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Ge Y, O’Shea DF. Review of Clinically Assessed Molecular Fluorophores for Intraoperative Image Guided Surgery. Molecules 2024; 29:5964. [PMID: 39770053 PMCID: PMC11679787 DOI: 10.3390/molecules29245964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 12/09/2024] [Accepted: 12/16/2024] [Indexed: 01/11/2025] Open
Abstract
The term "fluorescence" was first proposed nearly two centuries ago, yet its application in clinical medicine has a relatively brief history coming to the fore in the past decade. Nowadays, as fluorescence is gradually expanding into more medical applications, fluorescence image-guided surgery has become the new arena for this technology. It allows surgical teams to real-time visualize target tissues or anatomies intraoperatively to increase the precision of resection or preserve vital structures during open or laparoscopic surgeries. In this review, we introduce the concept of near-infrared fluorescence guided surgery, discuss the recent and ongoing clinical trials of molecular fluorophores (indocyanine green, 5-aminolevulinic acid, methylene blue, IR-dye 800CW, pafolacianine) and their surgical goals, highlight key chemical and medical factors for imaging agent optimization, deliberate challenges and potential advantages, and propose a framework for integrating this technology into routine surgical care in the near future. The notable clinical achievements of these fluorophores over the past decade strongly indicates that the future of fluorescence in surgery is bright with many more patient benefits to come.
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Affiliation(s)
| | - Donal F. O’Shea
- Department of Chemistry, RCSI, University of Medicine and Health Sciences, 123 St Stephen’s Green, Dublin 2, D02 YN77 Dublin, Ireland
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Ryu S, Imaizumi Y, Nakashima S, Kawakubo H, Kawai H, Kobayashi T, Ito R, Nakabayashi Y. Utility and challenges of ureteral visualization using a fluorescent ureteral catheter in high risk surgeries for colorectal cancer. Surg Endosc 2024; 38:6184-6192. [PMID: 39266754 DOI: 10.1007/s00464-024-11211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/19/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Ureteral injury occurs in 0.3-1.5% of colorectal cancer surgeries. Devices to visualize the ureteral course and avoid ureteral injury are required for minimally invasive surgery (MIS). The NIRC™ fluorescent ureteral catheter (FUC) is a versatile ureteral visualization device currently available in Japan that can be used in combination with a variety of laparoscopic and robotic systems. In this study, we examined the outcomes of high-risk patients who underwent colorectal cancer surgery with FUC insertion. METHODS One hundred forty-one patients who underwent MIS for colorectal cancer and colorectal cancer recurrence at our institute between January 2021 and May 2024 underwent preoperative FUC insertion because of the high risk of ureteral injury and surgical difficulty. For these patients, patient background data and short-term outcomes were examined. The results are expressed as the median and interquartile range. RESULTS Age, 70 [60-78]; M:F(n), 84:57; BMI, 22.1 [19.7-24.7]; T4 (TNM classification), 52 cases (36.9%); preoperative intestinal obstruction, 45 cases (31.9%); abscess formation, 30 cases (21%); surgical history, 70 cases (50%); recurrent cancer, 14 cases (9.9%); preoperative chemo-radiotherapy, 28 cases (19.9%); time required for FUC insertion, 12 [9-19] minutes; operation time, 412 [309-552] minutes; blood loss, 10 [5-30] ml; open conversion, 0 cases; postoperative hospitalization, 12 [9-17.5]; circumferential resection margins < 1 mm (rectal surgery), 4/87 cases (4.6%); comorbidities, 0 ureteral injury, 1 urethral injury during FUC insertion (0.7%) and 16 CD Grade 3 or higher cases (11%). CONCLUSIONS FUC may improve the safety of MIS and reduce blood loss in addition to preventing ureteral injury and is expected to have oncological advantages for ensuring the margin of the tumor without fear of ureteral injury. However, the time required for and complications associated with FUC are challenging. New methods for less invasive and easier ureteral visualization may be needed.
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Affiliation(s)
- Shunjin Ryu
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Yuta Imaizumi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Shunsuke Nakashima
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Hyuga Kawakubo
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Hironari Kawai
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Takehiro Kobayashi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Ryusuke Ito
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Yukio Nakabayashi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
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Khalid A, Anuff H, Woodhead S, Yeung TM. Assessment of the Quality of Patient-Oriented Internet Information on Fluorescence Imaging in Surgery. Surg Innov 2024; 31:394-399. [PMID: 38785116 DOI: 10.1177/15533506241256827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND In the digital age, patients are increasingly turning to the Internet to seek medical information to aid in their decision-making process before undergoing medical treatments. Fluorescence imaging is an emerging technological tool that holds promise in enhancing intra-operative decision-making during surgical procedures. This study aims to evaluate the quality of patient information available online regarding fluorescence imaging in surgery and assesses whether it adequately supports informed decision-making. METHOD The term "patient information on fluorescence imaging in surgery" was searched on Google. The websites that fulfilled the inclusion criteria were assessed using 2 scoring instruments. DISCERN was used to evaluate the reliability of consumer health information. QUEST was used to assess authorship, tone, conflict of interest and complementarity. RESULTS Out of the 50 websites identified from the initial search, 10 fulfilled the inclusion criteria. Only two of these websites were updated in the last two years. The definition of fluorescence imaging was stated in only 50% of the websites. Although all websites mentioned the benefits of fluorescence imaging, none mentioned potential risks. Assessment by DISCERN showed that 30% of the websites were rated low and 70% were rated moderate. With QUEST, the websites demonstrated an average score of 62.5%. CONCLUSION This study highlights the importance of providing patients with accurate and balanced information about medical technologies and procedures they may undergo. Fluorescence imaging in surgery is a promising technology that can potentially improve surgical outcomes. However, patients need to be well-informed about its benefits and limitations in order to make informed decisions about their healthcare.
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Affiliation(s)
- Aizaz Khalid
- Department of Colorectal Surgery, St Richard's Hospital, Chichester, Univeristy Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Heena Anuff
- Department of Colorectal Surgery, St Richard's Hospital, Chichester, Univeristy Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Sophie Woodhead
- Department of Colorectal Surgery, St Richard's Hospital, Chichester, Univeristy Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Trevor M Yeung
- Department of Colorectal Surgery, St Richard's Hospital, Chichester, Univeristy Hospitals Sussex NHS Foundation Trust, Worthing, UK
- Department of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Menezes SD, Rao T. Innovative ICG Application in Benign Gynaecological Surgery: Enhancing Safety and Precision. Case Rep Obstet Gynecol 2024; 2024:1642315. [PMID: 39105141 PMCID: PMC11300066 DOI: 10.1155/2024/1642315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/20/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024] Open
Abstract
In the context of increased adoption of minimally invasive surgery for benign gynaecological conditions, this study underscores the paramount importance of patient safety. We explored the efficacy of indocyanine green (ICG), a fluorescent dye, in enhancing the visualisation of critical anatomical structures during complex laparoscopic procedures. Our methods involved the direct administration of ICG into the ureters for precise identification and dissection, as well as an innovative vaginal application to delineate the rectovaginal plane in cases with distorted pelvic anatomy. The study presented two cases: a laparoscopic hysterectomy for a multifibroid uterus and a case of advanced endometriosis with rectal involvement. Results indicated that ICG use significantly improved real-time visualisation of the ureters and the rectovaginal plane, which facilitated the surgeries and reduced the cognitive load on surgeons. There were no intraoperative complications, and the postoperative phase showed positive patient outcomes. In conclusion, the application of ICG in these laparoscopic surgeries proved to be a beneficial adjunct, suggesting its potential for broader application in benign gynaecological surgeries. Future research is warranted to explore additional uses of ICG, with a focus on enhancing patient safety and surgical efficacy.
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Affiliation(s)
- Summer Deah Menezes
- Obstetrics and Gynaecology DepartmentLiverpool Hospital, Locked Bag 7103 Liverpool 2170, Sydney, NSW, Australia
- University of New South WalesSouth Western Sydney Clinical SchoolLiverpool Hospital, Level 2, Clinical Building, Locked Bag 7103 Liverpool 2170, Sydney, NSW, Australia
| | - Tanushree Rao
- Obstetrics and Gynaecology DepartmentLiverpool Hospital, Locked Bag 7103 Liverpool 2170, Sydney, NSW, Australia
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Shao R, Shen F, Soleymani majd H, Qin X, Yao D, Long Y, Wang H, Wei Y, Chang X. Initial experience of ureteric visualization using methylene blue during laparoscopy for gynecological surgery. Front Surg 2024; 11:1387038. [PMID: 39092154 PMCID: PMC11291209 DOI: 10.3389/fsurg.2024.1387038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024] Open
Abstract
Objectives Iatrogenic ureteral injury is a severe surgical complication, with a highest incidence of 1.5% in gynecological surgeries. The purpose of this report is to document our initial experience with using methylene blue (MB) to label the ureter in gynecological laparoscopic surgeries and to explore its effectiveness and safety. This is also a novel description of simultaneously visualizing ureteral MB fluorescence and sentinel lymph nodes (SLN's) Indocyanine Green (ICG) fluorescence using the same camera. Methods This study included patients undergoing gynecological laparoscopic surgeries, with the same surgeon performing all cases. During the early stages of each surgery, rapid intravenous infusion of MB was administered. For cases requiring SLN imaging, we also injected ICG solution into the cervix. Assessment of the included cases was conducted both intraoperatively and postoperatively. The group that had MB fluorescence (Group A) was compared to a control group that did not have it (Group B). Results A total of 25 patients (Group A) received MB during surgery, demonstrating 45 ureters clearly, with an imaging success rate of 90%. Continuous and clearer fluorescence imaging was achieved in cases with ureteral hydronephrosis. In most patients, ureteral fluorescence was visible 15-20 min after intravenous infusion of MB, and 64% still exhibited fluorescence at the end of the surgery. In patients who had both ICG and MB, dual fluorescence imaging was achieved clearly. Among the included cases, there were no iatrogenic ureteral injuries (0%), which we observed to be lower than in patients who did not receive MB (1.3%). The rate of adverse events was similar in both groups. Conclusion Using MB fluorescence is an effective and safe method of visualizing the ureters during gynecological surgeries, and can diminish iatrogenic ureteral injury without increased associated adverse events. It therefore may offer promising prospects for clinical application.
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Affiliation(s)
- Ruyu Shao
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Faquan Shen
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Hooman Soleymani majd
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Xiaoqing Qin
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Desheng Yao
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Ying Long
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - He Wang
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Yousheng Wei
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Xin Chang
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
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Khalafi S, Botero Fonnegra C, Reyes A, Hui VW. Developments in the Use of Indocyanine Green (ICG) Fluorescence in Colorectal Surgery. J Clin Med 2024; 13:4003. [PMID: 39064041 PMCID: PMC11276973 DOI: 10.3390/jcm13144003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/28/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
Indocyanine Green (ICG) has significantly advanced minimally invasive surgery. It is widely recognized for its ability to visualize blood vessel patency in real-time across various surgical specialties. While its primary use in colorectal surgery is to evaluate anastomoses for leaks, numerous other applications have been documented in the literature. In this review, we aim to explore both established and emerging applications of ICG fluorescence in colorectal surgery, with the goal of improving patient outcomes. This includes preoperative tumor marking and the detection of metastatic disease. Some applications, such as lymphatic mapping, require further research to determine their impact on clinical practices. Conversely, others, like the intraoperative localizations of ureters, necessitate additional procedures and are not yet widely accepted by the surgical community. However, the development of alternative compounds could offer better solutions. Future research should focus on areas like quantitative ICG and protocol standardization in prospective multicenter studies.
