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Wang LG, Montaño AR, Masillati AM, Jones JA, Barth CW, Combs JR, Kumarapeli SU, Shams NA, van den Berg NS, Antaris AL, Galvis SN, McDowall I, Rizvi SZH, Alani AWG, Sorger JM, Gibbs SL. Nerve Visualization using Phenoxazine-Based Near-Infrared Fluorophores to Guide Prostatectomy. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2304724. [PMID: 37653576 DOI: 10.1002/adma.202304724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/27/2023] [Indexed: 09/02/2023]
Abstract
Fluorescence-guided surgery (FGS) is poised to revolutionize surgical medicine through near-infrared (NIR) fluorophores for tissue- and disease-specific contrast. Clinical open and laparoscopic FGS vision systems operate nearly exclusively at NIR wavelengths. However, tissue-specific NIR contrast agents compatible with clinically available imaging systems are lacking, leaving nerve tissue identification during prostatectomy a persistent challenge. Here, it is shown that combining drug-like molecular design concepts and fluorophore chemistry enabled the production of a library of NIR phenoxazine-based fluorophores for intraoperative nerve-specific imaging. The lead candidate readily delineated prostatic nerves in the canine and iliac plexus in the swine using the clinical da Vinci Surgical System that has been popularized for minimally invasive prostatectomy procedures. These results demonstrate the feasibility of molecular engineering of NIR nerve-binding fluorophores for ready integration into the existing surgical workflow, paving the path for clinical translation to reduce morbidity from nerve injury for prostate cancer patients.
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Affiliation(s)
- Lei G Wang
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, 97201, USA
| | - Antonio R Montaño
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
| | - Anas M Masillati
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
| | - Jocelyn A Jones
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
| | - Connor W Barth
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
| | - Jason R Combs
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
| | | | - Nourhan A Shams
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
| | | | | | - S N Galvis
- Intuitive Surgical, Sunnyvale, CA, 94086, USA
| | | | - Syed Zaki Husain Rizvi
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
| | - Adam W G Alani
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, 97201, USA
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA
| | | | - Summer L Gibbs
- Biomedical Engineering Department, Oregon Health and Science University, Portland, OR, 97201, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, 97201, USA
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Sievert KD, Hennenlotter J, Dillenburg T, Toomey P, Wöllner J, Zweers P, Pannek J, Andersson KE, Amend B. Extended periprostatic nerve distributions on the prostate surface confirmed using diffusion tensor imaging. BJU Int 2019; 123:995-1004. [DOI: 10.1111/bju.14508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Karl-Dietrich Sievert
- Department of Urology; Eberhard-Karls University Tuebingen; Tuebingen Germany
- PMU; Salzburg Austria
- Department of Urology; Medical University of Vienna; Vienna Austria
- Klinikum Lippe; Detmold Germany
| | - Jörg Hennenlotter
- Department of Urology; Eberhard-Karls University Tuebingen; Tuebingen Germany
| | - Thomas Dillenburg
- Department of Urology; Eberhard-Karls University Tuebingen; Tuebingen Germany
| | | | - Jens Wöllner
- Department of Urology; Medical University of Vienna; Vienna Austria
- Neuro-Urology; Swiss Paraplegic Center; Nottwil Switzerland
| | - Peter Zweers
- Klinikum Lippe; Detmold Germany
- Neuro-Urology; Swiss Paraplegic Center; Nottwil Switzerland
| | - Jürgen Pannek
- Klinikum Lippe; Detmold Germany
