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Komatsu S, Terui K, Takenouchi A, Kawaguchi Y, Nishimura K, Oita S, Yoshizawa H, Takiguchi S, Hishiki T. Indocyanine green fluorescence imaging as a predictor of long-term testicular atrophy in testicular torsion: a pilot study. Surg Today 2024:10.1007/s00595-024-02908-9. [PMID: 39085699 DOI: 10.1007/s00595-024-02908-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE This pilot study evaluated indocyanine green-guided near-infrared fluorescence (ICG-NIRF) imaging of testicular blood flow to predict long-term testicular atrophy after testicular torsion (TT) surgery. METHODS The subjects of this retrospective study were patients who underwent surgery for TT at our hospital between December, 2020 and July, 2022. After detorsion, testicular blood flow was evaluated by ICG-NIRF imaging and classified into three categories: fluorescence detected, no fluorescence detected, and fluorescence detected only in the tunica albuginea vessels. Testicular volume was measured by ultrasonography up to 12 months after surgery to evaluate long-term outcomes. RESULTS Twelve patients were included in this analysis. We found a 100% correlation between the absence of ICG-NIRF signals and subsequent testicular atrophy. In three patients without an ICG-NIRF signal, the median testis size 12 months postoperatively was significantly smaller (16.5% of the contralateral testis; range 13-20%) than that in six patients with an ICG-NIRF signal (96%; 89-115%) (p = 0.013). Mild atrophy (74.5%; 73-76%) was also observed in the three patients for whom an ICG-NIRF signal was detected only in the tunica albuginea vessels. CONCLUSIONS Our pilot study highlights the potential of ICG-NIRF imaging as a prognostic tool for guiding surgical decision-making for patients with TT, by predicting postoperative testicular atrophy.
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Affiliation(s)
- Shugo Komatsu
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan.
| | - Keita Terui
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Ayako Takenouchi
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Yunosuke Kawaguchi
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Katsuhiro Nishimura
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Satoru Oita
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Hiroko Yoshizawa
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Shota Takiguchi
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
| | - Tomoro Hishiki
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba, 260-8677, Japan
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Szavay PO, Bondoc A, Esposito C, Goldstein SD, Harms M, Kowalewski G, Lautz TB, Lopez M, Pachl M, Pandya S, Piché N, Rothenberg SS, Ruiterkamp J, Scholz S, Zendejas B, Rentea RM. Clinical Consensus Statement on the Use of Indocyanine Green Fluorescence-guided Surgery in Pediatric Patients. J Pediatr Surg 2024:161657. [PMID: 39179501 DOI: 10.1016/j.jpedsurg.2024.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 07/20/2024] [Accepted: 07/26/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND AND AIMS Indocyanine Green Fluorescence (ICG-F)- guided surgery is becoming an increasingly helpful tool in pediatric surgical care. This consensus statement investigates the utility of ICG-F in various pediatric surgical applications, primarily focusing on its evidence base, safety, indications, use across different surgical specialties and dosing strategies. The aim is to establish an international consensus for ICG-F use in pediatric surgery. METHODS An international panel of 15 pediatric surgeons from 9 countries was assembled. The structured process consisted of a rapid scoping review, iterative discussion sessions, mixed-methods studies with key stakeholders, and voting rounds on individual statements to create draft consensus statements. RESULTS 100 articles were identified during the review and summarized by application. Based on this condensed evidence, consensus statements were generated after 3 iterative rounds of anonymous voting. Key areas of agreement were quality of evidence, the safety of ICG, pediatric surgical indications, utilization per surgical specialty, and dosing of ICG. CONCLUSION This consensus statement aims to guide healthcare professionals in managing ICG-F use in pediatric surgical cases based on the best available evidence, key stakeholder consultation, and expert opinions. Despite ICG-F's promising potential, the need for higher-quality evidence, prospective trials, and safety studies is underscored. The consensus also provides a framework for pediatric surgeons to utilize ICG-F effectively. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Philipp O Szavay
- Department of Pediatric Surgery, Lucerne Children's Hospital, Lucerne, Switzerland
| | - Alex Bondoc
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ciro Esposito
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Seth D Goldstein
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Marc Harms
