• endotoxaemia
• equine anaesthesia
• horse
• microcirculation
• side‐stream darkfield technique

• meta
• prognostic
• sepsis
• sublingual microcirculation

• Humans
• Microcirculation/physiology
• Sepsis/mortality
• Sepsis/physiopathology
• Mouth Floor/blood supply
• Prognosis
• ROC Curve
• Female
• Male
• Middle Aged
• Predictive Value of Tests

• automated capillary refill time
• microcirculation
• remote photoplethysmography
• septic shock

• Humans
• Photoplethysmography/methods
• COVID-19/complications
• COVID-19/physiopathology
• Microcirculation/physiology
• Prospective Studies
• Male
• Female
• Shock, Septic/physiopathology
• Shock, Septic/complications
• Middle Aged
• Aged
• SARS-CoV-2
• Hemodynamics/physiology
• Fluid Therapy/methods

• FLPP-0326 the Latvian Council of Science under the project (FLPP_

• coronary artery disease
• handheld video microscopy
• incident darkfield microscopy
• sublingual microcirculation

• Humans
• Microcirculation
• Prognosis
• Mouth Floor/blood supply
• Regional Blood Flow
• Microvessels/physiopathology

• R01 HL155618 NHLBI NIH HHS
• HL155618 HHS | NIH | National Heart, Lung, and Blood Institute (NHLBI)

• critical care
• hemodynamic monitoring
• microcirculation
• near-infrared spectroscopy
• skeletal muscle

• Humans
• Spectroscopy, Near-Infrared/methods
• Muscle, Skeletal/blood supply
• Muscle, Skeletal/metabolism
• Pilot Projects
• Male
• Prospective Studies
• Female
• Middle Aged
• Intensive Care Units
• Arterial Pressure/physiology
• Homeostasis/physiology
• Critical Illness
• Aged
• Adult
• Microcirculation/physiology
• Brain/blood supply
• Brain/metabolism
• Brain/diagnostic imaging

• New Investigator Operating Grant University of Manitoba, Department of Internal Medicine
• Graduate Fellowship Program University of Manitoba
• Endowed Manitoba Public Insurance (MPI) Chair in Neuroscience University of Manitoba
• Lyonel G Israels Endowed Research Chair in Hematology University of Manitoba
• Manitoba Medical Service Foundation
• Canadian Institutes of Health Research
• Natural Sciences and Engineering Research Council of Canada

• Swine
• Female
• Animals
• Blood Pressure/physiology
• Carbon Dioxide
• Hemorrhage
• Hemodynamics/physiology
• Shock, Hemorrhagic
• Blood Coagulation Disorders/etiology
• Lactic Acid
• Disease Models, Animal

• Defense Health Agency
• Medical Research and Materiel Command

• Antioxidants
• Ascorbic acid
• Endothelial glycocalyx
• Microcirculation

• Ascorbic Acid/therapeutic use
• Glycocalyx
• Microcirculation
• Sepsis/drug therapy
• Shock, Septic/drug therapy
• Humans

• cardiac output
• respiratory quotient
• tissue oxygenation
• tissue perfusion
• venous minus arterial carbon dioxide partial pressure

• PICT 2018-03977 Agencia Nacional de Promoción Científica y Tecnológica, Argentina

• glycocalyx
• microcirculation
• sepsis
• septic shock
• sublingual videomicroscopy
• tissue perfusion

• Diagnostic accuracy
• Lactate clearance
• Shock
• Tissue oxygen saturation

• 2021-I2M-1-062 Chinese Academy of Medical Sciences
• 2021YFC2500801 Ministry of Science and Technology of the People's Republic of China

• Artificial intelligence
• Hand-held vital microscopes
• Hemodynamic resuscitation
• ICU
• Microcirculation

• Critical Care/trends
• Microcirculation
• Resuscitation
• Hemodynamics
• Artificial Intelligence

• ICU
• endothelial damage
• endotypes
• gene modular features
• immunomodulation therapies
• immunosuppression
• regulatory inference
• sepsis
• septic shock HLA-DR
• transcriptomics

• IDF imaging
• Microcirculation
• Sublingual mucosa

• Humans
• Microcirculation
• Mouth Floor/blood supply
• Tongue/blood supply
• Capillaries

The intestinal microcirculation functions in food absorption and metabolic substance exchanges. Accumulating evidence indicates that intestinal microcirculatory dysfunction is a significant source of multiple gastrointestinal diseases. To date, there has not been a scientometric analysis of intestinal microcirculatory research.

