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Three-dimensional intraoperative imaging with O-arm to establish a working trajectory in percutaneous endoscopic lumbar discectomy
摘要： Introduction: Successful percutaneous endoscopic lumbar discectomy (PELD) requires an appropriate working trajectory. Due to the complexity of spinal anatomy, this is difficult to verify with conventional 2-dimensional fluoroscopy. Aim: Here we assessed the feasibility and utility of the O-arm for establishing the working trajectory for PELD. Material and methods: We retrospectively reviewed the records of 89 patients with lumbar disc herniation who underwent PELD using the O-arm. The working trajectory was evaluated with standard fluoroscopic images or 3-dimensional, volumetric computed tomography scan. Based on the detail provided by the multiplanar view, we confirmed the ideal working trajectory and adjusted the surgical approach accordingly. Results: At the 12-month follow-up, based on MacNab’s criteria, 85.9% of patients showed an excellent or good outcome. There were no major complications. Conclusions: The O-arm provides detailed multiplanar intraoperative high-quality imaging for PELD, and enables the surgeon to ascertain the surgical anatomy, determine the optimal working trajectory, and improve the accuracy of surgery.
关键词： O-arm,disc herniation,intraoperative imaging,percutaneous endoscopic lumbar discectomy,low back pain
更新于2025-09-23 15:21:21
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The Clinical Application of Fluorescence-Guided Surgery in Head and Neck Cancer
摘要： Although surgical resection has been the primary treatment modality of solid tumors for decades, surgeons still rely on visual cues and palpation to delineate healthy from cancerous tissue. This may contribute to the high rate (up to 30%) of positive margins in head and neck cancer resections. Margin status in these patients is the most important prognostic factor for overall survival. In addition, second primary lesions may be present at the time of surgery. Although often unnoticed by the medical team, these lesions can have significant survival ramifications. We hypothesize that real-time fluorescence imaging can enhance intraoperative decision-making by aiding the surgeon in detecting close or positive margins and visualizing unanticipated regions of primary disease. The purpose of this study was to assess the clinical utility of real-time fluorescence imaging for intraoperative decision-making. Methods: Head and neck cancer patients (n=14) scheduled for curative resection were enrolled in a clinical trial evaluating panitumumab-IRDye800CW for surgical guidance (NCT02415881). Open-field fluorescence imaging was performed throughout the surgical procedure. The fluorescence signal was quantified as signal-to-background ratios to characterize the fluorescence contrast of regions of interest relative to background. Results: Fluorescence imaging was able to improve surgical decision-making in three cases (21.4%); identification of a close margin (n=1) and unanticipated regions of primary disease (n=2). Conclusion: This study demonstrates the clinical applications of fluorescence imaging on intraoperative decision-making. This information is required for designing phase III clinical trials using this technique. Furthermore, this study is the first to demonstrate this application for intraoperative decision-making during resection of primary tumors.
关键词： real-time intraoperative imaging,head and neck cancer,Fluorescence-guided surgery
更新于2025-09-19 17:15:36
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A new method of near-infrared fluorescence image-guided hepatectomy for patients with hepatolithiasis: a??randomized controlled trial
摘要： Background Hepatectomy is a definitive treatment for hepatolithiasis because it simultaneously removes intrahepatic duct (IHD) stones and biliary tract strictures together with the involved liver region en bloc. Unlike cystic or solid liver tumors, hepatolithiasis is usually associated with alterations of anatomical structures and perihepatic adhesions because of chronic recurrent inflammation. This complicates identification of the target hepatic region and location of biliary strictures. Methods To determine the efficacy of near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG), we performed a comparative trial and developed a white-light and near-infrared dual-channel image-guided device (DPM-I) for both open and endoscopic surgery. Forty-four eligible patients were randomly assigned to Group A (NIRF imaging) or Group B (traditional hepatectomy). We injected ICG via peripheral veins for patients in Group A. Results The NIRF imaging method was associated with less blood loss (OR 1.004, 95% CI 0.999–1.010; P = 0.016), briefer hospitalization (OR 1.336, 95% CI 1.016–1.756; P = 0.001), lower rates of margins with dilated bile ducts (OR 1.278, 95% CI 1.030–1.585; P = 0.023), lower postoperative white blood cell counts (OR 1.262, 95% CI 0.931–1.712; P = 0.038), lower procalcitonin levels (OR 1.316, 95% CI 1.020–1.513; P = 0.002), and lower alanine aminotransferase levels (OR 1.013, 95% CI 1.003–1.023; P = 0.002) compared with traditional hepatectomy. Conclusions These data demonstrate the efficacy of NIRF imaging with ICG using DPM-I for treating hepatolithiasis.
