Feasibility of laser speckle contrast imaging (LSCI) in colorectal surgery: a prospective comparison with indocyanine green (ICG) fluorescence angiography

Adequate bowel perfusion is essential for anastomotic healing in colorectal surgery. Indocyanine green (ICG) fluorescence angiography (FA) is currently considered the gold standard for intraoperative perfusion assessment. Laser speckle contrast imaging (LSCI) is an emerging, dye-free technology that enables real-time evaluation of microvascular blood flow. The aim of this study is to assess the feasibility of LSCI in elective colorectal surgery and to compare its performance with ICG-FA for intraoperative evaluation of bowel perfusion.

A prospective study was conducted including consecutive patients undergoing elective laparoscopic colorectal surgery between September 2025 and March 2026. Bowel perfusion was assessed intraoperatively using both LSCI and ICG-FA. The primary endpoint was feasibility of LSCI, while the secondary endpoint was concordance between these two technologies in determining the bowel section line.

Twenty-two patients were included: 7 right hemicolectomies, 11 left hemicolectomies, and 4 anterior rectal resections. LSCI and ICG-FA were successfully performed in all cases (100%). Overall concordance between LSCI and ICG-FA was 86.2%. Concordance was 100% for ileum and 57.1% for transverse colon in right hemicolectomy, 100% in left hemicolectomy and 75% in anterior resection of the rectum. Two postoperative complications were observed, both following anterior resection of the rectum: one patient developed postoperative ileus (Clavien–Dindo I), and one patient developed abdominal pain, fever of unknown origin, and intra-abdominal fluid collection requiring revision surgery, which did not reveal an anastomotic leak (Clavien–Dindo III-b). Mean hospital stay was 6 ± 4 days.

LSCI appears to be a feasible tool for intraoperative assessment of bowel perfusion, demonstrating high concordance with ICG-FA. Its dye-free and real-time capabilities make it a promising adjunct to ICG-FA. Larger prospective, multicentre, randomized studies are warranted to further define the clinical impact of LSCI in evaluating bowel vascularization and its potential role in improving surgical outcomes.