To investigate the current status, development trends, and frontiers of intestinal microcirculatory research based on bibliometric analysis.

VOSviewer and CiteSpace 6.1.R2 were used to identify the overall characteristics and knowledge map of intestinal microcirculatory research based on the core literature published from 2000 to 2021 in the Web of Science database. The characteristics of each article, country of origin, institution, journal, cocitations, and other information were analyzed and visualized.

There were 1364 publications enrolled in the bibliometric analysis, exhibiting an upward trend from 2000 to 2021 with increased participation worldwide. The United States and Dalhousie University took the lead among countries and institutions, respectively. Shock was the most prolific journal, and Nature Reviews Microbiology Clinical had the most citations. The topical hotspots and frontiers in intestinal microcirculatory research were centered on the pathological processes of functional impairment of intestinal microvessels, diverse intestinal illnesses, and clinical treatment.

Our study highlights insights into trends of the published research on the intestinal microcirculation and offers serviceable guidance to researchers by summarizing the prolific areas in intestinal disease research to date.

• Intestinal microcirculation
• Bibliometric analysis
• CiteSpace
• VOSviewer
• Visualization

• Humans
• Microcirculation
• Intestines
• Bibliometrics
• Databases, Factual
• Microvessels

• hemodynamic monitoring
• hemodynamic parameter measurements
• minimally invasive monitoring
• patient monitoring

• Humans
• Hemodynamics
• Heart Rate
• Blood Pressure
• Cardiac Output
• Critical Care

• fluid resuscitation
• intensive care
• microcirculation
• resuscitation
• sepsis
• septic shock

• COVID-19
• endothelial glycocalyx
• endothelium
• intensive care
• microcirculation
• sepsis

Gut ischemia is a frequent but underdiagnosed complication, especially in critically ill intensive care patients, and represents a special diagnostic challenge that can only be solved in an interdisciplinary manner. We report a case of a 54-year-old woman with acute mesenteric ischemia (AMI) as a cause of septic shock diagnosed by intravital microscopy (IVM) 2 days before visible necrotic changes in a multimodality approach. We show that intravital microscopy can be a serious alternative for the early diagnosis of mesenteric ischemia in the hands of the skilled. We use this case to discuss the value and clinical perspective of IVM in the intensive care setting.

• anesthesia
• cardiovascular dynamics
• hemodynamic coherence
• hemodynamics
• microcirculation
• oxygen transport
• physiology
• red blood cell velocity
• tissue perfusion

• Citocina
• Cytokine
• Endotelio
• Endothelium
• Endotoxin
• Endotoxina
• Inflammatory response
• Microcirculación
• Microcirculation
• Respuesta inflamatoria
• Sepsis
• Septic shock
• Shock séptico

• Animals
• Digestive System Surgical Procedures/veterinary
• Hemodynamics
• Horses
• Microcirculation
• Microscopy, Video/veterinary
• Mouth Floor/surgery

Alterations of microcirculation are associated with organ hypoperfusion and high mortality in septic shock. This study is aimed at investigating the effects of unfractionated heparin (UFH) on intestinal microcirculatory perfusion and systemic circulation in a septic shock model.

Twenty-four beagle dogs were randomly allocated into four groups: (a) sham group: healthy controls, (b) shock group: septic shock induced by Escherichia coli, (c) basic therapy group: septic shock animals treated with antibiotics and 10 ml/kg/h saline, and (d) heparin group: septic shock animals treated with basic therapy plus UFH. Hemodynamic variables were measured within 24 h after E. coli administration. The intestinal microcirculation was simultaneously investigated with a sidestream dark-field imaging technique. Additionally, the function of vital organs was evaluated at 12 h postadministration (T12).

E. coli induced a progressive septic shock in which the mean arterial pressure (MAP) decreased and lactate levels sharply increased, accompanied by deteriorated microvessel perfusion. While basic therapy partially improved the microvascular flow index and the perfused microvessel density in the jejunal villi, UFH significantly restored major microcirculation variables at T12. Physiological variables, including MAP, urine output, and lactate levels, were improved by UFH, whereas some hemodynamic indices were not affected by UFH. With respect to organ function, UFH increased the platelet count and decreased the creatinine level.

