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Intrauterine interventions such as twin-to-twin transfusion syndrome procedure require accurate mapping of the fetal placental vasculature to ensure complete photocoagulation of vascular anastomoses. However, surgeons are currently limited to fetoscopy and external ultrasound imaging, which are unable to accurately identify all vessels especially those that are narrow and at the periphery. Laser speckle contrast imaging LSCI is an optical method for imaging blood flow that is emerging as an intraoperative tool for neurosurgery. Here we explore the application of LSCI to minimally invasive fetal surgery, with an endoscopic LSCI system based on a 2.7-mm-diameter fetoscope. We establish using an optical phantom that it can image flow in 1-mm-diameter vessels as far as 4 mm below the surface. We demonstrate that a spatiotemporal algorithm produces the clearest images of vessels within 200 ms, and that speckle contrast images can be accurately registered using groupwise registration to correct for significant motion of target or probe. When tested on a perfused term ex vivo human placenta, our endoscopic LSCI system revealed small capillaries not evident in the fetoscopic images.

A Registration Approach to Endoscopic Laser Speckle Contrast Imaging for Intrauterine Visualisation of Placental Vessels