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

Abstract

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

Real time monitoring peripheral nerve function with ICG and BDA-ICG by NIR-II fluorescence imaging

“…In fact, whether ICG could directly label the peripheral nerve is controversial. Some studies believe ICG is a non-specific fluorescent contrast agent without nerve-targeting properties [ 16 ]. However, recently some reports found that preoperative intravenous injection of ICG was able to visualize the neuroanatomical structures such as the thoracic sympathetic ganglion and the genitourinary nerve in patients during the surgery and the immunofluorescence results showed ICG mainly located in axons [ 17 , 18 ].…”