Laser Speckle Contrast Imaging (LSCI) is a dye-free non-contact, non-invasive image-based method, capable of quantitative estimation of the local intestinal perfusion. Further, it allows for time-independent repeated measurements. LSCI uses laser light to generate a speckle pattern: When an object is in motion or contains moving particles such as blood cells, the interference between beams is affected, leading to variations in the phases and the creation of a dynamic speckle pattern. Based on the movements of the red blood cells, LSCI can be used to assess the blood flow within the tissue (microcirculation). Thus, LSCI cannot measure absolute flow but rather measures contrast changes and results are expressed as flux in arbitrary laser speckle perfusion units (LSPU), where higher LSPU values correspond to better tissue perfusion. LSCI is validated and used in small animal and human studies of the gastro-intestinal tract but has not yet been thoroughly tested in a true clinical setting.

LSCI has been utilized in various clinical contexts, including the gastrointestinal system, demonstrating ease and safety of use. However, there is only one similar study from 2019 in Japan where measurements were conducted on 8 patients undergoing colon surgery. The limitations of this study include its single-center nature, involvement of only one surgeon, and a lack of description regarding the surgeons\' perspectives on LSCI measurements - whether they consider it a useful tool in their intraoperative procedures. Recently, another study has been published employing LSCI to measure the colon intraoperatively. Nevertheless, this study utilizes a newly developed laparoscopic-based LSCI technique, and it compares surgeons\' subjective assessments of the technique. The findings indicate a high level of satisfaction, with 67% of surgeons expressing a willingness to make changes during surgery based on the images. Despite numerous clinical studies supporting the feasibility of LSCI, the literature on colon surgery lacks sufficient evidence to generalize the use of open LSCI equipment across all operating rooms as a tool for surgeons, despite its demonstrated potential.

It is hypothesized that LSCI is a method that could help surgeons evaluate and qualify the peri-operative intestinal microcirculation when anastomoses are formed.

The aim of this study is to investigate this hypothesis.

Study objectives:

  1. To provide a descriptive analysis of using LSCI during colorectal surgery to assess microcirculation in the intestines before and after anastomosis formation and evaluate the feasibility of the method.
  2. To assess the surgeon's subjective perception whether LSCI could be a useful tool to aid their decision-making during surgery.
Being tested
Laser speckle contrast imaging
Keywords
microcirculation, surgical decision making, colon surgery

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Laser speckle contrast imagingDevice

    LSCI measurements will be taken before and after the formation of the anastomosis, with the surgeon blinded to the measurements to prevent any influence on surgical decision-making. The surgery will be performed as standard-of-care, unaffected by the LSCI measurements.

    Following the surgery, the LSCI images will be presented to the surgeon, who will complete a questionnaire assessing whether the LSCI images, if presented perioperatively, would have influenced their decision regarding the location of the anastomotic site. Additionally, the surgeon will be asked if they consider LSCI to be a useful intraoperative tool in general. The surgical case and the series of LSCI images will also be presented to an independent surgeon, who will answer the same set of questions.

    The LSCI measurements will be correlated with 30-day complication rates, with a specific focus on anastomotic leakage (AL).

    Microcirculation is assessed using LSCI at a wavelength of 785 nm (MoorFLPI-2, Moor Instruments

Study groups in NCT06637176
Study groupRoleWhat they receive
Group 1: Colon Surgery with Extracorporeal AnastomosisAll individuals over 18 years old undergoing elective colon surgery with the formation of an extracorporeal anastomosis are eligible to participate, regardless of indication, comorbidities, or other conditions.
Receives: Device: Laser speckle contrast imaging

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Descriptive analysis of using LSCI during colorectal surgery

    The operation time and the time required to perform LSCI will be recorded. It is predefined that an acceptable LSCI duration will be a maximum of 5% of the total operation time.

    Measured: from enrollment to surgery, aroundt 1-2 weeks.

