Confocal microlaparoscope for imaging the fallopian tube

Recent evidence suggests that epithelial ovarian cancer may originate in the fimbriated end of the fallopian tube1. Unlike many other cancers, poor access to the ovary and fallopian tubes has limited the ability to study the progression of this deadly disease and to diagnosis it during the early stage when it is most amenable to therapy. We have previously reported on a rigid confocal microlaparoscope system that is currently undergoing a clinical trial to image the epithelial surface of the ovary2. In order to gain in vivo access to the fallopian tubes we have developed a new confocal microlaparoscope with an articulating distal tip. The new instrument builds upon the technology developed for the existing confocal microlaparoscope. It has an ergonomic handle fabricated by a rapid prototyping printer. While maintaining compatibility with a 5 mm trocar, the articulating distal tip of the instrument consists of a 2.2 mm diameter bare fiber bundle catheter with automated dye delivery for fluorescence imaging. This small and flexible catheter design should enable the confocal microlaparoscope to image early stage ovarian cancer arising inside the fallopian tube. Early ex vivo mages of human fallopian tube and in vivo imaging results from recent open surgeries using the rigid confocal microlaparoscope system are presented. Ex vivo images from animal models using the new articulating bare fiber system are also presented. These high quality images collected by the new flexible system are similar in quality to those obtained from the epithelial surface of ovaries with the rigid clinical confocal microlaparoscope.

[1]  David M Herrington,et al.  Early menopause predicts future coronary heart disease and stroke: the Multi-Ethnic Study of Atherosclerosis , 2012, Menopause.

[2]  Susanna I. Lee,et al.  MRI, CT, and PET/CT for ovarian cancer detection and adnexal lesion characterization. , 2010, AJR. American journal of roentgenology.

[3]  T. Rebbeck,et al.  Prophylactic oophorectomy in women at increased cancer risk , 2007, Current opinion in obstetrics & gynecology.

[4]  Jeffrey J Rodríguez,et al.  Computer-aided identification of ovarian cancer in confocal microendoscope images. , 2008, Journal of biomedical optics.

[5]  James Mackay,et al.  High-risk premenopausal women's experiences of undergoing prophylactic oophorectomy: a descriptive study. , 2004, Genetic testing.

[6]  Thomas D. Wang,et al.  Dual-axis confocal microscope for high-resolution in vivo imaging. , 2003, Optics letters.

[7]  K. Dunbar,et al.  Endomicroscopy in the evaluation of Barrett's esophagus , 2011, Current opinion in gastroenterology.

[8]  Ross S Berkowitz,et al.  Primary fallopian tube malignancies in BRCA-positive women undergoing surgery for ovarian cancer risk reduction. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[9]  A. Polglase,et al.  Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. , 2004, Gastroenterology.

[10]  A. Rouse,et al.  Clinical confocal microlaparoscope for real-time in vivo optical biopsies. , 2009, Journal of biomedical optics.

[11]  L. Dubeau,et al.  The cell of origin of ovarian epithelial tumours. , 2008, The Lancet. Oncology.

[12]  Setsuko K Chambers,et al.  Tubal origin of ovarian low-grade serous carcinoma. , 2013, American journal of clinical and experimental obstetrics and gynecology.

[13]  Y. Sabharwal,et al.  Slit-scanning confocal microendoscope for high-resolution in vivo imaging. , 1999, Applied optics.

[14]  R. Kiesslich,et al.  In vivo histology of Barrett's esophagus and associated neoplasia by confocal laser endomicroscopy. , 2005, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[15]  D Yelin,et al.  Large area confocal microscopy. , 2007, Optics letters.

[16]  P. Leung,et al.  Ovarian surface epithelium: biology, endocrinology, and pathology. , 2001, Endocrine reviews.

[17]  A. Rouse,et al.  Multispectral confocal microendoscope for in vivo and in situ imaging. , 2008, Journal of biomedical optics.

[18]  Angelique Kano,et al.  Design and demonstration of a miniature catheter for a confocal microendoscope. , 2004, Applied optics.

[19]  A. Rouse,et al.  In vivo imaging of ovarian tissue using a novel confocal microlaparoscope. , 2010, American journal of obstetrics and gynecology.