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Brollo PP, Puggioni A, Tumminelli F, Colangelo A, Biddau C, Cherchi V, Bresadola V. Preventing iatrogenic ureteral injury in colorectal surgery: a comprehensive and systematic review of the last 2 decades of literature and future perspectives. Surg Today 2024; 54:291-309. [PMID: 36593285 DOI: 10.1007/s00595-022-02639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
Iatrogenic ureteral injury (IUI) during colorectal surgery is a rare complication but related to a serious burden of morbidity. This comprehensive and systematic review aims to provide a critical overview of the most recent literature about IUI prevention techniques in colorectal surgery. We performed a comprehensive and systematic review of studies published from 2000 to 2022 and assessed the use of techniques for ureteral injury prevention and intraoperative localization. 26 publications were included, divided into stent-based (prophylactic/lighted ureteral stent and near-infrared fluorescent ureteral catheter [PUS/LUS/NIRFUC]) and fluorescent dye (FD) groups. Costs, the percentage and number of IUIs detected, reported limitations, complication rates and other outcome points were compared. The IUI incidence rate ranged from 0 to 1.9% (mean 0.5%) and 0 to 1.2% (mean 0.3%) in the PUS/LUS/NIRFUC and FD groups, respectively. The acute kidney injury (AKI) and urinary tact infection (UTI) incidence rate ranged from 0.4 to 32.6% and 0 to 17.3%, respectively, in the PUS/LUS/NIRFUC group and 0-15% and 0-6.3%, respectively, in the FD group. Many other complications were also compared and descriptively analyzed (length-of-stay, mortality, etc.). These techniques appear to be feasible and safe in select patients with a high risk of IUI, but the delineation of reliable guidelines for preventing IUI will require more randomized controlled trials.
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Affiliation(s)
- Pier Paolo Brollo
- General Surgical Oncology Department, IRCCS CRO di Aviano (Istituto Nazionale Tumori), Aviano, Italy.
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy.
| | - Alessandro Puggioni
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Francesco Tumminelli
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
- General Surgery Department, Hospital of Pordenone, Pordenone, Italy
| | - Antonio Colangelo
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
- General Surgery Department, Hospital of Pordenone, Pordenone, Italy
| | - Carlo Biddau
- General Surgery Department, Hospital of Pordenone, Pordenone, Italy
| | - Vittorio Cherchi
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Vittorio Bresadola
- General Surgery Department and Simulation Center, Department of Medicine, Academic Hospital of Udine, University of Udine, Udine, Italy
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8
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Souli A, Alves A, Tillou X, Menahem B. Iatrogenic ureteral injury: What should the digestive surgeon know? J Visc Surg 2024; 161:6-14. [PMID: 38242812 DOI: 10.1016/j.jviscsurg.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
PURPOSE OF THE STUDY Iatrogenic ureteral injury (IUI) is a rare but formidable complication of any abdominal or pelvic surgery. The aim of this study was to describe the epidemiology of IUI in colorectal surgery in the Basse-Normandie region over the period 2004-2022, as well as to review the literature on the management of this complication. MATERIALS AND METHODS This multicenter retrospective analysis of clinical data (medical records and operative reports) concerned 22 patients (13 men and 9 women) who suffered an IUI during colorectal surgery between 2004 and 2022. Ureteral resections for oncological purposes and endoluminal instrumental injuries (post-ureteroscopy) were excluded from the study. We also carried out a review of the literature concerning the incidence of IUI in colorectal surgery. RESULTS The incidence of IUI was 0.27% over the study period (22 ureteral injuries out of 8129 colorectal procedures). Colorectal cancer and sigmoid diverticulitis were the dominant surgical indications (85% of cases). Proctectomy and left colectomy were the most performed resection procedures (75% of cases). Surgery was scheduled in 68% of cases. The approach was open laparotomy in 59% and laparoscopy in 41% of cases. The IUI involved the left ureter in 63% of cases and the pelvic ureter in 77% of cases. Conservative endoscopic treatment by insertion of a double-J catheter stent had a success rate of 87.5%. Surgical repairs consisting of re-implantation techniques and uretero-ureteral anastomosis had a success rate of 75%. The nephrectomy rate was 13.6% (3/22) and the mortality rate 9% (2/22). A literature review identified sixteen studies, where the incidence of IUI varied from 0.1 to 4.5%. FINDINGS IUI occurring during colorectal surgery is a rare occurrence but remain a formidable complication. No means of prevention has proven its effectiveness to date, but guidance devices using illuminated ureteral catheters or dyes seem to constitute a promising approach. Injuries to the left pelvic ureter are the most common, and the majority can be treated endoscopically if diagnosed early.
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Affiliation(s)
- Abdelaziz Souli
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - Arnaud Alves
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; UNICAEN, Inserm, ANTICIPE, Normandie university, 14000 Caen, France
| | - Xavier Tillou
- Department of urology, university hospital of Caen, Caen, France
| | - Benjamin Menahem
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; UNICAEN, Inserm, ANTICIPE, Normandie university, 14000 Caen, France.
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de'Angelis N, Schena CA, Marchegiani F, Reitano E, De Simone B, Wong GYM, Martínez-Pérez A, Abu-Zidan FM, Agnoletti V, Aisoni F, Ammendola M, Ansaloni L, Bala M, Biffl W, Ceccarelli G, Ceresoli M, Chiara O, Chiarugi M, Cimbanassi S, Coccolini F, Coimbra R, Di Saverio S, Diana M, Dioguardi Burgio M, Fraga G, Gavriilidis P, Gurrado A, Inchingolo R, Ingels A, Ivatury R, Kashuk JL, Khan J, Kirkpatrick AW, Kim FJ, Kluger Y, Lakkis Z, Leppäniemi A, Maier RV, Memeo R, Moore EE, Ordoñez CA, Peitzman AB, Pellino G, Picetti E, Pikoulis M, Pisano M, Podda M, Romeo O, Rosa F, Tan E, Ten Broek RP, Testini M, Tian Wei Cheng BA, Weber D, Sacco E, Sartelli M, Tonsi A, Dal Moro F, Catena F. 2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery. World J Emerg Surg 2023; 18:45. [PMID: 37689688 PMCID: PMC10492308 DOI: 10.1186/s13017-023-00513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023] Open
Abstract
Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
- Faculty of Medicine, University of Paris Cité, Paris, France
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France.
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, Clichy, Paris, France
| | - Elisa Reitano
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Guastalla Hospital, AUSL-IRCCS Reggio, Emilia, Italy
| | - Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Aleix Martínez-Pérez
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Filippo Aisoni
- Department of Morphology, Surgery and Experimental Medicine, Università Degli Studi Di Ferrara, Ferrara, Italy
| | - Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Luca Ansaloni
- Department of General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Miklosh Bala
- Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Graziano Ceccarelli
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Italy
| | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Riverside, CA, USA
| | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | - Michele Diana
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Research Institute Against Digestive Cancer (IRCAD), 67000, Strasbourg, France
| | | | - Gustavo Fraga
- Department of Trauma and Acute Care Surgery, University of Campinas, Campinas, Brazil
| | - Paschalis Gavriilidis
- Department of HBP Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, F. Miulli Hospital, 70021, Acquaviva Delle Fonti, Italy
| | - Alexandre Ingels
- Department of Urology, Henri Mondor Hospital, University of Paris Est Créteil (UPEC), 94000, Créteil, France
| | - Rao Ivatury
- Professor Emeritus, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeffry L Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jim Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, University of Portsmouth, Southwick Hill Road, Cosham, Portsmouth, UK
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, EG23T2N 2T9, Canada
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology - Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ronald V Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Bari, Italy
| | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Carlos A Ordoñez
- Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gianluca Pellino
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Manos Pikoulis
- 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Michele Pisano
- 1st General Surgery Unit, Department of Emergency, ASST Papa Giovanni Hospital Bergamo, Bergamo, Italy
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | | | - Fausto Rosa
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | | | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Emilio Sacco
- Department of Urology, Università Cattolica del Sacro Cuore Di Roma, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Alfredo Tonsi
- Digestive Diseases Department, Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy.
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10
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Heuvelings DJI, Al-Difaie Z, Scheepers MHMC, Okamoto N, Diana M, Stassen LPS, Bouvy ND, Al-Taher M. Simultaneous fluorescence imaging of bowel perfusion and ureter delineation using methylene blue: a demonstration in a porcine model. Surg Endosc 2023; 37:6779-6790. [PMID: 37253870 PMCID: PMC10462514 DOI: 10.1007/s00464-023-10142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Intraoperative near-infrared fluorescence imaging (NIRF) with preoperative optical dye administration is a promising technique for quick and easy intraoperative visualization of the ureter and for an improved, real-time assessment of intestinal perfusion. During colorectal surgery, there is a need for simultaneous non-invasive ureteral imaging and bowel perfusion assessment, using one single camera system. The purpose of this study is to investigate the feasibility of simultaneous intestinal perfusion and ureteral imaging using a single commercially available NIRF imaging system. METHODS Six Landrace pigs underwent laparotomy under general anesthesia in this experiment. An intravenous (IV) dose of 0.2 mg/kg indocyanine green (ICG) was given to assess bowel perfusion. Two pairs received a methylene blue (MB) iv injection of 0.75, 0.50 or 0.25 mg/kg respectively to investigate ureteral visualization. Quest Spectrum Fluorescence Camera (Quest Medical Imaging, Middenmeer, The Netherlands) was used for NIRF imaging. RESULTS Ureter visualization and bowel perfusion under NIRF imaging was achieved in all animals. All ureters were visible after five to ten minutes and remained clearly visible until the end of every experiment (120-420 min). A mixed model analysis did not show any significant differences neither between the three groups nor over time. Importantly, we demonstrated that bowel perfusion could be visualized with methylene blue (MB) as well. We observed no interference between ICG and MB and a faster washout of MB. CONCLUSION We successfully demonstrated simultaneous fluorescence angiography with ICG and ureteral imaging with MB in the same surgical procedure, with the same commercially available NIRF imaging equipment. More importantly, we showed that the use MB is adequate for bowel perfusion assessment and ureter visualization with this NIRF imaging system. Besides, MB showed an earlier washout time, which can be clinical beneficial as a repeated dye injection may be necessary during a surgical procedure.
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Affiliation(s)
- Danique J I Heuvelings
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Max H M C Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nariaki Okamoto
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Laurents P S Stassen
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nicole D Bouvy
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mahdi Al-Taher
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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11
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Teranishi K. Evaluation of the Utilization of Near-Infrared Fluorescent Contrast Agent ASP5354 for In Vivo Ureteral Identification in Renal Diseases Using Rat Models of Gentamicin-Induced Acute Kidney Injury. Diagnostics (Basel) 2023; 13:diagnostics13101823. [PMID: 37238307 DOI: 10.3390/diagnostics13101823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023] Open
Abstract
ASP5354 was recently developed as a near-infrared fluorescence (NIRF) contrast agent for intraoperative ureteral identification, and its use has been evaluated in healthy animals. However, the utilization of ASP5354 for ureteral identification has not been evaluated in animals with renal injury. In this study, we assessed the application of ASP5354 for ureteral imaging using rat models of gentamicin-induced mild, moderate, and severe acute kidney injury (AKI), using a clinically available NIRF detection system. NIRF was detected in the abdominal cavity and ureters after laparotomy, and the efficiency of ASP5354 was evaluated based on the NIRF signal intensity over 60 min. After the intravenous injection of ASP5354 into rats with mild or moderate AKI, the ureters were clearly imaged at a high ratio of NIRF intensity in the ureter to that in the tissues around the ureter. Six days after intravenous injection, the use of ASP5354 in rats with moderate AKI did not affect the biochemical kidney functions or histopathological conditions of the kidney tissues, as compared to those with no injection of ASP5354. In rats with severe AKI, ureteral imaging was not effective due to the relatively strong NIRF expression in the tissues around the ureters. These data indicate that ASP5354 holds potential as a contrast agent for intraoperative ureteral identification in patients with limited renal injury.
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Affiliation(s)
- Katsunori Teranishi
- Graduate School of Bioresources, Mie University, 1577 Kurimamachiya, Tsu 514-8507, Japan
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12
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Sutton PA, van Dam MA, Cahill RA, Mieog S, Polom K, Vahrmeijer AL, van der Vorst J. Fluorescence-guided surgery: comprehensive review. BJS Open 2023; 7:7162090. [PMID: 37183598 PMCID: PMC10183714 DOI: 10.1093/bjsopen/zrad049] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Despite significant improvements in preoperative workup and surgical planning, surgeons often rely on their eyes and hands during surgery. Although this can be sufficient in some patients, intraoperative guidance is highly desirable. Near-infrared fluorescence has been advocated as a potential technique to guide surgeons during surgery. METHODS A literature search was conducted to identify relevant articles for fluorescence-guided surgery. The literature search was performed using Medical Subject Headings on PubMed for articles in English until November 2022 and a narrative review undertaken. RESULTS The use of invisible light, enabling real-time imaging, superior penetration depth, and the possibility to use targeted imaging agents, makes this optical imaging technique increasingly popular. Four main indications are described in this review: tissue perfusion, lymph node assessment, anatomy of vital structures, and tumour tissue imaging. Furthermore, this review provides an overview of future opportunities in the field of fluorescence-guided surgery. CONCLUSION Fluorescence-guided surgery has proven to be a widely innovative technique applicable in many fields of surgery. The potential indications for its use are diverse and can be combined. The big challenge for the future will be in bringing experimental fluorophores and conjugates through trials and into clinical practice, as well as validation of computer visualization with large data sets. This will require collaborative surgical groups focusing on utility, efficacy, and outcomes for these techniques.