UFH improves microcirculatory perfusion of the small intestine independently of the changes in systemic hemodynamic variables in a canine model of septic shock, thereby improving coagulation and renal function.

The peripheral perfusion index (PI), as a real-time bedside indicator of peripheral tissue perfusion, may be useful for determining mean arterial pressure (MAP) after early resuscitation of septic shock patients. The aim of this study was to explore the response of PI to norepinephrine (NE)-induced changes in MAP.

Twenty septic shock patients with pulse-induced contour cardiac output catheter, who had usual MAP under NE infusion after early resuscitation, were enrolled in this prospective, open-label study. Three MAP levels (usual MAP −10 mmHg, usual MAP, and usual MAP +10 mmHg) were obtained by NE titration, and the corresponding global hemodynamic parameters and PI were recorded. The general linear model with repeated measures was used for analysis of variance of related parameters at three MAP levels.

With increasing NE infusion, significant changes were found in MAP (F = 502.46, P < 0.001) and central venous pressure (F = 27.45, P < 0.001) during NE titration. However, there was not a significant and consistent change in continuous cardiac output (CO) (F = 0.41, P = 0.720) and PI (F = 0.73, P = 0.482) at different MAP levels. Of the 20 patients enrolled, seven reached the maximum PI value at usual MAP −10 mmHg, three reached the maximum PI value at usual MAP, and ten reached the maximum PI value at usual MAP +10 mmHg. The change in PI was not significantly correlated with the change in CO (r = 0.260, P = 0.269) from usual MAP −10 mmHg to usual MAP. There was also no significant correlation between the change in PI and change in CO (r = 0.084, P = 0.726) from usual MAP to usual MAP +10 mmHg.

Differing MAP levels by NE infusion induced diverse PI responses in septic shock patients, and these PI responses may be independent of the change in CO. PI may have potential applications for MAP optimization based on changes in peripheral tissue perfusion.

Fluid selection and administration during shock is typically guided by consideration of macrovascular abnormalities and resuscitative targets (perfusion parameters, heart rate, blood pressure, cardiac output). However, the microcirculatory unit (comprised of arterioles, true capillaries, and venules) is vital for the effective delivery of oxygen and nutrients to cells and removal of waste products from the tissue beds. Given that the microcirculation is subject to both systemic and local control, there is potential for functional changes and impacts on tissue perfusion that are not reflected by macrocirculatory parameters. This chapter will present an overview of the structure, function and regulation of the microcirculation and endothelial surface layer in health and shock states such as trauma, hemorrhage and sepsis. This will set the stage for consideration of how these microcirculatory characteristics, and the potential disconnect between micro- and macrovascular perfusion, may affect decisions related to acute fluid therapy (fluid type, amount, and rate) and monitoring of resuscitative efforts. Available evidence for the impact of various fluids and resuscitative strategies on the microcirculation will also be reviewed.

• glycocalyx
• hemorrhage
• macrocirculation
• microcirculation
• sepsis
• shock

Dynamic parameters of preload have been widely recommended to guide fluid therapy based on the principle of fluid responsiveness and with regard to cardiac output. An equally important aspect is however to also avoid volume-overload. This accounts particularly when capillary leakage is present and volume-overload will promote impairment of microcirculatory blood flow. The aim of this study was to evaluate, whether an impairment of intestinal microcirculation caused by volume-load potentially can be predicted using pulse pressure variation in an experimental model of ischemia/reperfusion injury. The study was designed as a prospective explorative large animal pilot study. The study was performed in 8 anesthetized domestic pigs (German landrace). Ischemia/reperfusion was induced during aortic surgery. 6 h after ischemia/reperfusion-injury measurements were performed during 4 consecutive volume-loading-steps, each consisting of 6 ml kg⁻¹ bodyweight⁻¹. Mean microcirculatory blood flow (mean Flux) of the ileum was measured using direct laser-speckle-contrast-imaging. Receiver operating characteristic analysis was performed to determine the ability of pulse pressure variation to predict a decrease in microcirculation. A reduction of ≥ 10% mean Flux was considered a relevant decrease. After ischemia–reperfusion, volume-loading-steps led to a significant increase of cardiac output as well as mean arterial pressure, while pulse pressure variation and mean Flux were significantly reduced (Pairwise comparison ischemia/reperfusion-injury vs. volume loading step no. 4): cardiac output (l min⁻¹) 1.68 (1.02–2.35) versus 2.84 (2.15–3.53), p = 0.002, mean arterial pressure (mmHg) 29.89 (21.65–38.12) versus 52.34 (43.55–61.14), p < 0.001, pulse pressure variation (%) 24.84 (17.45–32.22) versus 9.59 (1.68–17.49), p = 0.004, mean Flux (p.u.) 414.95 (295.18–534.72) versus 327.21 (206.95–447.48), p = 0.006. Receiver operating characteristic analysis revealed an area under the curve of 0.88 (CI 95% 0.73–1.00; p value < 0.001) for pulse pressure variation for predicting a decrease of microcirculatory blood flow. The results of our study show that pulse pressure variation does have the potential to predict decreases of intestinal microcirculatory blood flow due to volume-load after ischemia/reperfusion-injury. This should encourage further translational research and might help to prevent microcirculatory impairment due to excessive fluid resuscitation and to guide fluid therapy in the future.

