A novel method for near-infrared fluorescence imaging of the urethra during perineal and transanal surgery: demonstration in a cadaveric model
A novel method for near-infrared fluorescence imaging of the urethra during perineal and transanal surgery: demonstration in a cadaveric model
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DOI：
10.1111/codi.15156
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发表时间：
2020-11-01
影响因子：
3.4
通讯作者：
Diana, M.
中科院分区：
文献类型：
--
作者：
Barberio, M.;Al-Taher, M.;Diana, M.
目的经肛门全直肠系膜切除术是治疗低位直肠癌的一种新的保肛术式。然而，经肛门自下而上剥离术与医源性尿道损伤的发生率增加有关。近红外荧光（NIRF）成像，鉴于其更深的组织渗透，已在有限数量的研究中探索，以增强术中尿道可视化。在这项研究中，我们探索了一种新型、超亮、生物相容性荧光聚合物涂覆导尿管以实现手术中尿道可视化的可行性。方法在离体实验中，使用近红外腹腔镜，涂层导管的荧光信号（设备的近红外涂层，NICE）与吲哚菁绿色（ICG）/Instillagel（R）混合物和几种浓度的ICG填充导管的信号进行定性和定量比较。此外，在三名男性人体躯干，使用荧光导尿管，近红外线引导会阴剥离和经肛门全直肠系膜切除术进行。术中NIRF为基础的尿道visualizations.Results在定性和定量的荧光信号评估，NICE涂层导管明显优于ICG为基础的解决方案上级。在尸体实验中，增强尿道可视化是可能的，即使在早期阶段的解剖，当器官被覆盖的几个组织layers.Conclusions NICE涂层导管代表一个很有前途的潜力，允许基于NIRF的术中尿道可视化。
Aim Transanal total mesorectal excision is a promising novel sphincter-saving procedure for low rectal cancer. However, the transanal bottom-up dissection is associated with increased rates of iatrogenic urethral injuries. Near-infrared fluorescence (NIRF) imaging, given its deeper tissue penetration, has been explored in a limited number of studies for enhanced intra-operative urethral visualization. In this study, we explored the feasibility of a novel, ultrabright, biocompatible fluorescent polymer to coat urinary catheters for the purpose of intra-operative urethral visualization.Methods In an ex vivo experiment, using a near-infrared laparoscope, the fluorescent signal of a coated catheter (near-infrared coating of equipment, NICE) was qualitatively and quantitatively compared to the signal of indocyanine green (ICG)/Instillagel (R) mixtures and ICG-filled catheters at several concentrations. Also, in three male human torsos, using fluorescent urinary catheters, NIRF-guided perineal dissections and a transanal total mesorectal excision were performed. Intra-operative NIRF-based urethral visualization was performed systematically.Results During the qualitative and quantitative fluorescence signal assessment, NICE-coated catheters were clearly superior to the ICG-based solutions. In the cadaveric experiments, enhanced urethral visualization was possible even at early stages of dissection, when the organ was covered by several tissue layers.Conclusions NICE-coated catheters represent a promising potential to allow for NIRF-based intra-operative urethral visualization.