Clinical translation of laser speckle contrast imaging

Humankind is moving forward in an astonishing pace in every scientific specialty. It is therefore remarkable that the current standard-of-care for blood flow assessment has remained unchanged for decades. The desire to 'see' tissue perfusion (i.e. blood flow) intraoperatively has never been greater due to the increasing awareness that adequate perfusion is an essential part of organ function and wound healing and also plays a leading role in prevention of mortality and morbidity. Currently, intraoperative perfusion measurements are generally based on subjective clinical indicators of tissue vitality (e.g., tissue color, bleeding from resected edges, or pulsatile movement of tissue). This fuels the need for an objective imaging method capable of imaging the perfusion of organs and tissues in real time. The aim of this thesis was to develop and validate a laparoscopic tool to measure blood flow using laser speckle contrast imaging (LSCI) technology. In the first part of the thesis, a new LSCI method is described and validated on a pig kidney model. Next, setting up a scientifically sound imaging protocol for clinical optical imaging studies is described. The acquired knowledge about LSCI has been used in the development of a laparoscopic LSCI device. This device has been validated through two preclinical pig studies in which the blood flow in the large and small intestines was measured. The validated device has been used in two multicenter studies investigating the effect of the new imaging technique on clinical decision-making during colon resections.