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Wang LG, Gibbs SL. Improving precision surgery: A review of current intraoperative nerve tissue fluorescence imaging. Curr Opin Chem Biol 2023; 76:102361. [PMID: 37454623 DOI: 10.1016/j.cbpa.2023.102361] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/11/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
Iatrogenic nerve injury represents one of the most feared surgical complications and remains a major morbidity across many surgical specialties. Currently, no clinically approved technique can directly enhance intraoperative nerve visualization, where intraoperative nerve identification continues to challenge even experienced surgeons. Fluorescence-guided surgery (FGS) has been successfully integrated into clinical medicine to improve safety and efficacy in the surgical arena. A number of tissue- and disease-specific contrast agents are in the clinical translation pipeline for future FGS integration. Within this context, a diverse repertoire of fluorescent tracers have been developed to improve surgeons' intraoperative vision. This review aims to convey the recent developments for nerve-specific FGS and its potential for clinical translation.
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Affiliation(s)
- Lei G Wang
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Portland, OR 97201, USA; Knight Cancer Institute, Oregon Health & Science University, 2720 S Moody Ave, Portland, OR 97201, USA
| | - Summer L Gibbs
- Biomedical Engineering Department, Oregon Health & Science University, 2730 S Moody Ave, Portland, OR 97201, USA; Knight Cancer Institute, Oregon Health & Science University, 2720 S Moody Ave, Portland, OR 97201, USA.
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Barth C, Rizvi SZH, Masillati AM, Chackraborty S, Wang LG, Montaño AR, Szafran DA, Greer WS, van den Berg N, Sorger J, Rao DA, Alani AW, Gibbs SL. Nerve-Sparing Gynecologic Surgery Enabled by A Near-Infrared Nerve-Specific Fluorophore Using Existing Clinical Fluorescence Imaging Systems. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023:e2300011. [PMID: 37452434 PMCID: PMC11042870 DOI: 10.1002/smll.202300011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 05/09/2023] [Indexed: 07/18/2023]
Abstract
Patients undergoing gynecological procedures suffer from lasting side effects due to intraoperative nerve damage. Small, delicate nerves with complex and nonuniform branching patterns in the female pelvic neuroanatomy make nerve-sparing efforts during standard gynecological procedures such as hysterectomy, cystectomy, and colorectal cancer resection difficult, and thus many patients are left with incontinence and sexual dysfunction. Herein, a near-infrared (NIR) fluorescent nerve-specific contrast agent, LGW08-35, that is spectrally compatible with clinical fluorescence guided surgery (FGS) systems is formulated and characterized for rapid implementation for nerve-sparing gynecologic surgeries. The toxicology, pharmacokinetics (PK), and pharmacodynamics (PD) of micelle formulated LGW08-35 are examined, enabling the determination of the optimal imaging doses and time points, blood and tissue uptake parameters, and maximum tolerated dose (MTD). Application of the formulated fluorophore to imaging of female rat and swine pelvic neuroanatomy validates the continued clinical translation and use for real-time identification of important nerves such as the femoral, sciatic, lumbar, iliac, and hypogastric nerves. Further development of LGW08-35 for clinical use will unlock a valuable tool for surgeons in direct visualization of important nerves and contribute to the ongoing characterization of the female pelvic neuroanatomy to eliminate the debilitating side effects of nerve damage during gynecological procedures.
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Affiliation(s)
- Connor Barth
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201
| | - Syed Zaki Husain Rizvi
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201
| | - Anas M. Masillati
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201
| | - Samrat Chackraborty
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201
| | - Lei G. Wang
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97201
| | - Antonio R. Montaño
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201
| | - Dani A. Szafran
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201
| | - William S. Greer
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201
| | | | | | - Deepa A. Rao
- School of Pharmacy, Pacific University, Hillsboro, OR 97123
| | - Adam W.G. Alani
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97201
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201
| | - Summer L. Gibbs
- Biomedical Engineering Department, Oregon Health & Science University, Portland, OR 97201
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97201
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Wei B, Su H, Chen P, Tan HL, Li N, Qin ZE, Huang P, Chang S. Recent advancements in peripheral nerve-specific fluorescent compounds. Biomater Sci 2021; 9:7799-7810. [PMID: 34747953 DOI: 10.1039/d1bm01256h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Nerve injury is a common complication of surgery. Accidental nerve damage or transection can lead to severe clinical symptoms including pain, numbness, paralysis and even expiratory dyspnoea. In recent years, with the rise of the field of fluorescence-guided surgery, researchers have discovered that nerve-specific fluorescent agents can serve as nerve markers in animals and can be used to guide surgical procedures and reduce the incidence of intraoperative nerve damage. Currently, researchers have begun to focus on biochemistry, materials chemistry and other fields to produce more neuro-specific fluorescent agents with physiological relevance and they are expected to have clinical applications. This review discusses the agents with potential to be used in fluorescence-guided nerve imaging during surgery.
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Affiliation(s)
- Bo Wei
- Department of General Surgery, Xiangya Hospital Central South University, Changsha 410008, Hunan, P.R. China.
| | - Huo Su
- Department of General Surgery, Xiangya Hospital Central South University, Changsha 410008, Hunan, P.R. China.
| | - Pei Chen
- Department of General Surgery, Xiangya Hospital Central South University, Changsha 410008, Hunan, P.R. China.
| | - Hai-Long Tan
- Department of General Surgery, Xiangya Hospital Central South University, Changsha 410008, Hunan, P.R. China.
| | - Ning Li
- Department of General Surgery, Xiangya Hospital Central South University, Changsha 410008, Hunan, P.R. China.
| | - Zi-En Qin
- Department of General Surgery, Xiangya Hospital Central South University, Changsha 410008, Hunan, P.R. China.
| | - Peng Huang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha 410008, Hunan, P.R. China.
| | - Shi Chang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha 410008, Hunan, P.R. China. .,National Clinical Research Center for Geriatric Disorders, Changsha 410008, Hunan, P.R. China.,Clinical Research Center for Thyroid Diseases in Hunan Province, Changsha 410008, Hunan, P.R. China
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