Validation of video-rate laparoscopic multispectral imaging systems for quantitative bowel perfusion assessment using a hyperspectral reference in a porcine model

Abstract Quantitative assessment of bowel perfusion remains challenging during minimally invasive surgery. This study investigated whether video-rate laparoscopic multispectral imaging can provide contrast-agent-free perfusion assessment under intra-abdominal conditions. Ten pigs were examined in vivo. Regions of the small bowel were imaged during baseline perfusion, partial vascular occlusion, and complete ischemia. Matched measurements were acquired using two prototype laparoscopic multispectral imaging systems and the approved TIVITA Mini hyperspectral imaging system as reference. The first system was evaluated in six animals and the second in four. Multispectral imaging-derived perfusion parameters from ten consecutive frames per region of interest were compared with hyperspectral near-infrared perfusion index values using linear regression, Pearson correlation, and leave-one-pig-out cross-validation. Overall, 1329 matched multispectral–hyperspectral measurements were analysed, comprising 772 from the first system and 557 from the second. System-specific correlations between multispectral imaging-derived perfusion parameters and hyperspectral reference values were strong for both systems (r = 0.915 and r = 0.840, both p < 0.001). Leave-one-pig-out validation yielded coefficients of determination of 0.812 and 0.664 and root mean square errors of 0.058 and 0.067 for the first and second systems, respectively. These findings show strong associations between calibrated video-rate laparoscopic multispectral imaging and hyperspectral reference imaging across perfusion states.