  2. Descriptive analysis of using LSCI during colorectal surgery

    The number of times the sterile field is breached, the nature of each breach, and whether the breach can be rectified will be recorded. An acceptable sterile breach rate is predefined at 95%, and LSCI will only be considered feasible if 100% of the breaches are mendable.

    Measured: from enrollment to surgery, aroundt 1-2 weeks.

  3. Descriptive analysis of using LSCI during colorectal surgery

    The number of LSCI measurement attempts made for each patient before a successful final measurement is obtained will be recorded. It is predefined that up to two attempts per successful LSCI measurement is considered acceptable.

    Measured: from enrollment to surgery, aroundt 1-2 weeks.

  4. Descriptive analysis of using LSCI during colorectal surgery

    Surgeons will be asked, through a questionnaire, for their subjective opinion on whether LSCI in any way disturbs or interferes with the standard procedure in an unacceptable manner. It is predefined that LSCI will not be considered disruptive to the surgical procedure if more than 90% of surgeons find it acceptable.

    Measured: from enrollment to surgery, aroundt 1-2 weeks.

Secondary outcomes (2)
  1. Assess the surgeon's subjective perception whether LSCI could be a useful tool to aid their decision-making during surgery

    By questionnaire, surgeons are asked their subjective opinion on whether LSCI is a useful intraoperative tool. The endpoint is expressed as the percentage of surgeons who subjectively find LSCI will be a useful tool.

    Measured: from enrollment to surgery, aroundt 1-2 weeks.

  2. Assess the surgeon's subjective perception whether LSCI could be a useful tool to aid their decision-making during surgery

    By questionnaire, surgeons are asked their subjective opinion on whether they would have changed their intestinal resection line or anastomosis site if LSCI measurements were available during the operation. The endpoint is expressed at the percentage of surgeons who would have changed the resection line or anastomotic site if LSCI measurements had been available.

    Measured: from enrollment to surgery, aroundt 1-2 weeks.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Oct 2024
  2. Study start1 Apr 2024
  3. Primary completion20 Aug 2024
  4. Study completion10 Sep 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case only
Time perspective
Prospective
Enrolment
20 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06637176
Sponsor's protocol ID
2314383
Other IDs
Doc.nr.: 2913575
Status last verified
Apr 2024
First submitted
9 Oct 2024
Last updated
23 Oct 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: There are so few patients that Danish GDP data cannot be shared as it cannot be anonymized, which would be in violation of Danish data protection law.

Publications

  • Heeman W, Calon J, van der Bilt A, Pierie JEN, Pereboom I, van Dam GM, Boerma EC. Dye-free visualisation of intestinal perfusion using laser speckle contrast imaging in laparoscopic surgery: a prospective, observational multi-centre study. Surg Endosc. 2023 Dec;37(12):9139-9146. doi: 10.1007/s00464-023-10493-0. Epub 2023 Oct 9.

    PubMed 37814165
  • Kojima S, Sakamoto T, Nagai Y, Matsui Y, Nambu K, Masamune K. Laser Speckle Contrast Imaging for Intraoperative Quantitative Assessment of Intestinal Blood Perfusion During Colorectal Surgery: A Prospective Pilot Study. Surg Innov. 2019 Jun;26(3):293-301. doi: 10.1177/1553350618823426. Epub 2019 Jan 13.

    PubMed 30638132
  • Paramasivam R, Kristensen NM, Ambrus R, Stavsetra M, Orntoft MB, Madsen AH. Laser speckle contrast imaging for intraoperative assessment of intestinal microcirculation in normo- and hypovolemic circulation in a porcine model. Eur Surg Res. 2023 Dec 7. doi: 10.1159/000535525. Online ahead of print.

    PubMed 38061337

Questions about this trial

What is this clinical trial studying?

An observational study of Surgical Procedure, Unspecified, run by University of Aarhus at 3 sites in Denmark.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 23 Oct 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Denmark. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Descriptive analysis of using LSCI during colorectal surgery (time frame: from enrollment to surgery, aroundt 1-2 weeks.). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06637176, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Oct 2024.

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