General introduction 13 Outline of the thesis This thesis is divided into two parts and describes both preclinical and clinical studies regarding two innovative optical techniques for application during surgery. Preceding the reports of these studies, a systematic review of the literature is given (Chapter 2), providing an overview of and an introduction to a variety of advanced intraoperative optical techniques, with special focus on minimally invasive surgery. In Part I near‐infrared fluorescence imaging after administration of a contrast agent is investigated. This concerns an already clinically available technique. Initially, the clinical feasibility of near‐infrared fluorescence imaging using indocyanine green was studied during laparoscopic cholecystectomy: as a method for real‐time intraoperative cholangiography (Chapter 3), and for concomitant extra‐hepatic bile duct and arterial visualization (Chapter 4). In the scope of optimization of the technique at the level of the administered near‐infrared fluorophore, the performance of a preclinical dye was tested in a pig model for two clinically relevant applications: extra‐hepatic bile duct and arterial delineation during laparoscopic cholecystectomy (Chapter 5) and ureteral guidance during laparoscopic surgery (Chapter 6). Part II focuses on wide‐band diffuse reflectance spectroscopy. Regarding this technique experiments were performed on a more developmental level to enable future multi‐ or hyperspectrally enhanced surgical imaging. In Chapter 7, the potential of diffuse reflectance spectroscopy for automated tissue classification is explored on freshly extirpated human colorectal specimens. Chapter 8 describes in vivo classification results of spectroscopic measurements, collected during colorectal surgery, providing differentiation of ureter and artery from surrounding adipose tissue. In Chapter 9, automated nerve classification in relation to adipose tissue is explored using in vivo spectral data acquired during thyroid and parathyroid surgery, as well as during carpal tunnel release procedures. With the future goal of intraoperative optical detection of the parathyroid glands, Chapter 10 then focuses on in vivo spectroscopy performed during thyroid and parathyroid surgery. Chapter 11 summarizes the main results and contributions as presented in this thesis; it depicts future perspectives and implications for further experimental research and clinical applications.
proefschrift_Schols_SLV
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