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Abstract
Objective In this review, we provide examples of applications of fluorescence imaging in urologic, gynecologic, general, and endocrine surgeries. Background While robotic-assisted surgery has helped increase the availability of minimally invasive procedures across surgical specialties, there remains an opportunity to reduce adverse events associated with open, laparoscopic, and robotic-assisted methods. In 2011, fluorescence imaging was introduced as an option to the da Vinci Surgical System, and has been standard equipment since 2014. Without interfering with surgical workflow, this fluorescence technology named Firefly® allows for acquisition and display of near-infrared fluorescent signals that are co-registered with white light endoscopic images. As a result, robotic surgeons of all specialties have been able to explore the clinical utility of fluorescence guided surgery. Methods Literature searches were performed using the PubMed and MEDLINE databases using the keywords "robotic-assisted fluorescence surgery", "ICG robotic surgery", and "fluorescence guided surgery" covering the years 2011-2020. Conclusions Real-time intraoperative fluorescence guidance has shown great potential in helping guide surgeons in both simple and complex surgical interventions. Indocyanine green is one of the most widely-used imaging agents in fluorescence guided surgery, and other targeted, near-infrared imaging agents are in various stages of development. Fluorescence is becoming a reliable tool that can help surgeons in their decision-making process in some specialties, while explorations continue in others.
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Affiliation(s)
- Yu-Jin Lee
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | | | - Ryan K Orosco
- Moores Cancer Center, La Jolla, CA, USA.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, CA, USA
| | - Eben L Rosenthal
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Jonathan M Sorger
- Department of Research, Intuitive Surgical, Inc., Sunnyvale, CA, USA
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Horgan CC, Bergholt MS, Thin MZ, Nagelkerke A, Kennedy R, Kalber TL, Stuckey DJ, Stevens MM. Image-guided Raman spectroscopy probe-tracking for tumor margin delineation. J Biomed Opt 2021; 26:JBO-200321R. [PMID: 33715315 PMCID: PMC7960531 DOI: 10.1117/1.jbo.26.3.036002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/17/2021] [Indexed: 06/01/2023]
Abstract
SIGNIFICANCE Tumor detection and margin delineation are essential for successful tumor resection. However, postsurgical positive margin rates remain high for many cancers. Raman spectroscopy has shown promise as a highly accurate clinical spectroscopic diagnostic modality, but its margin delineation capabilities are severely limited by the need for pointwise application. AIM We aim to extend Raman spectroscopic diagnostics and develop a multimodal computer vision-based diagnostic system capable of both the detection and identification of suspicious lesions and the precise delineation of disease margins. APPROACH We first apply visual tracking of a Raman spectroscopic probe to achieve real-time tumor margin delineation. We then combine this system with protoporphyrin IX fluorescence imaging to achieve fluorescence-guided Raman spectroscopic margin delineation. RESULTS Our system enables real-time Raman spectroscopic tumor margin delineation for both ex vivo human tumor biopsies and an in vivo tumor xenograft mouse model. We then further demonstrate that the addition of protoporphyrin IX fluorescence imaging enables fluorescence-guided Raman spectroscopic margin delineation in a tissue phantom model. CONCLUSIONS Our image-guided Raman spectroscopic probe-tracking system enables tumor margin delineation and is compatible with both white light and fluorescence image guidance, demonstrating the potential for our system to be developed toward clinical tumor resection surgeries.
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Affiliation(s)
- Conor C. Horgan
- Imperial College London, Department of Materials, London, United Kingdom
- Imperial College London, Department of Bioengineering, London, United Kingdom
- Imperial College London, Institute of Biomedical Engineering, London, United Kingdom
| | - Mads S. Bergholt
- Imperial College London, Department of Materials, London, United Kingdom
- Imperial College London, Department of Bioengineering, London, United Kingdom
- Imperial College London, Institute of Biomedical Engineering, London, United Kingdom
| | - May Zaw Thin
- University College London, Centre for Advanced Biomedical Imaging, London, United Kingdom
| | - Anika Nagelkerke
- Imperial College London, Department of Materials, London, United Kingdom
- Imperial College London, Department of Bioengineering, London, United Kingdom
- Imperial College London, Institute of Biomedical Engineering, London, United Kingdom
| | - Robert Kennedy
- King’s College London, Guy’s and St Thomas’ NHS Foundation Trust, Oral/Head and Neck Pathology Laboratory, London, United Kingdom
| | - Tammy L. Kalber
- University College London, Centre for Advanced Biomedical Imaging, London, United Kingdom
| | - Daniel J. Stuckey
- University College London, Centre for Advanced Biomedical Imaging, London, United Kingdom
| | - Molly M. Stevens
- Imperial College London, Department of Materials, London, United Kingdom
- Imperial College London, Department of Bioengineering, London, United Kingdom
- Imperial College London, Institute of Biomedical Engineering, London, United Kingdom