关键词： Hepatolithiasis,Near-infrared fluorescence,Indocyanine green,Fluorescence image-guided hepatectomy,Intraoperative imaging
更新于2025-09-19 17:13:59
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Hyperspectral based discrimination of thyroid and parathyroid during surgery
摘要： Unintended injuring of anatomical structures during endocrine neck operations can have severe consequences for patient. Especially the nerves and the parathyroid gland can be hard to identify visually. Therefore, intraoperative methods are needed to support the surgeon in this task. Hyperspectral imaging (HSI) is a new approach in the medical area which combines a camera with a spectrometer. The mean absorbance spectra of both glands showed differences in the range between 600 and 700 nm and at 760 and 960 nm. This means that thyroid and parathyroid have different oxygenation states and different contents of deoxygenated hemoglobin and water. From these observations, it is possible to define spectral signatures to characterize both glands. We showed on one patient how spectral signatures can be used in classification algorithms to automatically identify the thyroid and parathyroid from other structures.
关键词： patient data,intraoperative imaging,gastrointestinal operation,classification algorithms,spectral signature
更新于2025-09-09 09:28:46
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Intraoperative visualization of the tumor microenvironment and quantification of extracellular vesicles by label-free nonlinear imaging
摘要： Characterization of the tumor microenvironment, including extracellular vesicles (EVs), is important for understanding cancer progression. EV studies have traditionally been performed on dissociated cells, lacking spatial information. Since the distribution of EVs in the tumor microenvironment is associated with cellular function, there is a strong need for visualizing EVs in freshly resected tissues. We intraoperatively imaged untreated human breast tissues using a custom nonlinear imaging system. Label-free optical contrasts of the tissue, correlated with histological findings, enabled point-of-procedure characterization of the tumor microenvironment. EV densities from 29 patients with breast cancer were found to increase with higher histologic grade and shorter tumor-to-margin distance and were significantly higher than those from 7 cancer-free patients undergoing breast reduction surgery. Acquisition and interpretation of these intraoperative images not only provide real-time visualization of the tumor microenvironment but also offer the potential to use EVs as a label-free biomarker for cancer diagnosis and prognosis.
关键词： extracellular vesicles,label-free nonlinear imaging,breast cancer,intraoperative imaging,tumor microenvironment
更新于2025-09-04 15:30:14
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The application of fluorescence techniques in meningioma surgery—a review
摘要： Surgical resections of meningiomas, the most common intracranial tumor in adults, can only be curative if radical resection is achieved. Potentially, the extent of resection could be improved, especially in complex and/or high-grade meningiomas by fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA), indocyanine green (ICG), or fluorescein. This review aims to summarize and evaluate these fluorescence-guided meningioma surgery techniques. PubMed and Embase were searched for relevant articles. Additionally, we checked reference lists for further studies. Forty-eight articles were included in the final analysis. 5-ALA fluoresced with varying sensitivity and selectivity in meningiomas and in invaded bone and dura mater. Although ICG was mainly applied for video angiography, one report shows tumor fluorescence 18–28 h post-ICG injection. Lastly, the use of fluorescein could aid in the identification of tumor remnants; however, detection of dural tail is highly questionable. Fluorescence-guided meningioma surgery should be a reliable, highly specific, and sensitive technique. Despite numerous studies reporting the use of fluorescent dyes, currently, there is no evidence that these tools improve the radical resection rate and long-term recurrence-free outcome in meningioma surgery without neurological deficits. Evidence regarding the effectiveness and increased safety of resection after the application of these fluorophores is currently lacking. Future research should focus on the development of a meningioma-targeted, highly sensitive, and specific fluorophore.
关键词： Fluorescence-guided surgery,Meningioma,Indocyanine green,5-Aminolevulinic acid,Intraoperative imaging,Fluorescein
更新于2025-09-04 15:30:14