• Abdominal surgery
• Handheld vital microscopy
• Hemodynamic management
• Intestinal microcirculation

Microcirculation is a particular organ of the cardiovascular system. The goal of this narrative review is a critical reappraisal of the present knowledge of microcirculation monitoring, mainly focused on the videomicroscopic evaluation of sublingual microcirculation in critically ill patients. We discuss the technological developments in handheld videomicroscopy, which have resulted in adequate tools for the bedside monitoring of microcirculation. By means of these techniques, a large body of evidence has been acquired about the role of microcirculation in the pathophysiological mechanisms of shock, especially septic shock. We review the characteristics of sublingual microcirculation in septic shock, which mainly consist in a decrease in the perfused vascular density secondary to a reduction in the proportion of perfused vessels along with a high heterogeneity in perfusion. Even in patients with high cardiac output, red blood cell velocity is decreased. Thus, hyperdynamic flow is absent in the septic microcirculation. We also discuss the dissociation between microcirculation and systemic hemodynamics, particularly after shock resuscitation, and the different behavior among microvascular beds. In addition, we briefly comment the effects of some treatments on microcirculation. Despite the fact that sublingual microcirculation arises as a valuable goal for the resuscitation in critically ill patients, significant barriers remain present for its clinical application. Most of them are related to difficulties in video acquisition and analysis. We comprehensively analyzed these shortcomings. Unfortunately, a simpler approach, such as the central venous minus arterial PCO₂ difference, is a misleading surrogate for sublingual microcirculation. As conclusion, the monitoring of sublingual microcirculation is an appealing method for monitoring critically ill patients. Nevertheless, the lack of controlled studies showing benefits in terms of outcome, as well as technical limitations for its clinical implementation, render this technique mainly as a research tool.

• microcirculation
• monitoring
• sepsis
• shock

Although acute hypoxia is of utmost pathophysiologic relevance in health and disease, studies on its effects on both the macro- and microcirculation are scarce. Herein, we provide a comprehensive analysis of the effects of acute normobaric hypoxia on human macro- and microcirculation. 20 healthy participants were enrolled in this study. Hypoxia was induced in a normobaric hypoxia chamber by decreasing the partial pressure of oxygen in inhaled air stepwisely (pO₂; 21.25 kPa (0 k), 16.42 kPa (2 k), 12.63 kPa (4 k) and 9.64 kPa (6 k)). Macrocirculatory effects were assessed by cardiac output measurements, microcirculatory changes were investigated by sidestream dark-field imaging in the sublingual capillary bed and videocapillaroscopy at the nailfold. Exposure to hypoxia resulted in a decrease of systemic vascular resistance (p < 0.0001) and diastolic blood pressure (p = 0.014). Concomitantly, we observed an increase in heart rate (p < 0.0001) and an increase of cardiac output (p < 0.0001). In the sublingual microcirculation, exposure to hypoxia resulted in an increase of total vessel density, proportion of perfused vessels and perfused vessel density. Furthermore, we observed an increase in peripheral capillary density. Exposure to acute hypoxia results in vasodilatation of resistance arteries, as well as recruitment of microvessels of the central and peripheral microcirculation. The observed macro- and microcirculatory effects are most likely a result from compensatory mechanisms to ensure adequate tissue oxygenation.