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Affiliation(s)
- Paul A Sutton
- The Colorectal and Peritoneal Oncology Centre, Christie Hospital, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Martijn A van Dam
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ronan A Cahill
- RAC, UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
- RAC, Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sven Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Karol Polom
- Clinic of Oncological, Transplantation and General Surgery, Gdansk Medical University, Gdansk, Poland
| | | | - Joost van der Vorst
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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13
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Okamoto N, Al-Difaie Z, Scheepers MHMC, Heuvelings DJI, Rodríguez-Luna MR, Marescaux J, Diana M, Stassen LPS, Bouvy ND, Al-Taher M. Simultaneous, Multi-Channel, Near-Infrared Fluorescence Visualization of Mesenteric Lymph Nodes Using Indocyanine Green and Methylene Blue: A Demonstration in a Porcine Model. Diagnostics (Basel) 2023; 13:1469. [PMID: 37189570 PMCID: PMC10137483 DOI: 10.3390/diagnostics13081469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Near-infrared fluorescence (NIRF) image-guided surgery is a useful tool that can help reduce perioperative complications and improve tissue recognition. Indocyanine green (ICG) dye is the most frequently used in clinical studies. ICG NIRF imaging has been used for lymph node identification. However, there are still many challenges in lymph node identification by ICG. There is increasing evidence that methylene blue (MB), another clinically applicable fluorescent dye, can also be useful in the intraoperative fluorescence-guided identification of structures and tissues. We hypothesized that MB NIRF imaging could be used for lymph node identification. The aim of this study was to evaluate the feasibility of intraoperative lymph node fluorescence detection using intravenously (IV) administered MB and compare it to ICG via a camera that has two dedicated near-infrared (NIR) channels. Three pigs were used in this study. ICG (0.2 mg/kg) was administered via a peripheral venous catheter followed by immediate administration of MB (0.25 mg/kg). NIRF images were acquired as video recordings at different time points (every 10 min) over an hour using the QUEST SPECTRUM® 3 system (Quest Medical Imaging, Middenmeer, The Netherlands), which has two dedicated NIR channels for simultaneous intraoperative fluorescence guidance. The 800 nm channel was used to capture ICG fluorescence and the 700 nm channel was used for MB. The target (lymph nodes and small bowel) and the background (vessels-free field of the mesentery) were highlighted as the regions of interest (ROIs), and corresponding fluorescence intensities (FI) from these ROIs were measured. The target-to-background ratio (TBR) was then computed as the mean FI of the target minus the mean FI of the background divided by the mean FI of the background. In all included animals, a clear identification of lymph nodes was achieved at all time points. The mean TBR of ICG in lymph nodes and small bowel was 4.57 ± 1.00 and 4.37 ± 1.70, respectively for the overall experimental time. Regarding MB, the mean TBR in lymph nodes and small bowel was 4.60 ± 0.92 and 3.27 ± 0.62, respectively. The Mann-Whitney U test of the lymph node TBR/small bowel TBR showed that the TBR ratio of MB was statistically significantly higher than ICG. The fluorescence optical imaging technology used allows for double-wavelength assessment. This feasibility study proves that lymph nodes can be discriminated using two different fluorophores (MB and ICG) with different wavelengths. The results suggest that MB has a promising potential to be used to detect lymphatic tissue during image-guided surgery. Further preclinical trials are needed before clinical translation.
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Affiliation(s)
- Nariaki Okamoto
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Max H. M. C. Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Danique J. I. Heuvelings
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - María Rita Rodríguez-Luna
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Jacques Marescaux
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Laurents P. S. Stassen
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Nicole D. Bouvy
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Mahdi Al-Taher
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg, France
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
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14
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Abdelhamid HN. Dye encapsulation and one-pot synthesis of microporous-mesoporous zeolitic imidazolate frameworks for CO 2 sorption and adenosine triphosphate biosensing. Dalton Trans 2023; 52:2506-2517. [PMID: 36734459 DOI: 10.1039/d2dt04084k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
One-pot co-precipitation of target molecules e.g. organic dyes and the synthesis of a crystal containing microporous-mesoporous regimes of zeolitic imidazolate frameworks-8 (ZIF-8) are reported. The synthesis method can be used for cationic (rhodamine B (RhB), methylene blue (MB)), and anionic (methyl blue (MeB)) dyes. The crystal growth of the ZIF-8 crystals takes place via an intermediate phase of zinc hydroxyl nitrate (Zn5(OH)8(NO3)2) nanosheets that enabled the adsorption of the target molecules i.e., RhB, MB, and MeB into their layers. The dye molecules play a role during crystal formation. The successful encapsulation of the dye molecules was proved via diffuse reflectance spectroscopy (DRS) and electrochemical measurements e.g., cyclic voltammetry (CV), linear sweep voltammetry (LSV), and electrochemical impedance spectroscopy (EIS). The materials were investigated for carbon dioxide (CO2) adsorption and adenosine triphosphate (ATP) biosensing. ZIF-8, RhB@ZIF-8, MB@ZIF-8, and MeB@ZIF-8 offered CO2 adsorption capacities of 0.80, 0.84, 0.85, and 0.53 mmol g-1, respectively. The encapsulated cationic molecules improved the adsorption performance compared to anionic molecules inside the crystal. The materials were also tested as a fluorescent probe for ATP biosensing. The simple synthesis procedure offered new materials with tunable surface properties and the potential for multi-functional applications.
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Affiliation(s)
- Hani Nasser Abdelhamid
- Department of Materials and Environmental Chemistry, Stockholm University, SE-10691 Stockholm, Sweden. .,Nano-Biomedical Diagnostics Laboratory, Assiut University, Assiut, 71516, Egypt.,Nanotechnology Research Centre (NTRC), The British University in Egypt, El-Shorouk City, Suez Desert Road, P.O. Box 43, Cairo, 11837, Egypt
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15
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Prevention of ureteral injury during laparoscopic colorectal cancer surgery with horseshoe kidney using fluorescent ureteral catheters: a case report. Surg Case Rep 2023; 9:22. [PMID: 36781828 PMCID: PMC9925626 DOI: 10.1186/s40792-023-01604-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Horseshoe kidney is one of the most common congenital renal fusion anomalies and is characterized by abnormalities in the position, rotation, vascular supply, and ureteral anatomy of the kidney. When performing surgery for colorectal cancer in patients with horseshoe kidneys, anatomical identification is important to avoid organ injuries. Several reports on surgery for colorectal cancer with horseshoe kidneys have described the usefulness of three-dimensional (3D) computed tomography (CT) angiography for detecting abnormalities in vascular supply. However, few reports have focused on the prevention of ureteral injury in surgery for colorectal cancer with horseshoe kidney, despite abnormalities in the ureteral anatomy. Here, we report a case in which laparoscopic sigmoid colon resection for sigmoid colon cancer with a horseshoe kidney was safely performed using fluorescent ureteral catheters. CASE PRESENTATION A 60-year-old Japanese man presented to our hospital testing positive for fecal occult blood. Colonoscopy revealed sigmoid colon cancer, and CT confirmed a horseshoe kidney. The 3D-CT angiography showed aberrant renal arteries from the aorta and right common iliac artery, and the left ureter passed across the front of the renal isthmus. A fluorescent ureteral catheter was placed in the left ureter before the surgery to prevent ureteral injury. Laparoscopic sigmoid colon resection with D3 lymph node dissection was performed. The fluorescent ureteral catheter enabled the identification of the left ureter that passed across the front of the renal isthmus and the safe mobilization of the descending and sigmoid colon from the retroperitoneum. The operative time was 214 min, with intraoperative bleeding of 25 mL. The patient's postoperative course was good: no complications arose and she was discharged on the seventh postoperative day. CONCLUSION In patients with horseshoe kidney, the use of fluorescent ureteral catheters and 3D-CT angiography enables safer laparoscopic surgery for colorectal cancer. We recommend the placement of fluorescent ureteral catheters in such surgeries to prevent ureteral injury.
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16
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Ishizawa T, McCulloch P, Stassen L, van den Bos J, Regimbeau JM, Dembinski J, Schneider-Koriath S, Boni L, Aoki T, Nishino H, Hasegawa K, Sekine Y, Chen-Yoshikawa T, Yeung T, Berber E, Kahramangil B, Bouvet M, Diana M, Kokudo N, Dip F, White K, Rosenthal RJ. Assessing the development status of intraoperative fluorescence imaging for anatomy visualisation, using the IDEAL framework. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 4:e000156. [DOI: 10.1136/bmjsit-2022-000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
Abstract
ObjectivesIntraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: visualising anatomy, assessing tissue perfusion, identifying/localising cancer and mapping lymphatic systems. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging used to visualise anatomical structures using the IDEAL framework, a framework designed to describe the stages of innovation in surgery and other interventional procedures.DesignIDEAL staging based on a thorough literature review.SettingAll publications on intraoperative fluorescence imaging for visualising anatomical structures reported in PubMed through 2020 were identified for five surgical procedures: cholangiography, hepatic segmentation, lung segmentation, ureterography and parathyroid identification.Main outcome measuresThe IDEAL stage of research evidence was determined for each of the five procedures using a previously described approach.Results225 articles (8427 cases) were selected for analysis. Current status of research evidence on fluorescence imaging was rated IDEAL stage 2a for ureterography and lung segmentation, IDEAL 2b for hepatic segmentation and IDEAL stage 3 for cholangiography and parathyroid identification. Enhanced tissue identification rates using fluorescence imaging relative to conventional white-light imaging have been documented for all five procedures by comparative studies including randomised controlled trials for cholangiography and parathyroid identification. Advantages of anatomy visualisation with fluorescence imaging for improving short-term and long-term postoperative outcomes also were demonstrated, especially for hepatobiliary surgery and (para)thyroidectomy. No adverse reactions associated with fluorescent agents were reported.ConclusionsIntraoperative fluorescence imaging can be used safely to enhance the identification of anatomical structures, which may lead to improved postoperative outcomes. Overviewing current research knowledge using the IDEAL framework aids in designing further studies to develop fluorescence imaging techniques into an essential intraoperative navigation tool in each surgical field.
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17
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Okamoto N, Rodríguez-Luna MR, Bencteux V, Al-Taher M, Cinelli L, Felli E, Urade T, Nkusi R, Mutter D, Marescaux J, Hostettler A, Collins T, Diana M. Computer-Assisted Differentiation between Colon-Mesocolon and Retroperitoneum Using Hyperspectral Imaging (HSI) Technology. Diagnostics (Basel) 2022; 12:2225. [PMID: 36140626 PMCID: PMC9497769 DOI: 10.3390/diagnostics12092225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 12/01/2022] Open
Abstract
Complete mesocolic excision (CME), which involves the adequate resection of the tumor-bearing colonic segment with "en bloc" removal of its mesocolon along embryological fascial planes is associated with superior oncological outcomes. However, CME presents a higher complication rate compared to non-CME resections due to a higher risk of vascular injury. Hyperspectral imaging (HSI) is a contrast-free optical imaging technology, which facilitates the quantitative imaging of physiological tissue parameters and the visualization of anatomical structures. This study evaluates the accuracy of HSI combined with deep learning (DL) to differentiate the colon and its mesenteric tissue from retroperitoneal tissue. In an animal study including 20 pig models, intraoperative hyperspectral images of the sigmoid colon, sigmoid mesentery, and retroperitoneum were recorded. A convolutional neural network (CNN) was trained to distinguish the two tissue classes using HSI data, validated with a leave-one-out cross-validation process. The overall recognition sensitivity of the tissues to be preserved (retroperitoneum) and the tissues to be resected (colon and mesentery) was 79.0 ± 21.0% and 86.0 ± 16.0%, respectively. Automatic classification based on HSI and CNNs is a promising tool to automatically, non-invasively, and objectively differentiate the colon and its mesentery from retroperitoneal tissue.
