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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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Sang M, Huang Y, Wang L, Chen L, Nawsherwan, Li G, Wang Y, Yu X, Dai C, Zheng J. An "AND" Molecular Logic Gate as a Super-Enhancers for De Novo Designing Activatable Probe and Its Application in Atherosclerosis Imaging. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2207066. [PMID: 36808894 PMCID: PMC10131802 DOI: 10.1002/advs.202207066] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/31/2023] [Indexed: 09/30/2023]
Abstract
Developing activatable fluorescent probes with superlative fluorescence enhancement factor (F/F0 ) to improve the signal-to-noise (S/N) ratio is still an urgent issue. "AND" molecular logic gates are emerging as a useful tool for enhanced probes selectivity and accuracy. Here, an "AND" logic gate is developed as super-enhancers for designing activatable probes with huge F/F0 and S/N ratio. It utilizes lipid-droplets (LDs) as controllable background input and sets the target analyte as variable input. The fluorescence is tremendously quenching due to double locking, thus an extreme F/F0 ratio of target analyte is obtained. Importantly, this probe can transfer to LDs after a response occurs. The target analyte can be directly visualized through the spatial location without a control group. Accordingly, a peroxynitrite (ONOO- ) activatable probe (CNP2-B) is de novo designed. The F/F0 of CNP2-B achieves 2600 after reacting with ONOO- . Furthermore, CNP2-B can transfer from mitochondria to lipid droplets after being activated. The higher selectivity and S/N ratio of CNP2-B are obtained than commercial probe 3'-(p-hydroxyphenyl) fluorescein (HPFin vitro and in vivo. Therefore, the atherosclerotic plaques at mouse models are delineated clearly after administration with in situ CNP2-B probe gel. Such input controllable "AND" logic gate is envisioned to execute more imaging tasks.
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Affiliation(s)
- Mangmang Sang
- Institute of Cardiovascular DiseasesXiamen Cardiovascular Hospital of Xiamen UniversitySchool of MedicineXiamen UniversityNo. 2999 Jinshan Road, Huli DistrictXiamen361006China
| | - Yibo Huang
- Institute of Cardiovascular DiseasesXiamen Cardiovascular Hospital of Xiamen UniversitySchool of MedicineXiamen UniversityNo. 2999 Jinshan Road, Huli DistrictXiamen361006China
| | - Lu Wang
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese MedicineNanjing University of Chinese MedicineNo. 157, Daming Road, Qinhuai DistrictNanjing210000China
| | - Lei Chen
- School of PharmacyGannan Medical UniversityNo. 1 Medical College Road, Zhanggong DistrictGanzhou341000China
| | - Nawsherwan
- Institute of Cardiovascular DiseasesXiamen Cardiovascular Hospital of Xiamen UniversitySchool of MedicineXiamen UniversityNo. 2999 Jinshan Road, Huli DistrictXiamen361006China
| | - Gang Li
- Institute of Cardiovascular DiseasesXiamen Cardiovascular Hospital of Xiamen UniversitySchool of MedicineXiamen UniversityNo. 2999 Jinshan Road, Huli DistrictXiamen361006China
| | - Yan Wang
- Institute of Cardiovascular DiseasesXiamen Cardiovascular Hospital of Xiamen UniversitySchool of MedicineXiamen UniversityNo. 2999 Jinshan Road, Huli DistrictXiamen361006China
| | - Xiu Yu
- Shenzhen Key Laboratory of Respiratory DiseasesShenzhen People's HospitalSouthern University of Science and Technology3046 Shennan East Road, Luohu DistrictShenzhen518055China
| | - Cuilian Dai
- Institute of Cardiovascular DiseasesXiamen Cardiovascular Hospital of Xiamen UniversitySchool of MedicineXiamen UniversityNo. 2999 Jinshan Road, Huli DistrictXiamen361006China
| | - Jinrong Zheng
- Institute of Cardiovascular DiseasesXiamen Cardiovascular Hospital of Xiamen UniversitySchool of MedicineXiamen UniversityNo. 2999 Jinshan Road, Huli DistrictXiamen361006China
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Ryu S, Goto K, Kitagawa T, Shimada J, Ito R, Nakabayashi Y. Fluorescence urethral navigation for transperineal minimally invasive abdominoperineal resection for rectal cancer. Colorectal Dis 2023. [PMID: 36799056 DOI: 10.1111/codi.16525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/16/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Affiliation(s)
- Shunjin Ryu
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Keisuke Goto
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Takahiro Kitagawa
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Junichi Shimada
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Ryusuke Ito