• inflammation
• intravital microscopy
• microcirculation

Background: Internal hemorrhage is a medical emergency, which requires immediate causal therapy, but the recognition may be difficult. The reactive changes of the mesenteric circulation may be part of the earliest hemodynamic responses to bleeding. Methane is present in the luminal atmosphere; thus, we hypothesized that it can track the intestinal circulatory changes, induced by hemorrhage, non-invasively. Our goal was to validate and compare the sensitivity of this method with an established technique using sublingual microcirculatory monitoring in a large animal model of controlled, graded hemorrhage and the early phase of following fluid resuscitation.

Materials and Methods: The experiments were performed on anesthetized, ventilated Vietnamese minipigs (approval number: V/148/2013; n = 6). The animals were gradually bled seven times consecutively of 5% of their estimated blood volume (BV) each, followed by gradual fluid resuscitation with colloid (hydroxyethyl starch; 5% of the estimated BV/dose) until 80 mmHg mean arterial pressure was achieved. After each step, macrohemodynamic parameters were recorded, and exhaled methane level was monitored continuously with a custom-built photoacoustic laser-spectroscopy unit. The microcirculation of the sublingual area, ileal serosa, and mucosa was examined by intravital videomicroscopy (Cytocam-IDF, Braedius).

Results: Mesenteric perfusion was significantly reduced by a 5% blood loss, whereas microperfusion in the oral cavity deteriorated after a 25% loss. A statistically significant correlation was found between exhaled methane levels, superior mesenteric artery flow (r = 0.93), or microcirculatory changes in the ileal serosa (ρ = 0.78) and mucosa (r = 0.77). After resuscitation, the ileal mucosal microcirculation increased rapidly [De Backer score (DBS): 2.36 ± 0.42 vs. 8.6 ± 2.1 mm⁻¹], whereas serosal perfusion changed gradually and with a lower amplitude (DBS: 2.51 ± 0.48 vs. 5.73 ± 0.75). Sublingual perfusion correlated with mucosal (r = 0.74) and serosal (r = 0.66) mesenteric microperfusion during the hemorrhage phase but not during the resuscitation phase.

Conclusion: Detection of exhaled methane levels is of diagnostic significance during experimental hemorrhage as it indicates blood loss earlier than sublingual microcirculatory changes and in the early phase of fluid resuscitation, the exhaled methane values change in association with the mesenteric perfusion and the microcirculation of the ileum.

• diagnostic significance
• exhaled methane
• hemorrhage
• resuscitation
• small intestinal microcirculation

• abdominal sepsis
• deresuscitation
• intra-abdominal infection
• organ dysfunction

• Evidence evaluation
• Fluid resuscitation
• Microcirculation
• Organ perfusion
• Septic shock
• Surviving sepsis campaign guidelines
• Vasopressors

• Fluid challenge
• Hemodynamic
• Microcirculation
• Sepsis
• StO(2)

In vascular surgery with aortic cross-clamping, ischemia/reperfusion injury induces systemic haemodynamic and microcirculatory disturbances. Different anaesthetic regimens may have a varying impact on tissue perfusion. The aim of this study was to explore changes in microvascular perfusion in patients undergoing elective open abdominal aortic aneurysm repair under balanced or total intravenous anaesthesia.

Prospective observational study. Patients undergoing elective open infrarenal abdominal aortic aneurysm repair received balanced (desflurane + remifentanil, n = 20) or total intravenous anaesthesia (TIVA, propofol + remifentanil using target-controlled infusion, n = 20) according to the clinician’s decision. A goal-directed haemodynamic management was applied in all patients. Measurements were obtained before anaesthesia induction (baseline) and at end-surgery and included haemodynamics, arterial/venous blood gases, sublingual microvascular flow and density (incident dark field illumination imaging), peripheral muscle tissue oxygenation and microcirculatory reactivity (thenar near infrared spectroscopy with a vascular occlusion test).

The two groups did not differ for baseline characteristics, mean aortic-clamping time and requirement of vasoactive agents during surgery. Changes in mean arterial pressure, systemic vascular resistance index, haemoglobin and blood lactate levels were similar between the two groups, while the cardiac index increased at end-surgery in patients undergoing balanced anaesthesia. The sublingual microcirculation was globally unaltered in the TIVA group at end-surgery, while patients undergoing balanced anaesthesia showed an increase in the total and perfused small vessel densities (from 16.6 ± 4.2 to 19.1 ± 5.4 mm/mm², p < 0.05). Changes in microvascular density were negatively correlated with changes in the systemic vascular resistance index. The area of reactive hyperaemia during the VOT increased in the balanced anaesthesia group (from 14.8 ± 8.1 to 25.6 ± 14.8%*min, p < 0.05). At end-surgery, the tissue haemoglobin index in the TIVA group was lower than that in the balanced anaesthesia group.