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Affiliation(s)
- Nariaki Okamoto
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - María Rita Rodríguez-Luna
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Valentin Bencteux
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
| | - Mahdi Al-Taher
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Department of Surgery, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Lorenzo Cinelli
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Department of Gastrointestinal Surgery, San Raffaele Hospital IRCCS, 20132 Milan, Italy
| | - Eric Felli
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
| | - Takeshi Urade
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe 6500017, Japan
| | - Richard Nkusi
- Research Institute against Digestive Cancer (IRCAD), Kigali, Rwanda
| | - Didier Mutter
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, 67091 Strasbourg, France
- IHU-Strasbourg—Institut de Chirurgie Guidée par L’image, 67091 Strasbourg, France
| | - Jacques Marescaux
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
| | - Alexandre Hostettler
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Research Institute against Digestive Cancer (IRCAD), Kigali, Rwanda
| | - Toby Collins
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- Research Institute against Digestive Cancer (IRCAD), Kigali, Rwanda
| | - Michele Diana
- Research Institute against Digestive Cancer (IRCAD), 67091 Strasbourg, France
- ICube Laboratory, Photonics Instrumentation for Health, 67081 Strasbourg, France
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18
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Cwalinski T, Skokowski J, Polom W, Marano L, Swierblewski M, Drucis K, Roviello G, Cwalina N, Kalinowski L, Roviello F, Polom K. Fluorescence Imaging Using Methylene Blue Sentinel Lymph Node Biopsy in Melanoma. Surg Innov 2022; 29:503-510. [PMID: 35225083 DOI: 10.1177/15533506221074601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Abstract
INTRODUCTION Fluorescence imaging of sentinel node biopsy in melanoma is a novel method. Both indocyanine green (ICG) and methylene blue (MB) have fluorescent properties. The aim of this study was to present, for the first time in a clinical series of patients, the possible usage of MB as a fluorescent dye for sentinel node biopsy during surgery for melanoma. MATERIAL AND METHODS Twenty patients with skin melanoma, who were candidates for sentinel node biopsy were enrolled in our study. All patients underwent simultaneous use of standard nanocolloid and blue dye. Transcutaneous visualization of the sentinel node, visualization of lymphatic channels as well as sentinel node fluorescent visualization were all measured. We also performed calculations of Signal to Background ratios (SBR). RESULTS In 15% (3/20) of patients, the fluorescent sentinel node was visible through the skin. The median SBR for the sentinel node visualization by fluorescence was 3.15 (range, 2.7-3.5). Lymphatic channels were visible in lymphatic tissue via fluorescence before visualization by the naked eye in 4 patients (20%). The median SBR ratio was 3.69 (range, 2.7-4.2). Sentinel nodes were visible by fluorescence in 13 cases (65%). The median SBR ratio was 2.49 (range, 1.5-5.7). No factors were found to be associated with fluorescent MB visualization of a sentinel node during biopsy. CONCLUSION This is the first clinical study presenting the usefulness of fluorescent sentinel node biopsy in melanoma patients using MB as a fluorophore. Further studies are necessary to provide methods for its' clinical implementation.
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Affiliation(s)
- Tomasz Cwalinski
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Jarosław Skokowski
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
- Department of Medical Laboratory Diagnostics-Biobank, 37804Medical University of Gdańsk, Gdańsk, Poland
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.PL), Gdańsk, Poland
| | - Wojciech Polom
- Department of Urology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, 9313University of Siena, Siena, Italy
| | - Maciej Swierblewski
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Kamil Drucis
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | | | - Natalia Cwalina
- Department of Pediatrics, 553832Ascension St. John Children's Hospital, Detroit, MI, USA
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics-Biobank, 37804Medical University of Gdańsk, Gdańsk, Poland
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.PL), Gdańsk, Poland
- Department of Mechanics of Materials and Structures, Gdańsk University of Technology, Gdansk, Poland
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, 9313University of Siena, Siena, Italy
| | - Karol Polom
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
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Kitagawa T, Ryu S, Okamoto A, Marukuchi R, Hara K, Ito R, Nakabayashi Y. Fluorescent ureteral catheters in laparoscopic surgery for rectal cancer with invasion of the uterus: A case report. Ann Med Surg (Lond) 2022; 79:104114. [PMID: 35860125 PMCID: PMC9289508 DOI: 10.1016/j.amsu.2022.104114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Resection of the uterus is required in some cases of colorectal cancer with invasion of the uterus. Localisation of the ureters to prevent ureteral injuries is important during resection of advanced colorectal cancer and combined resection of the uterus. Case presentation We report a case of a woman in her 80s with rectal cancer with invasion of the uterus. She presented with appetite loss and lower abdominal pain. She was hospitalised after being diagnosed with intestinal obstruction due to rectal cancer. Colonoscopy revealed a tumor involving 100% of the circumference of the rectosigmoid colon, and imaging showed rectal cancer with invasion of the uterus and a giant uterine fibroid. Fluorescent ureteral catheters were placed bilaterally under cystoscopy, and laparoscopic anterior rectal resection, combined hysterectomy, and bilateral adnexectomy were performed 1 day later. Near-infrared visualisation of these catheters enabled safe release of the surrounding tissues from the uterus. Clinical discussion Surgical treatment of rectal cancer with invasion of the uterus is not standardised and requires more complicated procedures, which are associated with a high risk of ureteral injury. Fluorescent ureteral catheters allow visualisation of the course of the ureters without releasing them, thereby enabling safe surgery. Conclusion In fluorescence-guided surgery for rectal cancer, fluorescent ureteral catheters are particularly useful in patients with suspected invasion of other organs.
•T4b rectal cancer has higher risk of ureteral injury. •Fluorescent ureteral catheter is visualised clearly via near-infrared light. •Fluorescent ureteral catheter can be useful during surgery for T4b rectal cancer.
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20
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Yeung TM, Apte SS, Behrenbruch CC, Warrier SK, Heriot AG. Fluorescent imaging in colorectal surgery: an essential component of care? ANZ J Surg 2022; 92:1600-1601. [PMID: 35950669 DOI: 10.1111/ans.17790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Trevor M Yeung
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sameer S Apte
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Corina C Behrenbruch
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Satish K Warrier
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- Department of Colorectal Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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21
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Budner O, Cwalinski T, Skokowski J, Marano L, Resca L, Cwalina N, Kalinowski L, Hoveling R, Roviello F, Polom K. Methylene Blue Near-Infrared Fluorescence Imaging in Breast Cancer Sentinel Node Biopsy. Cancers (Basel) 2022; 14:1817. [PMID: 35406588 PMCID: PMC8997777 DOI: 10.3390/cancers14071817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Fluorescence-based navigation for breast cancer sentinel node biopsy is a novel method that uses indocyanine green as a fluorophore. However, methylene blue (MB) also has some fluorescent properties. This study is the first in a clinical series presenting the possible use of MB as a fluorescent dye for the identification of sentinel nodes in breast sentinel node biopsy. MATERIAL AND METHODS Forty-nine patients with breast cancer who underwent sentinel node biopsy procedures were enrolled in the study. All patients underwent standard simultaneous injection of nanocolloid and MB. We visualized and assessed the sentinel nodes and the lymphatic channels transcutaneously, with and without fluorescence, and calculated the signal-to-background ratio (SBR). We also analyzed the corresponding fluorescence intensity of various dilutions of MB. RESULTS In twenty-three patients (46.9%), the location of the sentinel node, or the end of the lymphatic path, was visible transcutaneously. The median SBR for transcutaneous sentinel node location was 1.69 (range 1.66-4.35). Lymphatic channels were visible under fluorescence in 14 patients (28.6%) prior to visualization by the naked eye, with an average SBR of 2.01 (range 1.14-5.6). The sentinel node was visible under fluorescence in 25 patients (51%). The median SBR for sentinel node visualization with MB fluorescence was 2.54 (range 1.34-6.86). Sentinel nodes were visualized faster under fluorescence during sentinel node preparation. Factors associated with the rate of visualization included diabetes (p = 0.001), neoadjuvant chemotherapy (p = 0.003), and multifocality (p = 0.004). The best fluorescence was obtained using 40 μM (0.0128 mg/mL) MB, but we also observed a clinically relevant dilution range between 20 μM (0.0064 mg/mL) and 100 μM (0.032 mg/mL). CONCLUSIONS For the first time, we propose the clinical usage of MB as a fluorophore for fluorescence-guided sentinel node biopsy in breast cancer patients. The quenching effect of the dye may be the reason for its poor detection rate. Our analysis of different concentrations of MB suggests a need for a detailed clinical analysis to highlight the practical usefulness of the dye.
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Affiliation(s)
- Oliver Budner
- Frauenheilkunde und Geburtshilfe, HELIOS Kliniken Schwerin, Wissmarsche Street 393-397, 19-055 Schwerin, Germany;
| | - Tomasz Cwalinski
- Department of Surgical Oncology, Faculty of Medicine, Medical University of Gdansk, Marii Sklodowskiej-Curie Street 3a, 80-217 Gdansk, Poland; (T.C.); (J.S.)
| | - Jarosław Skokowski
- Department of Surgical Oncology, Faculty of Medicine, Medical University of Gdansk, Marii Sklodowskiej-Curie Street 3a, 80-217 Gdansk, Poland; (T.C.); (J.S.)
- Department of Medical Laboratory Diagnostics–Biobank Fahrenheit BBMRI.pl, Medical University of Gdansk, Debinki Street 7, 80-211 Gdańsk, Poland;
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.pl), 80-210 Gdańsk, Poland
| | - Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci 16, 53-100 Siena, Italy; (L.M.); (L.R.); (F.R.)
| | - Luca Resca
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci 16, 53-100 Siena, Italy; (L.M.); (L.R.); (F.R.)
| | - Natalia Cwalina
- Department of Pediatrics Ascension, St. John Children’s Hospital, Detroit, MI 48236, USA;
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics–Biobank Fahrenheit BBMRI.pl, Medical University of Gdansk, Debinki Street 7, 80-211 Gdańsk, Poland;
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.pl), 80-210 Gdańsk, Poland
- BioTechMed/Department of Mechanics of Materials and Structures, Gdansk University of Technology, Gabriela Narutowicza Street 11/12, 80-233 Gdansk, Poland
| | - Richelle Hoveling
- Quest Medical Imagining, Industrieweg 41, 1775 PW Middenmeer, The Netherlands;
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci 16, 53-100 Siena, Italy; (L.M.); (L.R.); (F.R.)
| | - Karol Polom
- Department of Surgical Oncology, Faculty of Medicine, Medical University of Gdansk, Marii Sklodowskiej-Curie Street 3a, 80-217 Gdansk, Poland; (T.C.); (J.S.)
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22
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Daniluk P, Mazur N, Swierblewski M, Chand M, Diana M, Polom K. Fluorescence Imaging in Colorectal Surgery: An Updated Review and Future Trends. Surg Innov 2022; 29:479-487. [PMID: 35232304 DOI: 10.1177/15533506211072678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fluorescence imaging in colorectal surgery is considered a novel predominantly intraoperative method of ensuring a greater surgical success. The use of fluorescence is linked to advanced tumor visualization and projection of its lymphatics, both vessels and nodes, which results in a higher chance of achieving a total excision. Additionally, iatrogenic complications prove to be reduced using fluorescence during the surgical excision. The combination of fluorescence and artificial intelligence to better facilitate oncological surgery will soon become an established approach in operating rooms worldwide.