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Sardar HS, Zai Q, Xu X, Gunn JR, Pogue BW, Paulsen KD, Henderson ER, Samkoe KS. Dual-agent fluorescent labeling of soft-tissue sarcomas improves the contrast based upon targeting both interstitial and cellular components of the tumor milieu. J Surg Oncol 2020; 122:1711-1720. [PMID: 32885452 DOI: 10.1002/jso.26190] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/14/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Current practices for fluorescence-guided cancer surgery utilize a single fluorescent agent, but homogeneous distribution throughout the tumor is difficult to achieve. We hypothesize that administering a perfusion and a molecular-targeted agent at their optimal administration-to-imaging time will improve whole-tumor contrast. EXPERIMENTAL DESIGN Mice bearing subcutaneous xenograft human synovial sarcomas were administered indocyanine green (ICG) (3 mg/kg) or ABY-029 (48.7 μg/kg)-an epidermal growth factor receptor-targeted Affibody molecule-alone or in combination. Fluorescence contrast and signal distribution were compared between treatment groups. Two commercial fluorescence imaging systems were tested for simultaneous imaging of ICG and ABY-029. RESULTS ABY-029 has a moderate positive correlation with viable tumor (ρ = 0.2 ± 0.4), while ICG demonstrated a strong negative correlation (ρ = -0.6 ± 0.1). The contrast-to-variance ratio was highest in the ABY-029 +ICG (2.5 ± 0.8), compared to animals that received ABY-029 (2.3 ± 0.8) or ICG (2.0 ± 0.5) alone. Moreover, the combination of ABY-029 + ICG minimizes the correlation between viable tumor and fluorescence intensity (ρ = -0.1 ± 0.2) indicating the fluorescence signal distribution is more homogeneous throughout the tumor milieu. CONCLUSION Dual-agent imaging utilizing a single channel in a commercial fluorescence-guided imaging system tailored for IRDye 800CW is a promising method to increase tumor contrast in a clinical setting.
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Affiliation(s)
- Hira S Sardar
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Qais Zai
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Xiaochun Xu
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jason R Gunn
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.,Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.,Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Eric R Henderson
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Haj A, Doenitz C, Schebesch KM, Ehrensberger D, Hau P, Putnik K, Riemenschneider MJ, Wendl C, Gerken M, Pukrop T, Brawanski A, Proescholdt MA. Extent of Resection in Newly Diagnosed Glioblastoma: Impact of a Specialized Neuro-Oncology Care Center. Brain Sci 2017; 8:brainsci8010005. [PMID: 29295569 PMCID: PMC5789336 DOI: 10.3390/brainsci8010005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/07/2017] [Accepted: 12/19/2017] [Indexed: 02/05/2023] Open
Abstract
Treatment of glioblastoma (GBM) consists of microsurgical resection followed by concomitant radiochemotherapy and adjuvant chemotherapy. The best outcome regarding progression free (PFS) and overall survival (OS) is achieved by maximal resection. The foundation of a specialized neuro-oncology care center (NOC) has enabled the implementation of a large technical portfolio including functional imaging, awake craniotomy, PET scanning, fluorescence-guided resection, and integrated postsurgical therapy. This study analyzed whether the technically improved neurosurgical treatment structure yields a higher rate of complete resection, thus ultimately improving patient outcome. Patients and methods: The study included 149 patients treated surgically for newly diagnosed GBM. The neurological performance score (NPS) and the Karnofsky performance score (KPS) were measured before and after resection. The extent of resection (EOR) was volumetrically quantified. Patients were stratified into two subcohorts: treated before (A) and after (B) the foundation of the Regensburg NOC. The EOR and the PFS and OS were evaluated. Results: Prognostic factors for PFS and OS were age, preoperative KPS, O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation status, isocitrate dehydrogenase 1 (IDH1) mutation status and EOR. Patients with volumetrically defined complete resection had significantly better PFS (9.4 vs. 7.8 months; p = 0.042) and OS (18.4 vs. 14.5 months; p = 0.005) than patients with incomplete resection. The frequency of transient or permanent postoperative neurological deficits was not higher after complete resection in both subcohorts. The frequency of complete resection was significantly higher in subcohort B than in subcohort A (68.2% vs. 34.8%; p = 0.007). Accordingly, subcohort B showed significantly longer PFS (8.6 vs. 7.5 months; p = 0.010) and OS (18.7 vs. 12.4 months; p = 0.001). Multivariate Cox regression analysis showed complete resection, age, preoperative KPS, and MGMT promoter status as independent prognostic factors for PFS and OS. Our data show a higher frequency of complete resection in patients with GBM after the establishment of a series of technical developments that resulted in significantly better PFS and OS without increasing surgery-related morbidity.
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Affiliation(s)
- Amer Haj
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Christian Doenitz
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Karl-Michael Schebesch
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Denise Ehrensberger
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Peter Hau
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurology, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Kurt Putnik
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Radiation Oncology, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Markus J Riemenschneider
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neuropathology, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Christina Wendl
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neuroradiology, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Michael Gerken
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Tumor Center Regensburg, Institute of Quality Assurance and Health Services Research, University of Regensburg, 93053 Regensburg, Germany.
| | - Tobias Pukrop
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Hematology and Oncology, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Alexander Brawanski
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
| | - Martin A Proescholdt
- Wilhelm Sander Neuro-Oncology Unit, University Medical Center Regensburg, 93053 Regensburg, Germany.
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
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