Nerve autofluorescence under near-ultraviolet light: cutting-edge technology for intra-operative neural tissue visualization in 17 patients

Dip, Fernando; Rosenthal, Daniel; Socolovsky, Mariano; Falcó, Jorge; Fuente, Martin De La; White, Kevin P.; Rosenthal, Raúl J.

doi:10.1007/s00464-021-08729-y

Cited by 10 publications

(2 citation statements)

References 35 publications

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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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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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“…6,7 Similarly, ICG can injected into ureteric catheters directly allowing sustained fluorescence of the ureters. Recently, it has been shown that nerves have autofluorescence when visualized in the near ultra-violet light 8 and this could help avoid hypogastric nerve injury during TME and pelvic dissection.…”

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confidence: 99%

Fluorescent imaging in colorectal surgery: an essential component of care?

Yeung

Apte

Behrenbruch

et al. 2022

ANZ Journal of Surgery

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Nerve Visualization using Phenoxazine‐Based Near‐Infrared Fluorophores to Guide Prostatectomy

Wang,

Montaño,

Masillati

et al. 2023

Advanced Materials

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Fluorescence‐guided surgery (FGS) is poised to revolutionize surgical medicine through near‐infrared (NIR) fluorophores for tissue‐ and disease‐specific contrast. Clinical open and laparoscopic FGS vision systems operate nearly exclusively at NIR wavelengths. However, tissue‐specific NIR contrast agents compatible with clinically available imaging systems are lacking, leaving nerve tissue identification during prostatectomy a persistent challenge. Here, we show that combining drug‐like molecular design concepts and fluorophore chemistry enabled the production of a library of NIR phenoxazine‐based fluorophores for intraoperative nerve‐specific imaging. The lead candidate readily delineated prostatic nerves in the canine and iliac plexus in the swine models using the clinical da Vinci Surgical System that has been popularized for minimally invasive prostatectomy procedures. These results demonstrate the feasibility of molecular engineering of NIR nerve‐binding fluorophores for ready integration into the existing surigical workflow, paving the path for clinical translation to reduce morbidity from nerve injury for prostate cancer patients.This article is protected by copyright. All rights reserved

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Nerve autofluorescence under near-ultraviolet light: cutting-edge technology for intra-operative neural tissue visualization in 17 patients

Cited by 10 publications

References 35 publications

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

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

Fluorescent imaging in colorectal surgery: an essential component of care?

Nerve Visualization using Phenoxazine‐Based Near‐Infrared Fluorophores to Guide Prostatectomy

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