Application of a New Dye for Near-Infrared Fluorescence Laparoscopy of the Ureters

Schols, Rutger M.; Lodewick, Toine M.; Bouvy, Nicole D.; Dam, Gooitzen M. van; Dejong, Cornelis H. C.; Stassen, Laurents P. S.

doi:10.1097/dcr.0000000000000055

Cited by 29 publications

(29 citation statements)

References 13 publications

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“…In contrast, Schols et al recently utilized a laparoscopic imaging system similar to this study; however, the device is not FDA-approved for use in the United States and is unable to provide an overlay image. 25 Furthermore, the study examined only 2 doses of IRDye800CW-CA, one of which was deemed suboptimal for ureter visualization, and did not assess any tissue samples.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Fluorescent Visualization of the Ureter With Intravenous IRDye800CW

Korb¹,

Huh²,

Boone³

et al. 2015

Journal of Minimally Invasive Gynecology

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Objectives Ureter injury is a serious complication of laparoscopic surgery. Current strategies to identify the ureters, such as placement of a ureteral stent, carry additional risks for patients. To non-invasively reduce ureteral injury, we hypothesize that the systemically-injected near-infrared (NIR) dye IRDye800CW-CA can be used to visualize the ureter intraoperatively. Methods Adult female mixed breed pigs weighing 24–41 kg (n=2 per dose) were given a 30, 60, or 120 μg/kg systemic injection of IRDye800CW-CA. Using an FDA-cleared laparoscopic NIR system (PINPOINT), images of the ureter and bladder were captured every 10 minutes for 60 minutes after injection. To determine the biodistribution of the dye, tissues were collected for ex vivo analysis with the Pearl Impulse system. Image J software was used to quantify fluorescence signal and signal-to-background ratio (SBR) for the intraoperative images. Results The ureter was identified in all pigs at each dose with peak intensity being reached by 30 minutes and remaining elevated throughout the imaging (60 minutes). The 60μg/kg dose was determined to be optimal for differentiating ureter according to absolute fluorescence (>60 counts/pixel) and SBR (3.1). Urine fluorescence was inversely related to plasma fluorescence (R2=−0.82). Ex vivo imaging of kidney, ureter, bladder, and abdominal wall tissues revealed low fluorescence. Conclusions Systemic administration of IRDye800CW-CA shows promise in providing ureteral identification with high specificity during laparoscopic surgery. The low dose required, rapid time to visualization, and absence of invasive ureteral instrumentation inherent to this technique may reduce complications related to pelvic surgery.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Fluorescent Visualization of the Ureter With Intravenous IRDye800CW

Korb¹,

Huh²,

Boone³

et al. 2015

Journal of Minimally Invasive Gynecology

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“…Secondly, we found during laparoscopy that the pig's distinctive multilobulated liver configuration altered the handling and manipulation of the liver considerably in comparison with the expected characteristics in humans. Although the number of animals tested was small, the extensive data acquisition was comparable to similar studies published by other groups . The acquired number of images was sufficient to describe dual wavelength CLE imaging features and to evidence the feasibility of using fluorescence values to distinguish between vital and ablated liver parenchyma in an individual.…”

Section: Discussionmentioning

confidence: 62%

Utilizing confocal laser endomicroscopy for evaluating the adequacy of laparoscopic liver ablation

et al. 2015

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BackgroundLaparoscopic liver ablation therapy can be used for the treatment of primary and secondary liver malignancy. The increased incidence of cancer recurrence associated with this approach, has been attributed to the inability of monitoring the extent of ablated liver tissue.MethodsThe feasibility of assessing liver ablation with probe‐based confocal laser endomicroscopy (CLE) was studied in a porcine model of laparoscopic microwave liver ablation. Following the intravenous injection of the fluorophores fluorescein and indocyanine green, CLE images were recorded at 488 nm and 660 nm wavelength and compared to liver histology. Statistical analysis was performed to assess if fluorescence intensity change can predict the presence of ablated liver tissue.ResultsCLE imaging of fluorescein at 488 nm provided good visualization of the hepatic microvasculature; whereas, CLE imaging of indocyanine green at 660 nm enabled detailed visualization of hepatic sinusoid architecture and interlobular septations. Fluorescence intensity as measured in relative fluorescence units was found to be 75–100% lower in ablated compared to healthy liver regions. General linear mixed modeling and ROC analysis found the decrease in fluorescence to be statistically significant.ConclusionLaparoscopic, dual wavelength CLE imaging using two different fluorophores enables clinically useful visualization of multiple liver tissue compartments, in greater detail than is possible at a single wavelength. CLE imaging may provide valuable intraoperative information on the extent of laparoscopic liver ablation. Lasers Surg. Med. 48:299–310, 2016. © 2015 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

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“…171 The early detection and prevention of ureteral injury is clinically relevant and important in order to avoid this complication. 172 New developments in this field include the use of fluorescent stents, 95 use of specific fluorescent dye, 172 and use of augmented reality. 112,173 The use of augmented reality and fluorescence to assess the intestinal perfusion is also gaining an increased interest.…”

Section: Current Limitationsmentioning

confidence: 99%

Image-guided surgery

Azagury

Dua

Barrese

et al. 2015

Current Problems in Surgery

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Historical perspectives Stereotactic neurosurgery refers to a variety of techniques for performing intracranial procedures with a high level of precision and accuracy by establishing a fixed coordinate system within the brain. Traditionally, stereotactic head frames have been used to establish a coordinate system and introduce various instruments such as needles or electrodes. The development of stereotactic frames began toward the end of the 19th century. In 1873, Dittmar used a Contents lists available at ScienceDirect

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Application of a New Dye for Near-Infrared Fluorescence Laparoscopy of the Ureters

Abstract: Near-infrared fluorescence laparoscopy of the ureters, following intravenous CW800-CA administration, is easily applicable and provides real-time identification of the course of the ureters.

Cited by 29 publications

References 13 publications

Laparoscopic Fluorescent Visualization of the Ureter With Intravenous IRDye800CW

Laparoscopic Fluorescent Visualization of the Ureter With Intravenous IRDye800CW

Utilizing confocal laser endomicroscopy for evaluating the adequacy of laparoscopic liver ablation

Image-guided surgery

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