- Neuro-Urology; Swiss Paraplegic Center; Nottwil Switzerland
| | | | - Bastian Amend
- Department of Urology; Eberhard-Karls University Tuebingen; Tuebingen Germany
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Clarebrough E, Christidis D, Lindner U, Fernandes K, Fleshner N, Lawrentschuk N. Analysis of a practical surgical skills laboratory for nerve sparing radical prostatectomy. World J Urol 2018; 37:799-804. [PMID: 30191394 DOI: 10.1007/s00345-018-2472-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE With the rapidly expanding anatomical and technical knowledge surrounding nervesparing radical prostatectomy (NSRP), anatomical and operative textbooks have failed to keep pace with the literature. A surgical skill laboratory (SSL) was designed to educate urology trainees on surgical anatomy and techniques for NSRP. The objective was to assess the validity of a SSL program. METHODS A low-fidelity, anatomically accurate prostate model with its appropriate fascial coverings and location of the neurovascular bundle was created. Participants were surveyed prior to a SSL workshop for their knowledge of NSRP focusing on clinical and anatomical considerations. An interactive 2-h tutorial and workshop was then undertaken outlining the clinical and anatomical nuances for NSRP, with participants then practising an intra and inter-fascial NSRP on the model. Participants were resurveyed immediately after the workshop and at 6 months. RESULTS Thirty participants completed the NSRP workshop. Significant differences (p < 0.0001) in anatomical and clinical knowledge were noted after the workshop with improvements for both junior and senior trainees. The knowledge was retained at 6 months following the workshop. CONCLUSIONS A low-fidelity bench-top model is a feasible and reproducible technique for improving the understanding of periprostatic anatomy and the different surgical approaches for NSRP. The SSL is useful and knowledge gained appears to be retained by workshop participants. SSL workshops are a valid hands-on approach to teaching surgical skills and should remain an integral part of urology training.
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Affiliation(s)
- Emma Clarebrough
- Department of Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia. .,Young Urology Researchers Organisation (YURO), Melbourne, VIC, Australia.
| | - Daniel Christidis
- Young Urology Researchers Organisation (YURO), Melbourne, VIC, Australia.,Department of Surgery, Austin Health, Melbourne, VIC, Australia
| | - Uri Lindner
- Department of Urology and Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - Kimberly Fernandes
- Department of Urology and Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - Neil Fleshner
- Department of Urology and Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia.,Olivia Newton John Cancer Research Institute, Austin Health, Melbourne, VIC, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Hirose K, Aoki T, Furukawa T, Fukushima S, Niioka H, Deguchi S, Hashimoto M. Coherent anti-Stokes Raman scattering rigid endoscope toward robot-assisted surgery. BIOMEDICAL OPTICS EXPRESS 2018; 9:387-396. [PMID: 29552380 PMCID: PMC5854045 DOI: 10.1364/boe.9.000387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 05/16/2023]
Abstract
Label-free visualization of nerves and nervous plexuses will improve the preservation of neurological functions in nerve-sparing robot-assisted surgery. We have developed a coherent anti-Stokes Raman scattering (CARS) rigid endoscope to distinguish nerves from other tissues during surgery. The developed endoscope, which has a tube with a diameter of 12 mm and a length of 270 mm, achieved 0.91% image distortion and 8.6% non-uniformity of CARS intensity in the whole field of view (650 μm diameter). We demonstrated CARS imaging of a rat sciatic nerve and visualization of the fine structure of nerve fibers.
