Nerve autofluorescence in near-ultraviolet light markedly enhances nerve visualization in vivo

Dip, Fernando; Bregoli, Pedro; Falcó, Jorge; White, Kevin P.; Rosenthal, Raúl J.

doi:10.1007/s00464-021-08484-0

Cited by 12 publications

(8 citation statements)

References 38 publications

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“…Recently, neurons were found to generate near-ultraviolet (NUV) light fluorescence. The objectives of a study by Dip [87] were to establish the extent to which nerves glow brighter than background and vascular structures under NUV light and the intensity of NUV light at which nerves are most identifiable from other tissues. At all NUV intensities, a fluorescence score of 200 showed 100% accuracy for distinguishing nerves from other anatomical structures in vivo.…”

Section: Experimental Research and Results Foreshadow Future Clinical...mentioning

confidence: 99%

Indocyanine Green(Icg) And Colorectal Surgery: A Literature Review on Qualitative and Quantitative Methods of Usage

Simion¹,

Ionescu²,

Chitoran³

et al. 2023

Preprint

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Background: This literature review investigates qualitative and quantitative uses of indocyanine green (ICG) in surgical treatment, as this novel technique has become increasingly popular in ORs (operating rooms) worldwide due to its many advantages. Method: An extensive literature review was performed by searching for relevant terms in 5 international databases (www.pubmed.gov, www.sciencedirect.com, www.scopus.com, www.Oxfordjournals.com, www.reaxys.com). The results of this search were summarized into the main advantages of employing ICG in colorectal surgery as follows: a) intraoperative fluorescence angiography capability; b) fluorescence-guided identification of lymph node involvement in colorectal cancer and the sentinel lymph node method; c) positive fluorescence flagging of a liver tumour as small as "only" 200 tumour cells; d) facilitation of fistula diagnosis; and e) tumour tattooing. Moreover, in addition to qualitative intraoperative ICG use, this technique can be combined with quantitative methods and parameters, such as maximum intensity, relative maximum intensity, and different inflow parameters (time-to-peak, slope, and t1/2max). The conclusion of this article is that fluorescence surgery with ICG aided by near-infrared (NIR) light is a relatively recent technology, an advantage of which is improving the specific anatomic and functional information provided, thus allowing more comprehensive and safer tumour removal as well as preservation of important structures.

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Section: Experimental Research and Results Foreshadow Future Clinical...mentioning

confidence: 99%

Indocyanine Green(Icg) And Colorectal Surgery: A Literature Review on Qualitative and Quantitative Methods of Usage

Simion¹,

Ionescu²,

Chitoran³

et al. 2023

Preprint

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“…29 Our 10 experts also reached consensus that FI decreases the overall risks of TPS and has value in surgically treating cancer procedures, whether restricted to the thyroid or requiring radical neck dissection. Interestingly, recent studies have suggested that neural tissue also autofluoresces, albeit under near-ultraviolet rather than NIR light, [30][31][32] suggesting another potential advantage of FI during thyroid and parathyroid resections and radical neck dissections, given the recurrent laryngeal nerve's close proximity to the thyroid and highly variable location and course [33][34][35][36] with permanent laryngeal nerve palsy documented in from 2% 37 to 8% 38 of patients undergoing thyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

Use of fluorescence imaging and indocyanine green during thyroid and parathyroid surgery: Results of an intercontinental, multidisciplinary Delphi survey

Dip

Alesina

Anuwong

et al. 2022

Surgery

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“…Recent studies have demonstrated that nerves can auto-fluoresce in NUVL, [25][26][27] including a diverse case series of 17 patients in whom the nerves clearly auto-fluoresced during parotid resections, thyroid resections, resection of various peripheral nerve and spinal tumors, and neonatal brachial plexus injury repair. 27 The current case differs from these others in that it is the first time when purely sensory nerve branches have been visualized and preserved during breast surgery.…”

Section: Meaningmentioning

confidence: 99%

Fluorescence Imaging to Identify and Preserve Fifth Intercostal Sensory Nerves during Bilateral Nipple-sparing Mastectomies

Rancati

Angrigiani

Nahabedian³

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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The use of nipple-sparing mastectomies has increased steadily over the past 10-15 years. However, one major source of patient dissatisfaction with both skin-and nipple-sparing mastectomies is lost skin and/or nipple sensation postoperatively due to intraoperative, iatrogenic sensory nerve injury. We summarize the case of a 41-year-old woman with BRCA(+) breast cancer who underwent bilateral, risk-reducing nipple-sparing mastectomies, immediately followed by bilateral, direct-to-implant breast reconstruction, in whom a prototype fluorescent imaging camera was used to facilitate sensory nerve identification and preservation. Preoperatively, tactile and thermal quantitative sensory testing were performed using a 30-gauge needle to determine baseline sensory function over both breasts. Then, nipple-sparing mastectomies and direct-to-implant reconstruction were performed. Using a laterally-displaced submammary approach, the anterior intercostal artery perforator neurovascular pedicle was preserved. Then a prototype camera, which emits near-ultraviolet light, was used to detect nerve autofluorescence. Intraoperatively under near-ultraviolet light, both the fifth intercostal nerve and its sensory branches auto-fluoresced clearly, so that surgery was completed without apparent injury to the fifth intercostal nerve or any of its branches. Postoperatively, the patient reported full sensory function throughout both breasts and both nipple-areolar complexes, which was confirmed on both tactile and thermal sensory testing at 3-month follow-up. The patient experienced no complications and rated her overall satisfaction with surgery on both breasts as 10 out of 10. To our knowledge, this is the first time sensory nerve auto-fluorescence has been reported to reduce the likelihood of intraoperative, iatrogenic nerve injury and preserve sensory function.

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Nerve autofluorescence in near-ultraviolet light markedly enhances nerve visualization in vivo

Cited by 12 publications

References 38 publications

Indocyanine Green(Icg) And Colorectal Surgery: A Literature Review on Qualitative and Quantitative Methods of Usage

Indocyanine Green(Icg) And Colorectal Surgery: A Literature Review on Qualitative and Quantitative Methods of Usage

Use of fluorescence imaging and indocyanine green during thyroid and parathyroid surgery: Results of an intercontinental, multidisciplinary Delphi survey

Fluorescence Imaging to Identify and Preserve Fifth Intercostal Sensory Nerves during Bilateral Nipple-sparing Mastectomies

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