MP63-19 INTRAOPERATIVE IDENTIFICATION OF NERVES WITH AN INTRAVENOUS NERVE-BINDING FLUOROPHORE: SUBJECTIVE AND OBJECTIVE ASSESSMENT OF FLUORESCENCE IN PORCINE MODELS

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology IV1 Apr 2018MP63-19 INTRAOPERATIVE IDENTIFICATION OF NERVES WITH AN INTRAVENOUS NERVE-BINDING FLUOROPHORE: SUBJECTIVE AND OBJECTIVE ASSESSMENT OF FLUORESCENCE IN PORCINE MODELS Lucas W. Dean, Pedro Recabal, Dmitry V. Dylov, Cristina Tan Hehir, Aditya Bagrodia, Katie S. Murray, Sonia Sequeira, Erica Levine, Ouathek Ouerfelli, Jonathan A. Coleman, Peter T. Scardino, Vincent P. Laudone, and Timothy F. Donahue Lucas W. DeanLucas W. Dean More articles by this author , Pedro RecabalPedro Recabal More articles by this author , Dmitry V. DylovDmitry V. Dylov More articles by this author , Cristina Tan HehirCristina Tan Hehir More articles by this author , Aditya BagrodiaAditya Bagrodia More articles by this author , Katie S. MurrayKatie S. Murray More articles by this author , Sonia SequeiraSonia Sequeira More articles by this author , Erica LevineErica Levine More articles by this author , Ouathek OuerfelliOuathek Ouerfelli More articles by this author , Jonathan A. ColemanJonathan A. Coleman More articles by this author , Peter T. ScardinoPeter T. Scardino More articles by this author , Vincent P. LaudoneVincent P. Laudone More articles by this author , and Timothy F. DonahueTimothy F. Donahue More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2042AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Inadvertent nerve injury is a common complication occurring in both open and minimally invasive surgical procedures. Fluorescent imaging with a myelin-binding probe allows for improved intraoperative, real-time visualization of critical nerve structures. We aimed to describe the subjective and objective nerve fluorescence produced by a nerve-binding fluorophore. METHODS Laparoscopy was carried out under general anesthesia in porcine models. GE3126 was administered intravenously at a concentration of 1.0 mg/kg. Subjective assessment of a reference nerve in the lateral body wall was conducted at regular intervals under blue-light illumination (405 nm). Nerve fluorescence was graded by five observers on a standardized 5-point scale (1=no fluorescence of nerve; 2=background enhancement exceeds nerve fluorescence; 3=minimal contrast between nerve fluorescence and background; 4=moderate contrast between nerve and background; 5=maximal contrast between nerve and background). Still-frames from the video capture were analyzed to generate the objective nerve to background signal-to-noise ratio (SNR). The nerve contour line was selected manually in ImageJ software and fluorescent intensity was measured. This selection mask was translated to two adjacent nerve-free areas to calculate background intensity. Normalization of the SNR was achieved by scaling the measurements by the area of the mask. RESULTS Both the subjective observer scores and objective SNR reached a maximum approximately 40 minutes after administration of GE3126, with sustained signal registered at 90 minutes post-administration. The onset of measurable fluorescent activity in the nerve tissue was rapid, with the SNR reaching 1.5 within one minute. The correlation between the subjective observer scale and calculated SNR was 0.85. CONCLUSIONS Real-time intraoperative enhancement of nerves with GE3126 was achieved during porcine laparoscopy. A strong correlation was observed between subjective and objective assessments of nerve fluorescence over 90 minutes after systemic administration. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e848-e849 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Lucas W. Dean More articles by this author Pedro Recabal More articles by this author Dmitry V. Dylov More articles by this author Cristina Tan Hehir More articles by this author Aditya Bagrodia More articles by this author Katie S. Murray More articles by this author Sonia Sequeira More articles by this author Erica Levine More articles by this author Ouathek Ouerfelli More articles by this author Jonathan A. Coleman More articles by this author Peter T. Scardino More articles by this author Vincent P. Laudone More articles by this author Timothy F. Donahue More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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