In patients undergoing elective open abdominal aortic aneurysm repair with a goal-directed hemodynamic management, indices of sublingual or peripheral microvascular perfusion/oxygenation were globally preserved with both balanced anaesthesia and TIVA. Patients undergoing balanced anaesthesia showed microvascular recruitment at end-surgery.

NCT03510793, https://www.clinicaltrials.gov, date of registration April 27th 2018, retrospectively registered.

• Anaesthesia
• Aortic surgery
• Haemodynamics
• Ischemia/reperfusion injury
• Microcirculation

• critical care
• hemodynamic monitoring
• microcirculation
• neonates
• pediatrics

• abdominal organs
• inflammation
• magnetic resonance
• perfusion
• sepsis

• Aged
• Aged, 80 and over
• Enterocytes/pathology
• Fatty Acid-Binding Proteins/metabolism
• Female
• Humans
• Ischemia/metabolism
• Ischemia/pathology
• Male
• Middle Aged
• Prospective Studies
• Shock, Septic/metabolism
• Shock, Septic/pathology
• Tongue/metabolism
• Tongue/pathology
• Tongue Diseases/metabolism
• Tongue Diseases/pathology

Little is known about the microcirculatory alterations in patients with chronic mesenteric ischemia (CMI). We hypothesized that patients with CMI have an impaired microcirculatory function and show an oral microcirculatory response after caloric challenge compared to healthy controls.

All patients and controls received the standard workup for CMI. Sublingual micro-circulation was evaluated before (T0) and 20 minutes after (T1) feeding. The total vessel density (TVD; mm/mm²), perfused vessel density (PVD; mm/mm²), proportion of perfused vessels (PPV; %) and microvascular flow index (MFI; AU) were assessed.

We included 12 patients (63.2 years [IQR 48.8–70.4 years], 67% males) and 12 controls (32.7 years [IQR 27.7–38.1 years], 42% males). At baseline, patients with CMI had a decreased PPV of the sublingual small vessels (median 84.8% vs 95.7%, P=0.006), PPV of all vessels (PPV median 85.4% vs 95.3%, P=0.007) and microvascular flow index of all vessels (MFIa; median 3.00 vs 2.80, P=0.039) compared to healthy controls. After caloric challenge, PVD increased significantly in both small vessels (perfused vessel density of the small vessels [PVDs]) and all vessels (perfused vessel density of all vessels [PVDa]; PVDs [T0]) median 16.3 [IQR 13.3–22.1] vs [T1] median 19.9 [IQR 14.2–26.2], P=0.008; PVDa [T0] median 19.1 [IQR 16.2–23.6] vs [T1] median 22.2 [IQR 16.5–28.9], P=0.02; proportion of perfused vessels of the small vessels (PPVs; [T0] median 84.8% [IQR 75.3–90.4] vs [T1] median 91.0% [IQR 80.1–93.8], P=0.010). In contrast, no significant changes in microcirculatory parameters were observed after caloric challenge in healthy controls.

Patients with CMI have an impaired sublingual microcirculation at baseline and show a significant response in the sublingual microcirculation after caloric challenge, whereas healthy controls have a normal microcirculation at baseline and show no reactive response upon a caloric challenge as seen in CMI patients. Sublingual microcirculation visualization may offer a rapid noninvasive method to identify patients at risk for having CMI.

• Cytocam-IDF
• chronic mesenteric ischemia
• diagnosis
• ischemia
• sublingual microcirculation

• Aortic surgery
• Haemodynamics
• Ischaemia/reperfusion
• Microcirculation
• Volume management

• In vivo microcirculation
• Incident dark field imaging
• Peritoneal microcirculation

• Adult
• Aged
• Blood Flow Velocity
• Capillaries/physiology
• Feasibility Studies
• Female
• Hepatectomy
• Humans
• Image Interpretation, Computer-Assisted
• Intraoperative Period
• Male
• Microcirculation
• Microscopy, Video
• Middle Aged
• Peritoneum/blood supply
• Regional Blood Flow
• Time Factors
• Tongue/blood supply