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Affiliation(s)
- Paulina Daniluk
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Natalia Mazur
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Maciej Swierblewski
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
| | - Manish Chand
- Department of Surgery and Interventional Sciences, GENIE Centre, 4919University College London, University College London Hospitals, NHS Trust, London, UK
| | - Michele Diana
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Karol Polom
- Department of Surgical Oncology, 37804Medical University of Gdansk, Gdansk, Poland
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23
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Image Navigation Surgery With the Fluorescent Ureteral Catheter of Recurrent Tumors in the Pelvic Cavity. Dis Colon Rectum 2022; 65:e72-e76. [PMID: 34990431 DOI: 10.1097/dcr.0000000000002144] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Ureteral injury during pelvic surgery is a serious complication that requires special attention. The fluorescent ureteral catheter near-infrared ray catheter sets are 6.0F catheters containing fluorescent substances along their length that can be recognized by a laparoscopic indocyanine green camera. We present our experience using a near-infrared ray catheter in 6 consecutive patients who underwent surgery for recurrent pelvic tumors. TECHNIQUE The near-infrared ray catheters were inserted into the bilateral ureters in all patients, with the exception of patient 5 (left unilateral), by urologists using a cystoscope with the same technique as that commonly used in placing ureteral stents under general anesthesia. A laparoscopic indocyanine green camera was adapted to identify the ureters. From February 2020 to July 2020, 6 consecutive patients with recurrent pelvic tumors underwent surgery using a near-infrared ray catheter. In 3 patients, recurrent tumors were detected in the pelvic cavity after surgery for colon cancer (1 patient each of peritoneal recurrence behind the seminal vesicles, lymph node metastasis on the residual superior rectal artery, and peritoneal recurrence at the peritoneal reflection). Two patients had postoperative local recurrences of rectal cancer. The last patient had a recurrence of cervical carcinoma invading the rectum. RESULTS All patients underwent surgery under ureteral image navigation using near-infrared ray catheter not only for ureter preservation during the operation (4 patients) but also for the combined resection of the ureter with recurrent tumors (2 patients). One patient experienced postoperative ureteral stenosis on postoperative day 21 that required a ureteral double J-stent placement in the left ureter. CONCLUSION Near-infrared ray catheter has the potential to reduce inadvertent periureteral dissection because the ureter can be identified before approaching it.
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Multispectral Imaging Using Fluorescent Properties of Indocyanine Green and Methylene Blue in Colorectal Surgery-Initial Experience. J Clin Med 2022; 11:jcm11020368. [PMID: 35054062 PMCID: PMC8778329 DOI: 10.3390/jcm11020368] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/14/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction: Image-guided surgery is becoming a new tool in colorectal surgery. Intraoperative visualisation of different structures using fluorophores helps during various steps of operations. In our report, we used two fluorophores—indocyanine green (ICG), and methylene blue (MB)—during different steps of colorectal surgery, using one camera system for two separate near-infrared wavelengths. Material and methods: Twelve patients who underwent complex open or laparoscopic colorectal surgeries were enrolled. Intravenous injections of MB and ICG at different time points were administered. Visualisation of intraoperative ureter position and fluorescent angiography for optimal anastomosis was performed. A retrospective analysis of patients treated in our departments during 2020 was performed, and data about ureter injury and anastomotic site complications were collected. Results: Intraoperative localisation of ureters with MB under fluorescent light was possible in 11 patients. The mean signal-to-background ratio was 1.58 ± 0.71. Fluorescent angiography before performing anastomosis using ICG was successful in all 12 patients, and none required a change in position of the planned colon resection for anastomosis. The median signal-to-background ratios was 1.25 (IQR: 1.22–1.89). Across both centres, iatrogenic injury of the ureter was found in 0.4% of cases, and complications associated with anastomosis was found in 5.5% of cases. Conclusions: Our study showed a substantial opportunity for using two different fluorophores in colorectal surgery, whereby the visualisation of one will not change the possible quantification analysis of the other. Using two separate dyes during one procedure may help in optimisation of the fluorescent properties of both dyes when using them for different applications. Visualisation of different structures by different fluorophores seems to be the future of image-guided surgery, and shows progress in optical technologies used in image-guided surgery.
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25
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Fluorescence Molecular Targeting of Colon Cancer to Visualize the Invisible. Cells 2022; 11:cells11020249. [PMID: 35053365 PMCID: PMC8773892 DOI: 10.3390/cells11020249] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/28/2021] [Accepted: 01/07/2022] [Indexed: 02/04/2023] Open
Abstract
Colorectal cancer (CRC) is a common cause of cancer and cancer-related death. Surgery is the only curative modality. Fluorescence-enhanced visualization of CRC with targeted fluorescent probes that can delineate boundaries and target tumor-specific biomarkers can increase rates of curative resection. Approaches to enhancing visualization of the tumor-to-normal tissue interface are active areas of investigation. Nonspecific dyes are the most-used approach, but tumor-specific targeting agents are progressing in clinical trials. The present narrative review describes the principles of fluorescence targeting of CRC for diagnosis and fluorescence-guided surgery with molecular biomarkers for preclinical or clinical evaluation.
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Tsukamoto S, Kuchiba A, Moritani K, Shida D, Katayama H, Yorikane E, Kanemitsu Y. Laparoscopic surgery using 8 K ultra-high-definition technology: Outcomes of a phase II study. Asian J Endosc Surg 2022; 15:7-14. [PMID: 33881224 DOI: 10.1111/ases.12943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/25/2021] [Accepted: 04/10/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Currently, laparoscopic surgery generally relies on 2 K high-definition image quality. The National Cancer Center Hospital, Olympus Corporation, and NHK Engineering System Inc. recently developed a new laparoscopic system with an 8 K ultra-high-definition (UHD) camera that provides images with a high-resolution, wide color range, high frame rate, and high dynamic range. This study aimed to investigate the effectiveness and safety of a new laparoscopic system which uses an 8 K UHD camera system (8K UHD system). METHODS This phase II study enrolled 23 patients with colon or rectosigmoid cancer who were indicated for radical resection with laparoscopic colectomy using the 8 K UHD system. The primary endpoint was the proportion of patients with ≥30 mL of intraoperative blood loss. RESULTS Of the 23 patients, 22 completed laparoscopic surgery with the 8 K UHD system. One patient was converted to the 2 K high-definition laparoscopic system due to technical difficulties with the 8 K UHD system during surgery. The median amount of intraoperative blood loss was 14 mL (range, 2-71 mL), and number of patients with intraoperative blood loss ≥30 mL was four (17.4%). None of the patients had >100 mL of intraoperative blood loss. No intraoperative complications were noted, and four (17.4%) patients developed postoperative complications. Pathological complete resection was achieved in all patients, and no conversion to open surgery was required. CONCLUSIONS Laparoscopic surgery using the 8 K UHD system appears to be both safe and effective. However, further refinements may be necessary to improve usability.
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Affiliation(s)
- Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Aya Kuchiba
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
| | - Konosuke Moritani
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Shida
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Katayama
- Research Management Section, Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
| | - Eiko Yorikane
- Research Management Section, Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
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Abstract
The translation of laboratory science into effective clinical cancer therapy is gaining momentum more rapidly than any other time in history. Understanding cancer cell-surface receptors, cancer cell growth, and cancer metabolic pathways has led to many promising molecular-targeted therapies and cancer gene therapies. These same targets may also be exploited for optical imaging of cancer. Theoretically, any antibody or small molecule targeting cancer can be labeled with bioluminescent or fluorescent agents. In the laboratory setting, fluorescence imaging (FI) and bioluminescence imaging (BLI) have long been used in preclinical research for quantification of tumor bulk, assessment of targeting of tumors by experimental agents, and discrimination between primary and secondary effects of cancer treatments. Many of these laboratory techniques are now moving to clinical trials. Imageable engineered fluorescent probes that are highly specific for cancer are being advanced. This will allow for the identification of tumors for staging, tracking novel therapeutic agents, assisting in adequate surgical resection, and allowing image-guided biopsies. The critical components of FI include (1) a fluorescent protein that is biologically safe, stable, and distinctly visible with a high target to background ratio and (2) highly sensitive optical detectors. This review will summarize the most promising optical imaging agents and detection devices for cancer clinical research and clinical care.
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Ryu S, Hara K, Okamoto A, Kitagawa T, Marukuchi R, Ito R, Nakabayashi Y. Fluorescence ureteral navigation during laparoscopic surgery for clinically suspected stage T4 colorectal cancer: A cohort study. Surg Oncol 2021; 40:101672. [PMID: 34891060 DOI: 10.1016/j.suronc.2021.101672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Approximately 15% of patients with colorectal cancer present with locally advanced tumors (T4 stage). Laparoscopic surgery for stage T4 disease has not yet been established. The near-infrared ray catheter fluorescent ureteral catheter (NIRFUC) is a new device that uses near-infrared fluorescence resin. We examined the utility of fluorescence ureteral navigation (FUN) with the NIRFUC during laparoscopic surgery for stage T4 colorectal cancer. MATERIALS AND METHODS Patients with stage T4 colorectal cancer (n = 143, from January 2017 to March 2021) were divided into a T4FUN + group, in which the NIRFUC was used (n = 21), and a T4FUN- group, in which the NIRFUC was not used (n = 122). Short-term outcomes were compared between the groups. Next, the laparoscopic surgery rate and incidence of ureteral injury from January 2017 to March 2021 were compared between the T4FUN- group and the non-stage T4FUN- group (n = 434, from January 2017 to March 2021), in which fluorescence ureter navigation was not used. RESULTS Rectal cancer, stage T4b disease, and invasion into the urinary tract were observed more often in the T4FUN + group than in the T4FUN- group. In the comparisons of the T4FUN + versus T4FUN- groups, the operative time was 398 (161-1090) vs. 256 (93-839) minutes, the blood loss was 10 (1-710) vs. 25 (0-1360) ml, and the ratio of laparoscopic surgery to open surgery was 21:0 vs. 79:43. Postoperative complications (Clavien-Dindo grade ≥ III) were present in 2 (10%; 0 ureteral injury) patients in the T4FUN + group and 13 (11%; 2 ureteral injury) patients in the T4FUN- group. In the T4FUN + group, the operative time was longer (p < 0.0001), but the laparoscopic ratio was higher (p = 0.0002), and the blood loss volume and incidence of ureteral injury tended to be lower. In the comparisons of the T4FUN- versus non-stage T4FUN- groups, the ratio of laparoscopic surgery to open surgery was 79:43 vs. 384:50, the incidence of open conversion was 8 (6.6%) vs. 15 (3.5%), and the incidence of ureteral injury was 2 (1.6%) vs. 0 (0%). In the T4FUN- group, the open surgery rate (<0.0001), open conversion rate (p = 0.0205) and incidence of ureteral injury (p = 0.0478) were high, with a significant difference observed between the groups. CONCLUSION Patients with stage T4 disease have an increased risk of ureteral injury and are more likely to be converted to open surgery. FUN can help to safely increase the laparoscopic surgery rate while safely visualizing the ureter. FUN is recommended for laparoscopic surgery in patients with stage T4 colorectal cancer. CLINICAL TRIAL REGISTRATION Examination of fluorescence navigation for laparoscopic colorectal cancer surgery; Research Ethics Committee of the Kawaguchi Municipal Medical Center (Saitama, Japan) approval number: 2020-3. https://kawaguchi-mmc.org/wp-content/uploads/clinical research-r02.pdf.
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Affiliation(s)
- Shunjin Ryu
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Keigo Hara
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Atsuko Okamoto
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Takahiro Kitagawa
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Rui Marukuchi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Ryusuke Ito
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Yukio Nakabayashi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan.
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Mazzarella G, Muttillo EM, Picardi B, Rossi S, Rossi Del Monte S, Muttillo IA. Real-Time Intraoperative Ureteral Identification in Minimally Invasive Colorectal Surgery: A Systematic Review. J Laparoendosc Adv Surg Tech A 2021; 32:627-633. [PMID: 34669486 DOI: 10.1089/lap.2021.0292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Although colorectal surgery (CRS) has currently almost entirely standardized surgical procedures, it can still show pitfalls such as the intraoperative ureteral injury. Intraoperative ureteral identification (IUI) could reduce the ureteral injuries rate but evidence is still lacking. We aimed to analyze the utility and the effectiveness of real-time IUI in minimally invasive CRS. Materials and Methods: A systematic review was performed examining available data on randomized and nonrandomized studies evaluating the utility of intraureteral fluorescence dye (IFD) and lighted ureteral stent (LUS) for intraoperative identification of ureters in CRS, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. Primary endpoint was ureteral injuries rate. Secondary endpoints included acute kidney injury, hematuria, urinary tract infections (UTI), and fluorescence assessment. Results: After literature search, 158 studies have been recorded, 36 studies underwent full-text reviews and 12 studies met inclusion criteria. Overall, out of a total of 822 patients who successfully received IUI, 3 (0.33%) patients experienced ureteral injury. Hematuria was reported in 689 (97.6%) of patients following LUS-guided surgery and in 1 (2%) patient following IFD-guided surgery, although transient in all cases. UTI was reported in 15 (3.3%) LUS-guided resections and in 1 (2%) IFD-guided resections. Acute kidney injury occurred in 23 (2.5%) LUS-guided surgery and 1 (1%) IFD-guided surgery. Conclusions: Real-time ureteral identification techniques could represent a valid solution in complex minimally invasive CRS, safely, with no time consuming and always reproducible by surgeons. Prospective studies will be needed to confirm these findings.