- Stryker Endoscopy, Stryker Nederland BV, Amsterdam, CM 1101, Netherlands
| | - Grzegorz Kowalewski
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, 04-730 Warsaw, Poland
| | - Timothy B Lautz
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Manuel Lopez
- Division of Pediatric Surgery, Val d'Hebron Maternity and Children's Hospital, Barcelona, Spain
| | - Max Pachl
- Department of Paediatric Surgery and Urology, Birmingham Women's and Children's NHS Foundation Trust, UK; Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, UK
| | - Samir Pandya
- University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Nelson Piché
- Division of Pediatric Surgery, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Steven S Rothenberg
- Division of Pediatric Surgery, Department of Surgery. Rocky Mountain Hospital for Children, Denver, CO 80205, USA
| | - Jetske Ruiterkamp
- Division Child Health, Wilhelmina Children's Hospital, University Medical Center Utrecht, Pediatric Surgery, Utrecht, EA 3584, Netherlands
| | - Stefan Scholz
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Rebecca M Rentea
- Comprehensive Colorectal Center, Section of Colorectal and Pelvic Reconstructive Surgery, Department of Pediatric Surgery, Children's Mercy-Kansas City, Kansas City, MO, 64108, USA; University of Missouri- Kansas City, Kansas City, MO 64108, USA.
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Liu J, Xiu W, Duan G, Wang B, Jiang N, Dong Q, Xia N, Lin A. Digital medicine and minimally invasive surgery in pediatric hepatoblastoma: An update. Asian J Surg 2024; 47:2132-2137. [PMID: 38331610 DOI: 10.1016/j.asjsur.2024.01.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/15/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
Hepatoblastoma (HB) is the most common liver malignancy in children, accounting for approximately 60 % of liver tumors in this population. However, the exact cause of HB remains unclear. The combination of surgery and neoadjuvant chemotherapy has significantly improved the overall survival rate of children with HB, increasing it from 40 % in the past to over 70 %. The concept of precise hepatectomy, which aims to achieve the best rehabilitation outcomes with minimal trauma and maximum liver protection, has been widely accepted by hepatobiliary surgeons. This article provides a comprehensive review of the recent advancements in surgical treatment of HB, focusing on digital surgery and minimally invasive techniques.
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Affiliation(s)
- Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China; Department of Medical Biology of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Wenli Xiu
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Guangqi Duan
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Bao Wang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Nannan Jiang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Qian Dong
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.
| | - Nan Xia
- Institute of Digital Medicine and Computer-assisted Surgery of Qingdao University, Qingdao University, Qingdao, China; Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Qingdao, China.
| | - Aiqin Lin
- Department of Medical Biology of Wannan Medical College, Wannan Medical College, Wuhu, China.
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Yang J, Qu J, Teng X, Zhu W, Xu Y, Yang Y, Qian X. Tumor Microenvironment-Responsive Hydrogel for Direct Extracellular ATP Imaging-Guided Surgical Resection with Clear Boundaries. Adv Healthc Mater 2023; 12:e2301084. [PMID: 37219912 DOI: 10.1002/adhm.202301084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/20/2023] [Indexed: 05/24/2023]
Abstract
Most solid tumors are clinically treated using surgical resection, and the presence of residual tumor tissues at the surgical margins often determines tumor survival and recurrence. Herein, a hydrogel (Apt-HEX/Cp-BHQ1 Gel, termed AHB Gel) is developed for fluorescence-guided surgical resection. AHB Gel is constructed by tethering a polyacrylamide hydrogel and ATP-responsive aptamers together. It exhibits strong fluorescence under high ATP concentrations corresponding to the TME (100-500 µm) but shows little fluorescence at low ATP concentrations (10-100 nm) such as those in normal tissues. AHB Gel can rapidly (within 3 min) emit fluorescence after exposure to ATP, and the fluorescence signal only occurs at sites exposed to high ATP, resulting in a clear boundary between the ATP-high and ATP-low regions. In vivo, AHB Gel exhibits specific tumor-targeting capacity with no fluorescence response in normal tissue, providing clear tumor boundaries. In addition, AHB Gel has good storage stability, which is conducive to its future clinical application. In summary, AHB Gel is a novel tumor microenvironment-targeted DNA-hybrid hydrogel for ATP-based fluorescence imaging. It can enable the precise imaging of tumor tissues, showing promising application in fluorescence-guided surgeries in the future.