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Affiliation(s)
- K. Hirose
- Graduate School of Engineering Science, Osaka University, Osaka,
Japan
| | - T. Aoki
- Graduate School of Engineering Science, Osaka University, Osaka,
Japan
| | - T. Furukawa
- Faculty of Engineering, Yokohama National University, Yokohama,
Japan
| | - S. Fukushima
- Graduate School of Engineering Science, Osaka University, Osaka,
Japan
| | - H. Niioka
- Graduate School of Engineering Science, Osaka University, Osaka,
Japan
| | - S. Deguchi
- Graduate School of Engineering Science, Osaka University, Osaka,
Japan
| | - M. Hashimoto
- Graduate School of Information Science and Technology, Hokkaido University, Hokkaido,
Japan
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Hinata N, Murakami G, Miyake H, Abe SI, Fujisawa M. Histological Study of the Cavernous Nerve Mesh Outside the Periprostatic Region: Anatomical Basis for Erectile Function after Nonnerve Sparing Radical Prostatectomy. J Urol 2015; 193:1052-9. [DOI: 10.1016/j.juro.2014.08.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Nobuyuki Hinata
- Department of Urology, Kobe University School of Medicine, Kobe, Japan
| | - Gen Murakami
- Division of Internal Medicine, Iwamizawa Kojin-kai Hospital, Iwamizawa, Japan
| | - Hideaki Miyake
- Department of Urology, Kobe University School of Medicine, Kobe, Japan
| | - Shin-ichi Abe
- Department of Anatomy, Tokyo Dental University School of Medicine, Tokyo, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University School of Medicine, Kobe, Japan
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Schatloff O, Kameh D, Giedelman C, Samavedi S, Abdul-Muhsin H, Coelho RF, Kang SG, Palmer KJ, Patel VR. Proposal of a method to assess and report the extent of residual neurovascular tissue present in radical prostatectomy specimens. BJU Int 2013; 112:E301-6. [DOI: 10.1111/bju.12038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Oscar Schatloff
- Global Robotics Institute; Florida Hospital Celebration Health; Celebration; FL; USA
| | - Darian Kameh
- Global Robotics Institute; Florida Hospital Celebration Health; Celebration; FL; USA
| | - Camilo Giedelman
- Global Robotics Institute; Florida Hospital Celebration Health; Celebration; FL; USA
| | - Srinivas Samavedi
- Global Robotics Institute; Florida Hospital Celebration Health; Celebration; FL; USA
| | - Haidar Abdul-Muhsin
- Global Robotics Institute; Florida Hospital Celebration Health; Celebration; FL; USA
| | | | - Sung Gu Kang
- Department of Urology; Korea University School of Medicine; Seoul; Korea
| | - Kenneth J. Palmer
- Global Robotics Institute; Florida Hospital Celebration Health; Celebration; FL; USA
| | - Vipul R. Patel
- Global Robotics Institute; Florida Hospital Celebration Health; Celebration; FL; USA
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Effect of a Risk-stratified Grade of Nerve-sparing Technique on Early Return of Continence After Robot-assisted Laparoscopic Radical Prostatectomy. Eur Urol 2013; 63:438-44. [DOI: 10.1016/j.eururo.2012.07.009] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 07/09/2012] [Indexed: 11/18/2022]
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Ganzer R, Stolzenburg JU, Wieland WF, Bründl J. Anatomic Study of Periprostatic Nerve Distribution: Immunohistochemical Differentiation of Parasympathetic and Sympathetic Nerve Fibres. Eur Urol 2012; 62:1150-6. [DOI: 10.1016/j.eururo.2012.03.039] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 03/20/2012] [Indexed: 11/30/2022]
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Schatloff O, Chauhan S, Kameh D, Valero R, Ko YH, Sivaraman A, Coelho RF, Marquinez J, Palmer KJ, Patel VR. Cavernosal nerve preservation during robot-assisted radical prostatectomy is a graded rather than an all-or-none phenomenon: objective demonstration by assessment of residual nerve tissue on surgical specimens. Urology 2012; 79:596-600. [PMID: 22386406 DOI: 10.1016/j.urology.2011.11.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 11/20/2011] [Accepted: 11/20/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To demonstrate the existence of different degrees of nerve sparing (NS) (graded NS) by comparing the surgeon's intent of NS with the residual nerve tissue on prostatectomy specimens. METHODS We performed a prospective study of 133 consecutive patients who underwent robot-assisted radical prostatectomy in January and February of 2011. The surgeon graded the amount of NS intraoperatively independently for either side as follows: 1, no NS; 2, <50% NS; 3, 50% NS; 4, 75% NS; and 5, ≥ 95% NS. A pathologist who was unaware of the surgeon's score measured the area of residual nerve tissue on the posterolateral surface of the prostate. RESULTS A greater NS score correlated significantly with a decreasing area of residual nerve tissue on the prostatectomy specimens (P < .001). Overall, the area of residual nerve tissue on the prostatectomy specimens was significantly different among the NS groups (P < .001). On specific intergroup analysis, significant differences were found in the area of residual nerve tissue on the prostatectomy specimens between the greater NS groups: NS score 3 versus 4, median 13 mm(2) (interquartile range [IQR] 7-23) versus 3 mm(2) (IQR 0-8; P = .01); NS score 4 versus 5, median 3 mm(2) (IQR 0-8) versus 0.5 mm(2) (IQR 0-2; P = .001). CONCLUSION Subjective NS classification using the surgeon's intraoperative perception correlated significantly with the area of residual nerve tissue on the prostatectomy specimens determined by the pathologist. It is possible to intentionally tailor the amount of NS performed at surgery. This finding demonstrates that NS is a graded rather than an all-or-none phenomenon that can even go beyond the traditional concept of complete, partial, or no NS.