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Affiliation(s)
- Gennaro Mazzarella
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy.,Department of Emergency Surgery, Sapienza University of Rome, Rome, Italy
| | - Edoardo Maria Muttillo
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Biagio Picardi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Stefano Rossi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
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Comprehensive Review of Fluorescence Applications in Gynecology. J Clin Med 2021; 10:jcm10194387. [PMID: 34640405 PMCID: PMC8509149 DOI: 10.3390/jcm10194387] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022] Open
Abstract
Since the introduction of indocyanine green (ICG) as a fluorophore in near-infrared imaging, fluorescence visualization has become an essential tool in many fields of surgery. In the field of gynecology, recent new applications have been proposed and found their place in clinical practice. Different applications in gynecology were investigated, subcategorized, and overviewed concerning surgical applications and available dyes. Specific applications in which fluorescence-guided surgery was implemented in gynecology are described in this manuscript—namely, sentinel node biopsy, mesometrium visualization, angiography of different organs, safety issues in pregnant women, ureters visualization, detection of peritoneal metastases, targeted fluorophores for cancer detection, fluorescent contamination hysterectomy, lymphography for lower limb lymphedema prevention, tumor margin detection, endometriosis, and metastases mapping. With evolving technology, further innovative research on the new applications of fluorescence visualization in cancer surgery may help to establish these techniques as standards of high-quality surgery in gynecology. However, more investigations are necessary in order to assess if these innovative tools can also be effective to improve patient outcomes and quality of life in different gynecologic malignancies.
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31
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Ryu S, Hara K, Goto K, Okamoto A, Kitagawa T, Marukuchi R, Ito R, Nakabayashi Y. New Technique of Laparoscopic Paraaortic Lymph Node Dissection for Colorectal Cancer Using Fluorescence Navigation. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:317-322. [PMID: 35403145 PMCID: PMC8988955 DOI: 10.21873/cdp.10042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/14/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM According to limited current reports, therapeutic paraaortic lymph node (PALN) dissection with intensive combined therapy for colorectal cancer improves prognosis in select patients. Laparoscopic PALN dissection is a difficult technique that has not yet been established. We applied this procedure using an intraoperative fluorescence navigation technique with a near-infrared ray catheter (NIRC™) fluorescent ureteral catheter (NIRFUC). PATIENTS AND METHODS We evaluated the utility of laparoscopic fluorescence navigation and the short-term outcomes of 6 patients undergoing laparoscopic PALN dissection. RESULTS There were 3 surgeries for synchronous metastasis and 3 surgeries for recurrent metastasis. The mean surgical duration, blood loss, and postoperative hospital stay were 677 (range=518-1,090) min, 7.5 (range=3-1,600) ml, and 14 (range=9-33) days, respectively. Postoperative complications (Clavien-Dindo grade >III) occurred in 1 case. CONCLUSION Dissection around the ureter was navigated with a NIRFUC. Fluorescence ureteral navigation facilitated completion of the complex laparoscopic PALN dissection procedure.
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Affiliation(s)
- Shunjin Ryu
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Keigo Hara
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Keisuke Goto
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Atsuko Okamoto
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Takahiro Kitagawa
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Rui Marukuchi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Ryusuke Ito
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Yukio Nakabayashi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
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Zocola E, Meyer J, Christou N, Liot E, Toso C, Buchs NC, Ris F. Role of near-infrared fluorescence in colorectal surgery. World J Gastroenterol 2021; 27:5189-5200. [PMID: 34497444 PMCID: PMC8384744 DOI: 10.3748/wjg.v27.i31.5189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/27/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Near-infrared fluorescence (NIRF) is a technique of augmented reality that, when applied in the operating theatre, allows the colorectal surgeon to visualize and assess bowel vascularization, to identify lymph nodes draining a cancer site and to identify ureters. Herein, we review the literature regarding NIRF in colorectal surgery.
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Affiliation(s)
- Elodie Zocola
- Medical School, University of Geneva, Genève 1205, Switzerland
| | - Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1205, Switzerland
| | - Niki Christou
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Limoges Cedex 87025, France
| | - Emilie Liot
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1205, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1205, Switzerland
| | | | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Genève 1205, Switzerland
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Al-Taher M, Barberio M, Felli E, Agnus V, Ashoka AH, Gioux S, Klymchenko A, Bouvy N, Stassen L, Marescaux J, Diana M. Simultaneous multipurpose fluorescence imaging with IRDye® 800BK during laparoscopic surgery. Surg Endosc 2021; 35:4840-4848. [PMID: 32860134 DOI: 10.1007/s00464-020-07931-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
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Soriano CR, Cheng RR, Corman JM, Moonka R, Simianu VV, Kaplan JA. Feasibility of injected indocyanine green for ureteral identification during robotic left-sided colorectal resections. Am J Surg 2021; 223:14-20. [PMID: 34353619 DOI: 10.1016/j.amjsurg.2021.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/01/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Ureteral identification is essential to performing safe colorectal surgery. Injected immunofluorescence may aid with ureteral identification, but feasibility without ureteral catheterization is not well described. METHODS Case series of robotic colorectal resections where indocyanine green (ICG) injection with or without ureteral catheter placement was performed. Imaging protocol, time to ureteral identification, and factors impacting visualization are reported. RESULTS From 2019 to 2020, 83 patients underwent ureteral ICG injection, 20 with catheterization and 63 with injection only. Main indications were diverticulitis (52%) and cancer (36%). Median time to instill ICG was faster with injection alone than with catheter placement (4min vs 13.5min, p < 0.001). Median time [IQR] to right ureter (0.3 [0.01-1.2] min after robot docking) and left ureter (5.5 [3.1-8.8] min after beginning dissection) visualization was not different between injection alone and catheterization. CONCLUSION ICG injection alone is faster than with indwelling catheter placement and equally reliable at intraoperative ureteral identification.
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Affiliation(s)
- Celine R Soriano
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA.
| | - Ron Ron Cheng
- Department of Urology, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - John M Corman
- Department of Urology, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Ravi Moonka
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Jennifer A Kaplan
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
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35
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Ryu S, Okamoto A, Nakashima K, Hara K, Ishida K, Ito R, Nakabayashi Y. Ureteral navigation using a fluorescent ureteral catheter during laparoscopic colorectal surgery. Surg Endosc 2021; 35:4882-4889. [PMID: 33978850 DOI: 10.1007/s00464-021-08538-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 04/30/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ureteral injury is the most common urological complication of pelvic surgery, with a reported incidence during colon resection of 0.3-1.5%. Ureteral stenting is commonly performed preoperatively to prevent ureteral injury. Because tactile sensation is not reliable during laparoscopic surgery, the effect of the ureteral stent is considered limited. Recently, fluorescence imaging has been used in laparoscopic surgery. The Near-Infrared Ray Catheter (NIRC™) fluorescent ureteral catheter (NIRFUC) is a new catheter with built-in NIR fluorescent resin. This pilot study was performed to evaluate the utility of fluorescence ureteral navigation using the NIRFUC during laparoscopic colorectal surgery. METHODS We evaluated the intraoperative utility of the NIRFUC and the short-term outcomes in 20 patients treated with colorectal surgery at Kawaguchi Municipal Medical Center between February and July 2020. In all, 18 patients with malignant tumors and 2 patients with benign disease, i.e., a sigmoid colovesical fistula, were included. Ten patients developed preoperative intestinal obstruction. One patient experienced preoperative perforation. Nine patients developed preoperative peritumoral abscesses. Laparoscopic surgery was performed with the VISERA ELITE2 system. RESULTS In all cases, the ureters were very clearly identified as fluorescent without the need for dissection. In all cases, only a moment was required to identify the ureter by fluorescence observation. In all cases, R0 resection was performed. The mean surgical duration was 334 min (161-1014), the mean blood loss was 10 ml (1-500), and the mean postoperative hospital stay was 11 days (8-47). There were no cases of ureteral injury. CONCLUSION The NIRFUC was very clearly identified as fluorescent in a moment during surgery without dissection around the ureter. Fluorescence ureteral navigation using the NIRFUC may make colorectal surgery easier and facilitate completion of complex minimally invasive surgery, especially during surgery in patients with invasion of the surrounding tissue or a history of pelvic surgery or radiation.
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Affiliation(s)
- Shunjin Ryu
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi, Saitama, 333-0833, Japan.
| | - Atsuko Okamoto
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi, Saitama, 333-0833, Japan
| | - Keigo Nakashima
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi, Saitama, 333-0833, Japan
| | - Keigo Hara
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi, Saitama, 333-0833, Japan
| | - Kota Ishida
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi, Saitama, 333-0833, Japan
| | - Ryusuke Ito
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi, Saitama, 333-0833, Japan
| | - Yukio Nakabayashi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi, Saitama, 333-0833, Japan
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Fluorescence imaging in colorectal surgery. Surg Endosc 2021; 35:4956-4963. [PMID: 33966120 DOI: 10.1007/s00464-021-08534-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Fluorescent imaging is an emerging technological tool that can guide surgeons during surgery by highlighting anatomical structures and pathology, and help with intraoperative decision making. METHODS A comprehensive review of published literature was performed using the search terms "fluorescence", "imaging" and "colorectal surgery" in PubMed. Only clinical trials that were published in English were included in this review. Ex vivo and animal studies were excluded. RESULTS This review demonstrates the use of fluorescence imaging in colorectal surgery in four areas: (1) assessment of tissue perfusion and vasculature; (2) assessment of tumour; (3) lymphatic drainage and (4) identification of the urinary tract. The most commonly used fluorescent dyes are nonspecific, such as indocyanine green and methylene blue, but there is increasing interest in the development of specific fluorescently labelled molecular markers. CONCLUSION Fluorescence imaging is a potentially useful tool for colorectal surgery. Early studies on fluorescence imaging have been promising but larger scale randomised controlled trials are warranted to demonstrate the effectiveness and benefits of using fluorescence imaging routinely. The development of molecular dyes that are specific to targets could significantly increase the potential use of fluorescence imaging during surgery.
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Kamada T, Nakaseko Y, Yoshida M, Kai W, Takahashi J, Nakashima K, Suzuki N, Ohdaira H, Yamanouchi E, Suzuki Y. Indocyanine green fluorescence-guided laparoscopic colorectal cancer surgery with prophylactic retrograde transileal conduit ureteral catheter placement after previous total cystectomy: a case report. Surg Case Rep 2021; 7:67. [PMID: 33710480 PMCID: PMC7954966 DOI: 10.1186/s40792-021-01153-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/08/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Iatrogenic ureteral injury (UI) is a potentially serious complication of colorectal cancer surgery. Performing perioperative placement of ureteral stents or intraoperative fluorescence navigation surgery for the ureter using indocyanine green (ICG) has been employed as a method of preventing UI. However, transileal conduit stent placement has been considered challenging because it is difficult to identify the ureteral orifice due to the anatomical changes caused by a previous surgery. We report a case in which laparoscopic colectomy was safely performed using a combination of prophylactic transileal conduit ureteral catheter placement and intraoperative ICG fluorescence navigation surgery. CASE PRESENTATION A 75-year-old man presented to our hospital complaining of vomiting and abdominal distension. He had a history of open total cystectomy and ileal conduit urinary diversion 11 years prior to admission. Computed tomography confirmed colon dilation with fecal impaction from the ascending colon to the sigmoid colon and wall thickening in the sigmoid colon. Colonoscopy during the transanal ileus tube insertion revealed a Borrmann type II tumor with circumferential stenosis 10 cm distal to the junction between the descending colon and the sigmoid colon. The patient was diagnosed with colorectal ileus due to obstructive sigmoid colon cancer and underwent transanal ileus tube insertion. Severe intra-abdominal adhesions were expected due to the previous total cystectomy, and the left ureter was near the sigmoid colon tumor; therefore, prophylactic retrograde transileal conduit ureteral catheter placement was performed one day before the elective surgery. During the operation, 20 ml (5.0 × 10-2 mg/ml) ICG was administered from the transileal conduit ureteral catheter, and ICG fluorescence of the ureter was observed in the retroperitoneum. Laparoscopic Hartmann's operation was successfully performed, confirming ureter fluorescence. The operation time was 231 min, with 5 mL of intraoperative bleeding. The ureteral catheter was removed 3 days after the operation. The patient's postoperative course was good with no complications, and he was discharged on postoperative day 7. CONCLUSIONS Prophylactic transileal conduit ureteral catheter placement and ICG fluorescence navigation surgery were effective in performing laparoscopic colorectal surgery with severe adhesions after urinary diversion.
