Dual-mode laparoscopic fluorescence image-guided surgery using a single camera

Iatrogenic nerve damage is a leading cause of morbidity associated with many common surgical procedures. Complications arising from these injuries may result in loss of function and/or sensation, muscle atrophy, and chronic neuropathy. Fluorescence image-guided surgery offers a potential solution for avoiding intraoperative nerve damage by highlighting nerves that are otherwise difficult to visualize. In this work we present the development of a single camera, dual-mode laparoscope that provides near simultaneous display of white-light and fluorescence images of nerves. The capability of the instrumentation is demonstrated through imaging several types of in situ rat nerves via a nerve specific contrast agent. Full color white light and high brightness fluorescence images and video of nerves as small as 100 µm in diameter are presented.

[1]  A. Kaynan,et al.  Intraoperative electrical stimulation of cavernosal nerves with monitoring of intracorporeal pressure in patients undergoing nerve sparing radical prostatectomy , 1999, BJU international.

[2]  Samuel Achilefu,et al.  Hands-free, wireless goggles for near-infrared fluorescence and real-time image-guided surgery. , 2011, Surgery.

[3]  Peter L. Choyke,et al.  A Portable Fluorescence Camera for Testing Surgical Specimens in the Operating Room: Description and Early Evaluation , 2010, Molecular Imaging and Biology.

[4]  M. Michaelson,et al.  Management of Complications of Prostate Cancer Treatment , 2008, CA: a cancer journal for clinicians.

[5]  Jonathan M. Sorger,et al.  Nerve mapping for prostatectomies: novel technologies under development. , 2012, Journal of endourology.

[6]  John V. Frangioni,et al.  Nerve-Highlighting Fluorescent Contrast Agents for Image-Guided Surgery , 2011, Molecular imaging.

[7]  S. Bredow,et al.  Fluorescence Imaging of Fast Retrograde Axonal Transport in Living Animals , 2009, Molecular imaging.

[8]  George A. Reynolds,et al.  New coumarin dyes with rigidized structure for flashlamp-pumped dye lasers , 1975 .

[9]  Johannes Gahlen,et al.  Laparoscopic Fluorescence Diagnosis for Intraabdominal Fluorescence Targeting of Peritoneal Carcinosis: Experimental Studies , 2002, Annals of surgery.

[10]  Beth Friedman,et al.  Fluorescent peptides highlight peripheral nerves during surgery in mice , 2011, Nature Biotechnology.

[11]  Vasilis Ntziachristos,et al.  Current concepts and future perspectives on surgical optical imaging in cancer. , 2010, Journal of biomedical optics.

[12]  Sharmeela Kaushal,et al.  Fluorescence laparoscopy imaging of pancreatic tumor progression in an orthotopic mouse model , 2010, Surgical Endoscopy.

[13]  W. A. Chambers,et al.  Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome , 2005, British Journal of Cancer.

[14]  Y. Iwasaki,et al.  Non-Invasive Identification of Sentinel Lymph Nodes Using Indocyanine Green Fluorescence Imaging in Patients with Breast Cancer~!2009-11-04~!2009-12-23~!2010-05-26~! , 2010 .

[15]  R. Dworkin,et al.  Risk factors for chronic pain following breast cancer surgery: a prospective study. , 2006, The journal of pain : official journal of the American Pain Society.

[16]  V. Rusch,et al.  Intraoperative localization of lymph node metastases with a replication-competent herpes simplex virus. , 2006, The Journal of thoracic and cardiovascular surgery.

[17]  Siavash Yazdanfar,et al.  Compact instrument for fluorescence image-guided surgery. , 2010, Journal of biomedical optics.

[18]  J. Lakowicz Principles of fluorescence spectroscopy , 1983 .

[19]  J. Frangioni In vivo near-infrared fluorescence imaging. , 2003, Current opinion in chemical biology.

[20]  Alexander L. Vahrmeijer,et al.  Optical Image-guided Surgery—Where Do We Stand? , 2010, Molecular Imaging and Biology.

[21]  T. Peters Image-guidance for surgical procedures , 2006, Physics in medicine and biology.

[22]  Brian W Pogue,et al.  Review of Neurosurgical Fluorescence Imaging Methodologies , 2010, IEEE Journal of Selected Topics in Quantum Electronics.