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Affiliation(s)
- Jingyi Yang
- Shanghai Key Laboratory of Chemical Biology, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, P. R. China
| | - Jiahao Qu
- Shanghai Key Laboratory of Chemical Biology, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, P. R. China
| | - Xuanming Teng
- Shanghai Key Laboratory of Chemical Biology, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, P. R. China
| | - Weiping Zhu
- Shanghai Key Laboratory of Chemical Biology, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, P. R. China
- Shanghai Frontiers Science Center of Optogenetic Techniques for Cell Metabolism, School of Pharmacy, East China University of Science and Technology, 130 Mei Long Road, Shanghai, 200237, P. R. China
| | - Yufang Xu
- Shanghai Key Laboratory of Chemical Biology, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, P. R. China
| | - Yangyang Yang
- Shanghai Key Laboratory of Chemical Biology, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, P. R. China
| | - Xuhong Qian
- Shanghai Key Laboratory of Chemical Biology, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, P. R. China
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, 200237, P. R. China
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Warmann SW, Lieber J, Schaefer JF, Ebinger M, Urla C, Kirschner HJ, Tsiflikas I, Schmidt A, Fuchs J. Thoracoscopic Resection of Lung Nodules following CT-Guided Labeling in Children and Adolescents with Solid Tumors. CHILDREN 2023; 10:children10030542. [PMID: 36980100 PMCID: PMC10047192 DOI: 10.3390/children10030542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/09/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
Resection of lung metastases in children with solid tumors is regularly hampered by limited intraoperative detectability and relevant operative trauma of the open surgical access. The aim of this study was to analyze thoracoscopic resection of lung metastases in children following CT-guided labeling with coil wires. We retrospectively analyzed data of children and adolescents undergoing this approach at our institution between 2010 and 2022 with regard to technical aspects as well as surgical and oncological data. Within this period, we performed this procedure on 12 patients wherein we resected 18 lesions (1–5 per patient). The median age of patients was 178 months (51–265). The median duration of coil wire placement was 41 min (30–173) and the median surgery time was 53 min (11–157). No conversions were necessary and no intraoperative complications occurred. Complete microscopic resection (R0) was achieved in all labeled lesions and malignant tumor components were found in 5/12 patients. Our study shows that with a careful patient selection, thoracoscopic resection of lung metastases after coil wire labeling is a safe and reproducible procedure in children. Using this approach, lesions that are expected to have a reduced intraoperative detectability during open surgery become resectable. Patients benefit from the minimally invasive surgical access and reduced operative trauma.
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Affiliation(s)
- Steven W. Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children’s Hospital Tuebingen, 72076 Tübingen, Germany
- Correspondence: ; Tel.: +49-70712986621; Fax: +49-7071294046
| | - Justus Lieber
- Department of Pediatric Surgery and Pediatric Urology, University Children’s Hospital Tuebingen, 72076 Tübingen, Germany
| | - Juergen F. Schaefer
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, University Hospital Tuebingen, 72074 Tübingen, Germany
| | - Martin Ebinger
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Tuebingen, 72076 Tübingen, Germany
| | - Cristian Urla
- Department of Pediatric Surgery and Pediatric Urology, University Children’s Hospital Tuebingen, 72076 Tübingen, Germany
| | - Hans-Joachim Kirschner
- Department of Pediatric Surgery and Pediatric Urology, University Children’s Hospital Tuebingen, 72076 Tübingen, Germany
| | - Ilias Tsiflikas
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, University Hospital Tuebingen, 72074 Tübingen, Germany
| | - Andreas Schmidt
- Department of Pediatric Surgery and Pediatric Urology, University Children’s Hospital Tuebingen, 72076 Tübingen, Germany
| | - Joerg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children’s Hospital Tuebingen, 72076 Tübingen, Germany
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