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Affiliation(s)
- Teppei Kamada
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi Nasushiobara, Tochigi, 329-2763, Japan.
| | - Yuichi Nakaseko
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi Nasushiobara, Tochigi, 329-2763, Japan
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi Nasushiobara, Tochigi, 329-2763, Japan
| | - Wataru Kai
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi Nasushiobara, Tochigi, 329-2763, Japan
| | - Junji Takahashi
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi Nasushiobara, Tochigi, 329-2763, Japan
| | - Keigo Nakashima
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi Nasushiobara, Tochigi, 329-2763, Japan
| | - Norihiko Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi Nasushiobara, Tochigi, 329-2763, Japan
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi Nasushiobara, Tochigi, 329-2763, Japan
| | - Eigoro Yamanouchi
- Department of Radiology, International University of Health and Welfare Hospital, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi Nasushiobara, Tochigi, 329-2763, Japan
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Ghuman A, Kavalukas S, Sharp SP, Wexner SD. Clinical role of fluorescence imaging in colorectal surgery - an updated review. Expert Rev Med Devices 2020; 17:1277-1283. [PMID: 33183101 DOI: 10.1080/17434440.2020.1851191] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Colorectal surgery has markedly advanced due to the introduction of laparoscopic and robotic surgery. During the past 20 years, these two modalities have been further enhanced by fluorescence imaging. AREAS COVERED This article will review the common and novel uses for fluorophores in colorectal surgery, including tissue perfusion for anastomotic creation, ureter identification, lymphatic mapping, and tumor localization. EXPERT OPINION The versatility of this technology permeates through many aspects of colorectal procedures. The white light spectrum has historically been the only available modality to visualize tissue perfusion, tumor implants, and structures including the ureters and lymph nodes. The ability of the near-infrared spectrum to penetrate biologic tissues allows the identification of these structures with injection of fluorophores. The two most common intravenously utilized fluorophores are methylene blue and indocyanine green. Additionally, novel tumor marker-specific fluorophores are being investigated for purposes of cancer detection.
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Affiliation(s)
- Amandeep Ghuman
- Department of Colorectal Surgery, Cleveland Clinic Florida , Weston, FL, USA
| | - Sandra Kavalukas
- Department of Colorectal Surgery, Cleveland Clinic Florida , Weston, FL, USA
| | - Stephen P Sharp
- Department of Colorectal Surgery, Cleveland Clinic Florida , Weston, FL, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida , Weston, FL, USA
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Laparoscopic fluorescence navigation for left-sided colon and rectal cancer: Blood flow evaluation, vessel and ureteral navigation, clip marking and trans-anal tube insertion. Surg Oncol 2020; 35:434-440. [DOI: 10.1016/j.suronc.2020.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/21/2020] [Accepted: 10/02/2020] [Indexed: 12/16/2022]
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Cwalinski T, Polom W, Marano L, Roviello G, D’Angelo A, Cwalina N, Matuszewski M, Roviello F, Jaskiewicz J, Polom K. Methylene Blue-Current Knowledge, Fluorescent Properties, and Its Future Use. J Clin Med 2020; 9:3538. [PMID: 33147796 PMCID: PMC7693951 DOI: 10.3390/jcm9113538] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/24/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022] Open
Abstract
Methylene blue is a fluorescent dye discovered in 1876 and has since been used in different scientific fields. Only recently has methylene blue been used for intraoperative fluorescent imaging. Here, the authors review the emerging role of methylene blue, not only as a dye used in clinical practice, but also as a fluorophore in a surgical setting. We discuss the promising potential of methylene blue together with the challenges and limitations among specific surgical techniques. A literature review of PubMed and Medline was conducted based on the historical, current and future usage of methylene blue within the field of medicine. We reviewed not only the current usage of methylene blue, but we also tried to grasp its' function as a fluorophore in five main domains. These domains include the near-infrared imaging visualization of ureters, parathyroid gland identification, pancreatic tumors imaging, detection of breast cancer tumor margins, as well as breast cancer sentinel node biopsy. Methylene blue is used in countless clinical procedures with a relatively low risk for patients. Usage of its fluorescent properties is still at an early stage and more pre-clinical, as well as clinical research, must be performed to fully understand its potentials and limitations.
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Affiliation(s)
- Tomasz Cwalinski
- Department of Surgical Oncology, Medical University of Gdansk, 80-214 Gdansk, Poland; (T.C.); (J.J.)
| | - Wojciech Polom
- Department of Urology, Medical University of Gdansk, 80-214 Gdansk, Poland; (W.P.); (M.M.)
| | - Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, 53-100 Siena, Italy; (L.M.); (F.R.)
| | - Giandomenico Roviello
- Department of Health Sciences, University of Florence, viale Pieraccini 6, 50139 Florence, Italy;
| | - Alberto D’Angelo
- Department of Biology and Biochemistry, University of Bath, Bath BA2 7AY, UK;
| | - Natalia Cwalina
- Department of Pediatrics Ascension St. John Children’s Hospital, Detroit, MI 48236, USA;
| | - Marcin Matuszewski
- Department of Urology, Medical University of Gdansk, 80-214 Gdansk, Poland; (W.P.); (M.M.)
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, 53-100 Siena, Italy; (L.M.); (F.R.)
| | - Janusz Jaskiewicz
- Department of Surgical Oncology, Medical University of Gdansk, 80-214 Gdansk, Poland; (T.C.); (J.J.)
| | - Karol Polom
- Department of Surgical Oncology, Medical University of Gdansk, 80-214 Gdansk, Poland; (T.C.); (J.J.)
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Grosek J, Tomažič A. Key clinical applications for indocyanine green fluorescence imaging in minimally invasive colorectal surgery. J Minim Access Surg 2020; 16:308-314. [PMID: 31031317 PMCID: PMC7597871 DOI: 10.4103/jmas.jmas_312_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 12/21/2018] [Accepted: 01/15/2019] [Indexed: 02/06/2023] Open
Abstract
Near-infrared indocyanine green (ICG) fluorescence imaging has gained solid acceptance over the last years, and rightly so, as this technology has so much to offer, especially in the field of minimally invasive surgery. Firm evidence from ongoing and future studies will hopefully transform many of the applications of ICG fluorescence into the standard of care for our patients. This review examines the current status of ICG fluorescence for assessment of bowel perfusion, lymphatic mapping as well as intraoperative localisation of ureter in light of the published academic literature in English.
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Affiliation(s)
- Jan Grosek
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Aleš Tomažič
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
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42
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Al-Taher M, Okamoto N, Felli E, Agnus V, Barberio M, Gioux S, Bouvy N, Stassen L, Marescaux J, Diana M. Noninvasive Near-Infrared Fluorescence Imaging of the Ureter During Robotic Surgery: A Demonstration in a Porcine Model. J Laparoendosc Adv Surg Tech A 2020; 30:962-966. [PMID: 32716245 DOI: 10.1089/lap.2020.0399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Iatrogenic ureteral injury is one of the feared complications during intrapelvic surgery. There are limited data on the use of novel near-infrared fluorescence (NIRF) imaging dyes for the purpose of noninvasive ureteral visualization in robot-assisted laparoscopic surgery (RALS). In this study, we evaluated the feasibility of NIRF imaging of the ureter using the IRDye® 800BK dye as the fluorescence dye and a robotic platform with Firefly™ technology as an imaging system. Materials and Methods: An intravenous dose of 0.15 mg/kg was administered in 3 pigs and NIRF imaging was performed for a total duration of 60 minutes. The intraoperative video recordings were analyzed to determine fluorescence intensities and the target-to-background ratio (TBR). Results: In all included animals, a clear delineation of the ureter was achieved from 5 minutes after dye administration until the end of the study. During this time period, the ureter was clearly distinguishable from its surroundings and no statistical differences in TBR were observed. Conclusion: The IRDye 800BK dye, a novel NIRF dye currently undergoing clinical translation, is a promising contrast agent used for noninvasive ureteral imaging, which has the potential to be valuable during RALS.
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Affiliation(s)
- Mahdi Al-Taher
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nariaki Okamoto
- Research Institute against Digestive Cancer, IRCAD, Strasbourg, France
| | - Eric Felli
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
| | - Vincent Agnus
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
| | - Manuel Barberio
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
| | - Sylvain Gioux
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- ICUBE Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | - Nicole Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jacques Marescaux
- Research Institute against Digestive Cancer, IRCAD, Strasbourg, France
| | - Michele Diana
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- Research Institute against Digestive Cancer, IRCAD, Strasbourg, France
- ICUBE Laboratory, Photonics Instrumentation for Health, Strasbourg, France
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43
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Wu Y, Zhang F. Exploiting molecular probes to perform near‐infrared fluorescence‐guided surgery. VIEW 2020. [DOI: 10.1002/viw.20200068] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Yifan Wu
- Department of Chemistry State Key Laboratory of Molecular Engineering of Polymers Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials and iChem Fudan University Shanghai China
| | - Fan Zhang
- Department of Chemistry State Key Laboratory of Molecular Engineering of Polymers Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials and iChem Fudan University Shanghai China
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Al-Taher M, Diana M. The Use of IRDye 800BK for Intraoperative Ureteral Visualization: The Future of the Ureter Is Bright! J Laparoendosc Adv Surg Tech A 2020; 30:987-988. [PMID: 32667843 DOI: 10.1089/lap.2020.0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mahdi Al-Taher
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France.,Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michele Diana
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France.,Research Institute against Digestive Cancer, IRCAD, Strasbourg, France.,ICUBE Laboratory, Photonics Instrumentation for Health, Strasbourg, France
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Teranishi K. A Near-Infrared Fluorescent Probe Coated with β-Cyclodextrin Molecules for Real-Time Imaging-Guided Intraoperative Ureteral Identification and Diagnosis. Mol Pharm 2020; 17:2672-2681. [PMID: 32427488 DOI: 10.1021/acs.molpharmaceut.0c00364] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although iatrogenic ureteral injury and its lack of recognition due to ureteral invisibility are serious incidents in open and laparoscopic abdominal surgeries, there are currently no safe and effective methods for intraoperative ureteral identification (IUI) and diagnosis (IUD). In this study, I designed and chemically synthesized a near-infrared fluorescence (NIRF) imaging probe (CD-NIR-1) and evaluated its clearance and ability for IUI and IUD in animal models. CD-NIR-1 demonstrated high specificity and ultrarapid clearance by rat kidneys to the urinary bladder following intravenous administration of a single dose (25 nmol/kg of body weight), with 96% of the dose ultimately excreted at the first urination with no chemical modification. Furthermore, urine containing CD-NIR-1 in ureters showed strong NIRF, thereby enabling IUI and IUD via NIRF imaging. These results demonstrated the efficacy of CD-NIR-1 for clinical use.
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Du J, Liu S, Zhang P, Liu H, Li Y, He W, Li C, Chau JHC, Kwok RTK, Lam JWY, Cai L, Huang Y, Zhang W, Hou J, Tang BZ. Highly Stable and Bright NIR-II AIE Dots for Intraoperative Identification of Ureter. ACS APPLIED MATERIALS & INTERFACES 2020; 12:8040-8049. [PMID: 31970976 DOI: 10.1021/acsami.9b22957] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Iatrogenic ureteral injury is a dreaded complication of abdominal and pelvic surgeries, and thus, intraoperative identification of ureters is of paramount importance but lacks efficient methods and probes. Herein, we used near-infrared II (NIR-II, 1000-1700 nm) fluorescence imaging with advantages of higher spatial resolution, deeper tissue penetration, lower light scattering, and less tissue autofluorescence to identify ureters by aggregation-induced emission luminogen dots (AIE dots). The intraoperative ureteral injuries and common ureteral diseases can be visualized timely and precisely. Due to the longer emission wavelength and higher quantum yield of the AIE dots, it largely outperforms the commercial indocyanine green dye in brightness and penetration depth. It was the first time to realize the intraoperative identification of ureters in vivo using NIR-II imaging. Thus, our work provides a new platform for intraoperative monitoring during clinical operation.
