Real-time ancillary diagnostics for intraoperative assessment of intestinal viability in horses-looking for answers across species.
Authors: Verhaar Nicole, Geburek Florian
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Real-time Assessment of Intestinal Viability in Equine Colic Surgery Determining which sections of compromised intestine can be salvaged versus resected remains one of the most challenging intraoperative decisions in equine colic surgery, with significant implications for post-operative survival and quality of life. Verhaar and Geburek conducted a comprehensive narrative review examining real-time ancillary diagnostic technologies used across human medicine and companion animal surgery that could be adapted for equine intestinal viability assessment, classifying these modalities into two broad categories: tissue perfusion measurement (dark field microscopy, laser Doppler flowmetry, fluorescence angiography) and tissue oxygenation assessment (pulse oximetry, near-infrared spectrophotometry). Indocyanine green fluorescence angiography has emerged as particularly promising in human surgery for predicting intestinal injury and is gaining traction in veterinary medicine, whilst tissue oximetry techniques using visible light or near-infrared spectrophotometry have demonstrated correlation with clinical outcomes across multiple species. Several of these technologies—particularly indocyanine green fluorescence angiography and tissue oximetry—are already commercially available and theoretically applicable to colic surgery today; however, the authors emphasise that robust, blinded clinical trials specific to horses remain absent, and equine practitioners need species-specific validation data and objective cutoff values before these modalities can reliably guide resection decisions. For the equine surgical team, this review highlights both the promise of emerging technologies and the critical gap between their technical availability and evidence-based clinical implementation in equine practice.
Read the full abstract on PubMed
Practical Takeaways
- •Several real-time diagnostic technologies (indocyanine green angiography, tissue oximetry) are already commercially available and could potentially be incorporated into colic surgery protocols to improve viability assessment decisions.
- •Until equine-specific validation studies are completed, these ancillary diagnostics should be used as adjuncts to—not replacements for—traditional clinical assessment of intestinal viability during surgery.
- •There is significant opportunity for equine surgeons to collaborate with human and companion animal surgical specialists to establish evidence-based guidelines for intraoperative viability assessment.
Key Findings
- •Real-time ancillary diagnostics for intraoperative intestinal viability assessment can be classified as tissue perfusion or oxygenation assessments, with indocyanine green fluorescence angiography and tissue oximetry showing particular promise in veterinary practice.
- •Multiple modalities including dark field microscopy, laser Doppler flowmetry, pulse oximetry, and near-infrared spectrophotometry are minimally invasive and potentially applicable during equine colic surgery.
- •Blinded clinical trials are lacking in all species and equine-specific cutoff values and accuracy data have not been established for most techniques.
- •Indocyanine green fluorescence angiography has gained popularity in human medicine for predicting intestinal injury and may translate to equine applications with further validation.