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Affiliation(s)
- Oscar Schatloff
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, Florida 34747, USA.
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10
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Anatomic Grading of Nerve Sparing During Robot-Assisted Radical Prostatectomy. Eur Urol 2012; 61:796-802. [DOI: 10.1016/j.eururo.2011.12.048] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/23/2011] [Indexed: 11/23/2022]
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The Role of the Prostatic Vasculature as a Landmark for Nerve Sparing During Robot-Assisted Radical Prostatectomy. Eur Urol 2012; 61:571-6. [DOI: 10.1016/j.eururo.2011.12.047] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/20/2011] [Indexed: 11/18/2022]
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12
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Prostatic peripheral nerve distribution may impact the functional outcome of nerve-sparing prostatectomy. World J Urol 2011; 31:377-82. [DOI: 10.1007/s00345-011-0791-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022] Open
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Hisasue SI. Advances in the study of the peripheral nervous system for erection in animals and humans. Reprod Med Biol 2011; 10:121-129. [PMID: 29699088 DOI: 10.1007/s12522-011-0081-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 03/19/2011] [Indexed: 11/27/2022] Open
Abstract
Introduction Since Walsh first emphasized the importance of preserving the neurovascular bundle n to protect the cavernous nerve during pelvic surgery, patients' sexual life quality has dramatically improved. Today, nerve-sparing radical prostatectomy is the established gold standard for organ-confined prostate cancer patients. Recent technical advances in functional assessment such as intraoperative electrical stimulation have unveiled new anatomical features and physiological roles. Basic research has advanced understanding of cavernous nerve function, while molecular biology has uncovered the crucial role of neuronal nitric oxide in mediating erection, and has led to new treatments such as phosphodiesterase type-5 inhibitors. A recent focus in cavernous nerve research concerns the nerve distribution external to the neurovascular bundle. The cavernous nerves in humans appear to be distributed more widely beneath the lateral pelvic fascia than in other animals, and electrical stimulation studies suggest possible involvement of these nerves in erection. These findings have prompted new surgical techniques such as the "veil of Aphrodite", or "intrafascial nerve-sparing" procedures. Materials and Methods These recent anatomical and physiological studies in humans and animals and their impact are reviewed in this article. Conclusions Further investigation should stimulate future advances in strategies to preserve erectile function in RP patients.
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Affiliation(s)
- Shin-Ichi Hisasue
- Department of Urology, School of Medicine Sapporo Medical University S1-W16, Chuo-ku 060-8543 Sapporo Hokkaido Japan
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Baseline Erectile Function Alters the Cavernous Nerve Quantity and Distribution Around the Prostate. J Urol 2010; 184:2062-7. [DOI: 10.1016/j.juro.2010.06.108] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Indexed: 11/20/2022]
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Ganzer R, Blana A, Stolzenburg JU. Reply. Urology 2009. [DOI: 10.1016/j.urology.2009.01.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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