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Affiliation(s)
- Jian Du
- Department of Urology , The First Affiliated Hospital of Soochow University , NO. 188 Shizi Road , Suzhou 215006 , China
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science and State Key Laboratory of Molecular Neuroscience, Institute of Molecular Functional Materials, Department Chemical and Biological Engineering and Institute for Advanced Study , The Hong Kong University of Science and Technology , Clear Water Bay, Kowloon 999077 , Hong Kong , China
- Guangdong Key Laboratory of Nanomedicine, Shenzhen, engineering Laboratory of nanomedicine and nanoformulations, CAS Key Lab for Health Informatics , Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences , Shenzhen 518055 , China
| | - Shunjie Liu
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science and State Key Laboratory of Molecular Neuroscience, Institute of Molecular Functional Materials, Department Chemical and Biological Engineering and Institute for Advanced Study , The Hong Kong University of Science and Technology , Clear Water Bay, Kowloon 999077 , Hong Kong , China
| | - Pengfei Zhang
- Guangdong Key Laboratory of Nanomedicine, Shenzhen, engineering Laboratory of nanomedicine and nanoformulations, CAS Key Lab for Health Informatics , Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences , Shenzhen 518055 , China
| | - Haixiang Liu
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science and State Key Laboratory of Molecular Neuroscience, Institute of Molecular Functional Materials, Department Chemical and Biological Engineering and Institute for Advanced Study , The Hong Kong University of Science and Technology , Clear Water Bay, Kowloon 999077 , Hong Kong , China
| | - Yuanyuan Li
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science and State Key Laboratory of Molecular Neuroscience, Institute of Molecular Functional Materials, Department Chemical and Biological Engineering and Institute for Advanced Study , The Hong Kong University of Science and Technology , Clear Water Bay, Kowloon 999077 , Hong Kong , China
| | - Wei He
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science and State Key Laboratory of Molecular Neuroscience, Institute of Molecular Functional Materials, Department Chemical and Biological Engineering and Institute for Advanced Study , The Hong Kong University of Science and Technology , Clear Water Bay, Kowloon 999077 , Hong Kong , China
| | - Chunbin Li
- Guangdong Key Laboratory of Nanomedicine, Shenzhen, engineering Laboratory of nanomedicine and nanoformulations, CAS Key Lab for Health Informatics , Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences , Shenzhen 518055 , China
| | - Joe H C Chau
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science and State Key Laboratory of Molecular Neuroscience, Institute of Molecular Functional Materials, Department Chemical and Biological Engineering and Institute for Advanced Study , The Hong Kong University of Science and Technology , Clear Water Bay, Kowloon 999077 , Hong Kong , China
| | - Ryan T K Kwok
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science and State Key Laboratory of Molecular Neuroscience, Institute of Molecular Functional Materials, Department Chemical and Biological Engineering and Institute for Advanced Study , The Hong Kong University of Science and Technology , Clear Water Bay, Kowloon 999077 , Hong Kong , China
| | - Jacky W Y Lam
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science and State Key Laboratory of Molecular Neuroscience, Institute of Molecular Functional Materials, Department Chemical and Biological Engineering and Institute for Advanced Study , The Hong Kong University of Science and Technology , Clear Water Bay, Kowloon 999077 , Hong Kong , China
| | - Lintao Cai
- Guangdong Key Laboratory of Nanomedicine, Shenzhen, engineering Laboratory of nanomedicine and nanoformulations, CAS Key Lab for Health Informatics , Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences , Shenzhen 518055 , China
| | - Yuhua Huang
- Department of Urology , The First Affiliated Hospital of Soochow University , NO. 188 Shizi Road , Suzhou 215006 , China
| | - Weijie Zhang
- Department of Urology , The First Affiliated Hospital of Soochow University , NO. 188 Shizi Road , Suzhou 215006 , China
| | - Jianquan Hou
- Department of Urology , The First Affiliated Hospital of Soochow University , NO. 188 Shizi Road , Suzhou 215006 , China
| | - Ben Zhong Tang
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, Division of Life Science and State Key Laboratory of Molecular Neuroscience, Institute of Molecular Functional Materials, Department Chemical and Biological Engineering and Institute for Advanced Study , The Hong Kong University of Science and Technology , Clear Water Bay, Kowloon 999077 , Hong Kong , China
- HKUST Shenzhen Research Institute , No. 9 Yuexing First Road , South Area Hi-tech Park, Nanshan, Shenzhen 518057 , China
- Center for Aggregation-Induced Emission, SCUT-HKUST Joint Research Institute, State Key Laboratory of Luminescent Materials and Devices , South China University of Technology , Guangzhou 510640 , China
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Big colon surgery, little incisions: Minimally invasive techniques in emergent colon surgery. J Trauma Acute Care Surg 2020; 89:e1-e6. [PMID: 32068715 DOI: 10.1097/ta.0000000000002616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Douissard J, Meyer J, Ris F, Liot E, Morel P, Buchs NC. Iatrogenic ureteral injuries and their prevention in colorectal surgery: results from a nationwide survey. Colorectal Dis 2019; 21:595-602. [PMID: 30624852 DOI: 10.1111/codi.14552] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022]
Abstract
AIM Iatrogenic ureteral injury (IUI) occurs rarely during colorectal surgery but is associated with significant mortality, morbidity and medicolegal issues. Few cases are reported, and recommendations regarding prevention are lacking. The aim of this study is to describe the current state of practice regarding IUI and its prevention among general surgeons in Switzerland. METHOD All Swiss general surgeons who are members of either the Swiss Association of Laparoscopic and Thoracoscopic Surgery or the Swiss Surgical Society were invited to participate in an anonymous online survey. Demographics, surgical practice, rate of IUI and methods used to prevent IUI were investigated. RESULTS All participants were board-certified general surgeons, 63.4% were certified visceral surgeons and 17.9% were certified colorectal surgeons. The mean level of experience in colorectal surgery was 15.6 ± 9.2 years. Formal ureter identification was considered mandatory during sigmoid or rectal surgery by 83.7% of participants, and 31.7% considered identification of the right ureter during right colectomy to be mandatory. In total, 61.8% of the participants and 78.4% of surgeons with more than 20 years of experience had encountered at least one IUI. Prophylactic ureteral stenting was considered useful in complex procedures by 93.5% of participants, and 56.9% had used stents at least once in the past 12 months. Noninvasive techniques for identifying ureters would be considered in regular daily practice by 54.5% of the participants. CONCLUSION Most general surgeons experience IUI. Ureter identification is widely integrated in colorectal procedures. Prophylactic stenting is widely used for difficult cases. Noninvasive methods to improve ureter identification are now needed.
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Affiliation(s)
- J Douissard
- Visceral Surgery Department, University Hospital of Geneva and School of Medicine, Geneva, Switzerland
| | - J Meyer
- Visceral Surgery Department, University Hospital of Geneva and School of Medicine, Geneva, Switzerland
| | - F Ris
- Visceral Surgery Department, University Hospital of Geneva and School of Medicine, Geneva, Switzerland
| | - E Liot
- Visceral Surgery Department, University Hospital of Geneva and School of Medicine, Geneva, Switzerland
| | - P Morel
- Visceral Surgery Department, University Hospital of Geneva and School of Medicine, Geneva, Switzerland
| | - N C Buchs
- Visceral Surgery Department, University Hospital of Geneva and School of Medicine, Geneva, Switzerland
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Slooter MD, Janssen A, Bemelman WA, Tanis PJ, Hompes R. Currently available and experimental dyes for intraoperative near-infrared fluorescence imaging of the ureters: a systematic review. Tech Coloproctol 2019; 23:305-313. [PMID: 31030340 PMCID: PMC6536635 DOI: 10.1007/s10151-019-01973-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/26/2019] [Indexed: 01/23/2023]
Abstract
Background Iatrogenic ureteral injury (IUI) following abdominal surgery has a relatively low incidence, but is associated with high risks of morbidity and mortality. Conventional assessment of IUI includes visual inspection and palpation. This is especially challenging during laparoscopic procedures and has translated into an increased risk of IUI. The use of near-infrared fluorescent (NIRF) imaging is currently being considered as a novel method to identify the ureters intraoperatively. The aim of this review is to describe the currently available and experimental dyes for ureter visualization and to evaluate their feasibility of using them and their effectiveness. Methods This article adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard for systematic reviews. A systematic literature search was performed in the PubMed database. All included articles were screened for eligibility by two authors. Three clinical trial databases were consulted to identify ongoing or completed unpublished trials. Risk of bias was assessed for all articles. Results The search yielded 20 articles on ureter visualization. Two clinically available dyes, indocyanine green (ICG) and methylene blue (MB), and eight experimental dyes were described and assessed for their feasibility to identify the ureter. Two ongoing clinical trials on CW800-BK and one trial on ZW800-1 for ureter visualization were identified. Conclusions Currently available dyes, ICG and MB, are safe, but suboptimal for ureter visualization based on the route of administration and optical properties, respectively. Currently, MB has potential to be routinely used for ureter visualization in most patients, but (cRGD-)ZW800-1 holds potential for this role in the future, owing to its exclusive renal clearance and the near absence of background. To assess the benefit of NIRF imaging for reducing the incidence of IUI, larger patient cohorts need to be examined. Electronic supplementary material The online version of this article (10.1007/s10151-019-01973-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M D Slooter
- Department of Surgery, Amsterdam UMC, University of Amsterdam, G4, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
| | - A Janssen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, G4, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, G4, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, G4, Postbox 22660, 1100 DD, Amsterdam, The Netherlands
| | - R Hompes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, G4, Postbox 22660, 1100 DD, Amsterdam, The Netherlands.
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Near-infrared fluorescence laparoscopy of the ureter with three preclinical dyes in a pig model. Surg Endosc 2018; 33:986-991. [PMID: 30478696 PMCID: PMC6394806 DOI: 10.1007/s00464-018-6596-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 11/13/2018] [Indexed: 02/06/2023]
Abstract
Background Ureteric injury is reported to occur in 1–7.6% of colorectal surgeries. To reduce the incidence of ureteral injury, it is essential to identify the ureters. The use of near-infrared fluorescence (NIRF) imaging with intravenously administered dyes might be of added value for ureteral visualization during laparoscopy. The aim of this study is to assess the performance of three preclinical dyes; IRDye® 800BK, IRDye® 800NOS and IRDye® 800CW, for near-infrared fluorescence laparoscopy of the ureter in pigs. Methods In three female Dutch landrace pigs, the new dyes were evaluated. In each pig, 1 dye was tested using a 6-mg intravenous dose in a concentration of 1 mg/ml. Imaging was performed in fluorescence mode and white light mode with a laparoscopic imaging system. In order to further evaluate the dyes, an ex vivo imaging experiment was performed, in which 8 decreasing concentrations per dye, diluted in PBS, were evaluated in a transparent test tube with NIRF mode at a distance of 1, 5 and 10 cm from the laparoscope. Results All three dyes were effective in allowing the identification of the ureter with NIRF imaging. The ureter became fluorescent after 35, 45 and 10 min, respectively, for IRDye® 800BK, IRDye® 800NOS and IRDye® 800CW with a maximum target-to-background ratio (TBR) of 2.14, 0.66 and 1.44, respectively. In the ex vivo imaging experiment, all three dyes produced a strong fluorescence signal at all concentrations and all distances evaluated. Conclusions Intravenous administration of the preclinical dyes IRDye® 800CW, IRDye® 800 BK and IRDye® 800NOS facilitated successful identification of the anatomical course of the ureter in living pig models. The highest measured TBR occurred with the use of IRDye® 800BK. Ex vivo, a correlation was observed between the fluorescence intensities of the signal with the concentration of the dye and with the distance to the object.
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