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Yukio Nakabayashi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
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Zheng J, Zhao S, Mao Y, Du Z, Li G, Sang M. Lipid-Activatable Fluorescent Probe for Intraoperative Imaging of Atherosclerotic Plaque Using In Situ Patch. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2022; 18:e2104471. [PMID: 34837454 DOI: 10.1002/smll.202104471] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/09/2021] [Indexed: 06/13/2023]
Abstract
The surgical removal of lesions is among the most common and effective treatments for atherosclerosis. It is often the only curative treatment option, and the ability to visualize the full extent of atherosclerotic plaque during the operation has major implications for the therapeutic outcome. Fluorescence imaging is a promising approach for the inspection of atherosclerotic plaques during surgery. However, there is no systematic strategy for intraoperative fluorescent imaging in atherosclerosis. In this study, the in situ attachment of a lipid-activatable fluorescent probe (CN-N2)-soaked patch to the outer arterial surface is reported for rapid and precise localization of the atherosclerotic plaque in ApoE-deficient mouse during surgery. Stable imaging of the plaque is conducted within 5 min via rapid recognition of abnormally accumulated lipid droplets (LDs) in foam cells. Furthermore, the plaque/normal ratio (P/N) is significantly enhanced to facilitate surgical delineation of carotid atherosclerotic plaques. Visible fluorescence bioimaging using lipid-activatable probes can accurately delineate plaque sizes down to diameters of <0.5 mm, and the images can be swiftly captured within the stable plaque imaging time window. These findings on intraoperative fluorescent imaging of plaques via the in situ attachment of the CN-N2 patch hold promise for effective clinical applications.
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Affiliation(s)
- Jinrong Zheng
- Xiamen Cardiovascular Hospital, Xiamen University, 2999 Jinshan Road, Huli District, Xiamen, 361006, China
| | - Shanshan Zhao
- Xiamen Cardiovascular Hospital, Xiamen University, 2999 Jinshan Road, Huli District, Xiamen, 361006, China
| | - Yijie Mao
- Xiamen Cardiovascular Hospital, Xiamen University, 2999 Jinshan Road, Huli District, Xiamen, 361006, China
| | - Zhichao Du
- School of Pharmaceutical Sciences, Tsinghua University, 30 Shuangqing Road, Haiding District, Beijing, 100084, China
- Department of Pharmacy, Xilingol League Central Hospital, 9 Nadam Street, Xilinhot, 026000, China
| | - Gang Li
- Xiamen Cardiovascular Hospital, Xiamen University, 2999 Jinshan Road, Huli District, Xiamen, 361006, China
| | - Mangmang Sang
- Xiamen Cardiovascular Hospital, Xiamen University, 2999 Jinshan Road, Huli District, Xiamen, 361006, China
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Sang M, Cai B, Qin S, Zhao S, Mao Y, Wang Y, Yu X, Zheng J. Lipid Droplet-Specific Probe for Rapidly Locating Atherosclerotic Plaques and Intraoperative Imaging via In Situ Spraying. ACS APPLIED MATERIALS & INTERFACES 2021; 13:58369-58381. [PMID: 34870406 DOI: 10.1021/acsami.1c17797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The ability to visualize the full extent of atherosclerotic plaques during surgery has major implications for therapeutic outcomes. Fluorescence imaging is a promising approach for atherosclerotic plaque inspection during surgery. However, a specific strategy for the intraoperative fluorescence imaging of atherosclerosis has not been established. This study presents an in situ spraying aerosol of a lipid droplet-specific probe to rapidly and precisely locate atherosclerotic plaques during surgery. Stable imaging of the plaque was achieved within 5 min by nebulizing the aqueous solution of the lipid droplet-specific probe (CN-PD) into 3 μm droplets and rapidly permeating it in situ. The visible fluorescence bioimaging of CN-PD can accurately delineate the plaque margins and size even with a diameter ≤0.5 mm, which are capable of being swiftly captured during the stable plaque imaging window (>2 h). This strategy combines the consideration of a specific probe design and an efficient in situ delivery, which results in weak interference from the background signals. Therefore, the plaque-to-normal tissue ratio (P/N) is sufficient to facilitate the surgical delineation of carotid atherosclerotic plaques. The originality of the intraoperative fluorescence imaging of the plaques via in situ delivery of the lipid droplet-specific probe holds promise for effective clinical application.
