Innovative surgical guidance for label-free real-time parathyroid identification
Innovative surgical guidance for label-free real-time parathyroid identification
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DOI：
10.1016/j.surg.2018.04.079
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发表时间：
2019-01-01
期刊：
影响因子：
3.8
通讯作者：
Mahadevan-Jansen, Anita
中科院分区：
文献类型：
--
作者：
Thomas, Giju;McWade, Melanie A.;Mahadevan-Jansen, Anita
工作背景：在颈部手术中难以识别甲状旁腺可能导致意外的甲状旁腺切除和术后低钙血症。一个名为PTeye的临床原型被开发用于指导甲状旁腺的识别，使用一个光纤探针，当手术室的灯保持打开时，该探针检测甲状旁腺的近红外自体荧光。同时设计了一个覆盖组织成像系统，用于检测近红外自体荧光并将可见光精确地投射到甲状旁腺位置。PTeye和叠加组织成像系统分别在20名和15名患者中进行了测试，并在6名患者中研究了改良的近红外成像系统。41例患者均行甲状腺或甲状旁腺切除术。系统的准确性与外科医生的视觉确认原位甲状旁腺和组织学切除的甲状旁腺。结果：有近红外自体荧光的健康和患病的甲状旁腺之间没有明显的差异。PTeye识别98%的甲状旁腺，而近红外成像系统和覆盖组织成像系统识别100%和97%的甲状旁腺，respectively.Conclusion：PTeye可以指导实时甲状旁腺识别，即使手术室环境灯。近红外成像系统以高灵敏度进行甲状旁腺成像，而覆盖组织成像系统直接在手术区域内增强甲状旁腺可视化，而无需显示监视器。这些无标记技术对于术中识别甲状旁腺是有价值的。(C)2018爱思唯尔公司All rights reserved.
Background: Difficulty in identifying the parathyroid gland during neck operations can lead to accidental parathyroid gland excisions and postsurgical hypocalcemia. A clinical prototype called as PTeye was developed to guide parathyroid gland identification using a fiber-optic probe that detects near-infrared autofluorescence from parathyroid glands as operating room lights remain on. An Overlay Tissue Imaging System was designed concurrently to detect near-infrared autofluorescence and project visible light precisely onto parathyroid gland location.Methods: The PTeye and the Overlay Tissue Imaging System were tested in 20 and 15 patients, respectively, and a modified near-infrared imaging system was investigated in 6 patients. All 41 patients underwent thyroidectomy or parathyroidectomy. System accuracy was ascertained with surgeon's visual confirmation for in situ parathyroid glands and histology for excised parathyroid glands.Results: There was no observable difference between near-infrared autofluorescence of healthy and diseased parathyroid glands. The PTeye identified 98% of the parathyroid gland, whereas the near-infrared imaging system and the Overlay Tissue Imaging System identified 100% and 97% of the parathyroid glands, respectively.Conclusion: The PTeye can guide in real-time parathyroid gland identification even with ambient operating room lights. The near -infrared imaging system performs parathyroid gland imaging with high sensitivity, whereas the Overlay Tissue Imaging System enhances parathyroid gland visualization directly within the surgical field without requiring display monitors. These label-free technologies can be valuable adjuncts for identifying parathyroid glands intraoperatively. (C) 2018 Elsevier Inc. All rights reserved.