Real-Time Bowel Perfusion Monitoring with FUJIFILM Eluxeo in Colorectal Surgery

Background: Anastomotic leak is a serious complication of bowel anastomosis, with a multifactorial etiology. Thorough intraoperative evaluation of the anastomosis using white light endoscopy and leak tests is critical. Indocyanine green fluorescence angiography (ICG-FA) has emerged as a tool to assess bowel perfusion but has limitations, including patient allergies and procedural complexity. The FUJIFILM Eluxeo Vision system uses the Oxygen Saturation Index (OSI) to measure tissue oxygenation saturation (StO2) in real time, without requiring dye injection. This provides a quantitative approach for assessing bowel perfusion. Materials and Methods: We used the FUJIFILM Eluxeo Vision system to obtain intraoperative mucosal StO2 measurements in 12 patients post colon resection and anastomosis. Measurements were taken at four locations: proximal base, proximal staple line, distal staple line, and distal base. Patients were followed longitudinally via chart review to monitor outcomes. Results: The average StO2 differences were + 12.6% between the proximal base and proximal staple line and + 15.4% between the distal base and distal staple line. Significant differences were observed between well-perfused mucosa and staple lines (proximal: P = 0.005; distal: P = 0.003). No patients developed an anastomotic leak during the study. Conclusions and Future Directions: The Eluxeo Vision system provides valuable, quantitative data on tissue perfusion at and near anastomotic sites, complementing traditional white light endoscopy and leak tests. Larger prospective studies with long-term follow-up are needed to confirm the relationship between StO2 measurements and clinical outcomes such as anastomotic leaks and surgical site infections.