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Affiliation(s)
- Mangmang Sang
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital, Xiamen University, 2999 Jinshan Road, Huli District, Xiamen 361006, China
| | - Bicheng Cai
- Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen People's Hospital, Southern University of Science and Technology, 3046 Shennan East Road, Luohu District, Shenzhen 518055, China
| | - Shuheng Qin
- Department of Biomedical Engineering, School of Engineering, China Pharmaceutical University, 24 Tongjia Lane, Gulou District, Nanjing 210009, China
| | - Shanshan Zhao
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital, Xiamen University, 2999 Jinshan Road, Huli District, Xiamen 361006, China
| | - Yijie Mao
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital, Xiamen University, 2999 Jinshan Road, Huli District, Xiamen 361006, China
| | - Yan Wang
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital, Xiamen University, 2999 Jinshan Road, Huli District, Xiamen 361006, China
| | - Xiu Yu
- Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen People's Hospital, Southern University of Science and Technology, 3046 Shennan East Road, Luohu District, Shenzhen 518055, China
| | - Jinrong Zheng
- Institute of Cardiovascular Diseases, Xiamen Cardiovascular Hospital, Xiamen University, 2999 Jinshan Road, Huli District, Xiamen 361006, China
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Vilz TO, Kalff JC, Stoffels B. [Evidence of indocyanine green fluorescence in robotically assisted colorectal surgery : What is the status?]. Chirurg 2021; 92:115-121. [PMID: 33432386 DOI: 10.1007/s00104-020-01340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Indocyanine green (ICG) fluorescence imaging is increasingly being used in various areas of abdominal surgery. The constant improvement in the technology enables easy intraoperative use and progressively influences operative decision-making, also in robotically assisted colorectal surgery. OBJECTIVE Summation of current evidence on the use of ICG fluorescence imaging in robotically assisted colorectal surgery. MATERIAL AND METHODS The assessment of evidence is based on a comprehensive literature search (PubMed). RESULTS First individual studies (feasibility, case matched, prospective cohort, multicenter phase II, single center randomized controlled study/trial) showed a significant reduction in the incidence of anastomotic leakage (AL) after colorectal anastomosis through the use of ICG fluorescence angiography (FA, 9.1% vs. 16.3%; p = 0.04). First feasibility studies demonstrated lymph node detection or navigation as well as ureter visualization. CONCLUSION The ICG-FA reliably detects tissue perfusion, quickly and effectively with few side effects. It can influence intraoperative decision-making and reduce AL rates. In addition, patients may be offered more precise tumor therapy via ICG sentinel lymph node (SLN) detection and lateral pelvic lymph node (LPN) mapping and navigation. Iatrogenic lesions, such as ureteral injuries can be sufficiently prevented by appropriate visualization; however, valid data in order to be able to derive standardized operative consequences require further convincing multicenter, randomized controlled trials (mRCT).
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Affiliation(s)
| | | | - B Stoffels
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
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Simultaneous multipurpose fluorescence imaging with IRDye® 800BK during laparoscopic surgery. Surg Endosc 2020; 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] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND IRDye® 800BK is a fluorophore, currently undergoing clinical translation, which has both biliary and renal clearance. To date, there is no description of a fluorophore, which can be simultaneously used for non-invasive, near-infrared fluorescence-based (NIRF) visualization of different structures and perfusion evaluation. The purpose of this study was to evaluate IRDye® 800BK for the simultaneous assessment of bowel perfusion, lymphography, ureter and bile duct delineation. METHODS Six pigs received a 0.15 mg/kg dye as a single bolus intravenous injection (IV). With the FLER (fluorescence-based enhanced reality) software, fluorescence intensity (FI) of 5 regions of interest (ROI) in an ischemic bowel loop was measured along with the time to reach the FI peak, and capillary lactate was measured from the same ROI, followed by the assessment of the ureters and bile ducts for a maximal duration of 180 min after dye administration. In 3 animals, the procedure was initiated via gastroscopic injection of a 0.6 mg (1 mg/mL) dye in the gastric submucosa followed by lymphography in a NIRF setting. RESULTS Excellent visualization of the ureters and bowel perfusion was obtained under NIRF imaging. Additionally, the bile duct and gastric lymph ducts and nodes were visualized. A positive correlation was found between the time to peak FI in the ischemic bowel loop and the corresponding capillary lactate levels (rho 0.59, p < 0.001). CONCLUSION In this study, we successfully demonstrated the simultaneous multipurpose IRDye® 800BK applicability during laparoscopic surgery. This fluorophore has the potential to become a powerful and versatile image-guided surgery tool.
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