[23]  M. Graefen,et al.  Basic principles of anatomy for optimal surgical treatment of prostate cancer , 2007, World Journal of Urology.

[24]  S. Achilefu,et al.  A NIR Dye for Development of Peripheral Nerve Targeted Probes. , 2012, MedChemComm.

[25]  V. P. Staudinger,et al.  Intraoperative Fluorescence Imaging of Peripheral and Central Nerves Through a Myelin-Selective Contrast Agent , 2012, Molecular Imaging and Biology.

[26]  Stavros G Demos,et al.  In vivo testing of a prototype system providing simultaneous white light and near infrared autofluorescence image acquisition for detection of bladder cancer. , 2011, Journal of biomedical optics.

[27]  Watt W Webb,et al.  Multiphoton microscopy of prostate and periprostatic neural tissue: a promising imaging technique for improving nerve-sparing prostatectomy. , 2009, Journal of endourology.

[28]  Matthew B. Bouchard,et al.  SPLASSH: Open source software for camera-based high-speed, multispectral in-vivo optical image acquisition , 2010, Biomedical optics express.

[29]  W. Steers,et al.  Fiberoptic imaging of cavernous nerves in vivo. , 2007, The Journal of urology.

[30]  N. Yaegashi,et al.  Intraoperative electrical stimulation of the pelvic splanchnic nerves during nerve-sparing radical hysterectomy. , 2005, Gynecologic oncology.

[31]  M. Policarpo,et al.  Post-thyroidectomy superior laryngeal nerve injury , 2001, European Archives of Oto-Rhino-Laryngology.

[32]  John C Rasmussen,et al.  Molecular imaging with optics: primer and case for near-infrared fluorescence techniques in personalized medicine. , 2008, Journal of biomedical optics.

[33]  Anita Mahadevan-Jansen,et al.  Liquid-crystal tunable filter spectral imaging for brain tumor demarcation. , 2007, Applied optics.

[34]  P. Low,et al.  Intraoperative tumor-specific fluorescence imaging in ovarian cancer by folate receptor-α targeting: first in-human results , 2011, Nature Medicine.

[35]  D. Taggart,et al.  Preliminary experience with a novel intraoperative fluorescence imaging technique to evaluate the patency of bypass grafts in total arterial revascularization. , 2003, The Annals of thoracic surgery.

[36]  H. Grocott,et al.  Peripheral Nerve Injuries During Cardiac Surgery: Risk Factors, Diagnosis, Prognosis, and Prevention , 2000, Anesthesia and analgesia.

[37]  D. Cooper Thyroxine monotherapy after thyroidectomy: coming full circle. , 2008, JAMA.

[38]  Vasilis Ntziachristos,et al.  Multispectral imaging using multiple-bandpass filters. , 2008, Optics letters.

[39]  W. A. Chambers,et al.  The prevalence of chronic chest and leg pain following cardiac surgery: a historical cohort study , 2003, Pain.

[40]  J. Frangioni,et al.  Image-Guided Surgery Using Invisible Near-Infrared Light: Fundamentals of Clinical Translation , 2010, Molecular imaging.

[41]  Ji-Xin Cheng,et al.  Ex vivo and in vivo imaging of myelin fibers in mouse brain by coherent anti-Stokes Raman scattering microscopy. , 2008, Optics express.

[42]  L. Ngo,et al.  The FLARE™ Intraoperative Near-Infrared Fluorescence Imaging System: A First-in-Human Clinical Trial in Breast Cancer Sentinel Lymph Node Mapping , 2009, Annals of Surgical Oncology.

[43]  Jouke Dijkstra,et al.  Novel Intraoperative Near-Infrared Fluorescence Camera System for Optical Image-Guided Cancer Surgery , 2010, Molecular imaging.

[44]  Tessa Buckle,et al.  Intraoperative laparoscopic fluorescence guidance to the sentinel lymph node in prostate cancer patients: clinical proof of concept of an integrated functional imaging approach using a multimodal tracer. , 2011, European urology.

[45]  Hani Rashid,et al.  Near infrared fluorescence imaging with robotic assisted laparoscopic partial nephrectomy: initial clinical experience for renal cortical tumors. , 2011, The Journal of urology.

[46]  Dingrong Yi,et al.  Single sensor that outputs narrowband multispectral images. , 2010, Journal of biomedical optics.