‘real-time’ Measurement of Tissue Oxygenation During Gastrointestinal Stapling: Mucosal But Not Serosal Surface Ischemia Occurs and Is Not Influenced By Staple Size

Tension, tissue ischemia and technical error are known factors which can lead to anastomotic complications such as leak, stricture, and ulceration/bleeding. Currently surgeons evaluate tissue ischemia without benefit of any simple routine measurement technique to assess tissue viability. A new tissue surface probe (T-STAT microvascular tissue oximeter, Spectros Corporation, Portola Valley, California) provides continuous measurement of tissue hemoglobin oxygen saturation (StO2) and may have clinical utility for intra-operative assessment of blood flow in areas of surgical anastomosis. This is a pilot study to determine local StO2 during gut stapling using various staple sizes for the purpose of assessing the tool’s ability to measure changes and the reproducibility of those changes with stapling. We sought to evaluate mucosal versus serosal measurements and to determine if the proximity to the staple line correlated with possible tissue ischemia. Measurements were made in 5 anesthetized adult swine during laparotomy. Various staple heights (Endo-GIA Autosuture, Connecticut, USA) of 2.0, 2.5 and 4.8 millimeter (mm) were used to transect small bowel (SB) and colon (C). Serosal and mucosal surface measurements were obtained at baseline and on each side (proximal and distal) of the transection using the T-Stat device at the staple line and 2 cm away from it. The baseline StO2 within the mucosa is significantly less than the serosa for both small bowel (serosa 61.1 +/-3 versus mucosa 48 +/-5, p < 0.05 t test) and colon (serosa 65 +/-4 versus mucosa 40 +/-13, p < 0.05 t test). There was no change in serosal surface oxygenation with stapling. Mean values of mucosal SB and C StO2 are presented in the Table with staple heights utilized (n = 20 measurements per viscus at each location, ANOVA * p

Session: Podium Presentation

Program Number: S076

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