Feasibility of quantitative diffuse reflectance spectroscopy for targeted measurement of renal ischemia during laparoscopic partial nephrectomy

Laparoscopic diffuse reflectance spectroscopy of an underlying tubular inclusion: a phantom study

We demonstrate diffuse reflectance spectroscopy (DRS) of a subsurface tubular inclusion by using a fiber probe having a single source-detector pair attached to a laparoscopic bipolar device. A forward model was also developed for DRS sensing of an underlying long absorbing tubular inclusion set in parallel to the tissue surface, normal to the line of sight of the source-detector pair, and equidistant from the source and the detector. The model agreed with measurements performed at 500 nm and using a 10 mm source-detector separation (SDS) on an aqueous tissue phantom embedding a tubing of 2 or 4 mm inner diameter that contained 9.1% to 33.3% red dye at a depth of up to 11.5 mm. When tested on solid phantoms using the 10 mm SDS, a tubular inclusion of $ \ge 3\;{\rm mm}$≥3mm inner diameter containing 0.05% red dye at a background absorption coefficient of $ 0.021\;{\rm mm}^{-1} $0.021mm^-1 caused $ \ge 8\% $≥8% change of the signal at 500 nm versus the baseline when the inclusion was shallower than 5 mm. When assessed on avian muscle tissue having a 4 mm tubular inclusion embedded at an edge depth of 2 mm, DRS with the 10 mm SDS differentiated the following contents of the inclusion: 33.3% red dye (mimicking blood), 33.3% green dye, 33.3% yellow dye (mimicking bile), water (mimicking urine), and air.

Simple analytical total diffuse reflectance over a reduced-scattering-pathlength scaled dimension of [10-5, 10-1] from a medium with HG scattering anisotropy

Model approximation is necessary for reflectance assessment of tissue at sub-diffusive to non-diffusive scale. For tissue probing over a sub-diffusive circular area centered on the point of incidence, we demonstrate simple analytical steady-state total diffuse reflectance from a semi-infinite medium with the Henyey-Greenstein (HG) scattering anisotropy (factor $g$g). Two physical constraints are abided to: (1) the total diffuse reflectance is the integration of the radial diffuse reflectance; (2) the radial and total diffuse reflectance at $g \gt {0}$g>0 analytically must resort to their respective forms corresponding to isotropic scattering as $g$g becomes zero. Steady-state radial diffuse reflectance near the point of incidence from a semi-infinite medium of $g \approx 0$g≈0 is developed based on the radiative transfer for isotropic scattering, then integrated to find the total diffuse reflectance for $g \approx 0$g≈0. The radial diffuse reflectance for $g \ge 0.5$g≥0.5 is semi-empirically formulated by comparing to Monte Carlo simulation results and abiding to the second constraint. Its integration leads to a total diffuse reflectance for $g \ge 0.5$g≥0.5 that is also bounded by the second constraint. Over a collection diameter of the reduced-scattering pathlength ($1/\mu _s^{ \prime}$1/μs') scaled size of [${{10}^{ - 5}}$10^-5, ${{10}^{ - 1}}$10^-1] for $g = [{0.5},{0.95}]$g=[0.5,0.95] and the absorption coefficient as strong as the reduced scattering coefficient, the simple analytical total diffuse reflectance is found to be accurate, with an average error of 16.1%.

Perspective review on solid-organ transplant: needs in point-of-care optical biomarkers

Solid-organ transplant is one of the most complex areas of modern medicine involving surgery. There are challenging opportunities in solid-organ transplant, specifically regarding the deficiencies in pathology workflow or gaps in pathology support, which may await alleviations or even de novo solutions, by means of point-of-care, or point-of-procedure optical biomarkers. Focusing the discussions of pathology workflow on donor liver assessment, we analyze the undermet need for intraoperative, real-time, and nondestructive assessment of the donor injuries (such as fibrosis, steatosis, and necrosis) that are the most significant predictors of post-transplant viability. We also identify an unmet need for real-time and nondestructive characterization of ischemia or irreversible injuries to the donor liver, earlier than appearing on morphological histology examined with light microscopy. Point-of-procedure laparoscopic optical biomarkers of liver injuries and tissue ischemia may also facilitate post-transplant management that is currently difficult for or devoid of pathological consultation due to lack of tools. The potential and pitfalls of point-of-procedure optical biomarkers for liver assessment are exemplified in breadth for steatosis. The more general and overarching challenges of point-of-procedure optical biomarkers for liver transplant pathology, including the shielding effect of the liver capsule that was quantitated only recently, are projected. The technological and presentational benchmarks that a candidate technology of point-of-procedure optical biomarkers for transplant pathology must demonstrate to motivate clinical translation are also foreseen.