Advanced intraoperative imaging methods for laparoscopic anatomy navigation Following the fluorescent vessels, the SLNs can be identified in the mesentery as bright spots after approximately 10 minutes post‐injection. Evaluation of the detection of sentinel lymph nodes in open and laparoscopic gastric cancer surgery was conducted by Japanese researchers33‐36. Their study results showed that the ICG fluorescence SLN mapping can very well facilitate dye‐guided SLN biopsy in gastric cancer surgery. The applicability of combining preoperative, intraoperative and postoperative sentinel lymph node imaging using an integrated diagnostic approach based on a multimodal (i.e. both radioactive and fluorescent) imaging agent, ICG‐99mTc‐NanoColloid, is described37. The fluorescent antenna ICG in combination with a laparoscopic fluorescence imaging system can facilitate the dissection of SLNs during robot‐assisted laparoscopic prostatectomy. ICG fluorescence imaging has been tested for several tissue characterization purposes: blood flow confirmation in the hepatic artery around the anastomosis in living‐donor liver transplant surgery27, endoscopic visualization of the placental vascular network in the treatment of twin‐twin transfusion syndrome38, and evaluation of the renal vasculature in robotic assisted laparoscopic partial nephrectomy39. Laparoscopic fluorometry using ultraviolet light, already mentioned for delineation of the extra‐hepatic biliary anatomy, was also reported as a minimally invasive tool for intraoperative evaluation of intestinal blood perfusion. In a porcine model the feasibility of this technique was evaluated for diagnosing mesenteric ischemia40,41. Optical coherence tomography Optical coherence tomography (OCT), using an optical fiber probe, can be applied for high‐resolution, cross‐sectional in vivo and in situ imaging of microstructures in biological tissues42. This technique includes a limited penetration depth (2mm) that prevents deeper tissue architecture from being visualized and necessitates precise placement of the OCT probe on the tissue being examined. Therefore, in‐depth imaging of smaller tissue structures is challenging43. OCT imaging has been demonstrated to successfully differentiate the cavernous nerves from the prostate gland in a rat model44,45. Aron et al.43 described their experience with an imaging system including an OCT probe during laparoscopic and robotic radical prostatectomy to determine image characteristics of the neurovascular bundle, adipose tissue, the prostate capsule, the endopelvic fascia and lymphatics. OCT was able to correctly image the neurovascular bundle in all prostatectomy patients. Besides the prostatectomy, a potential role is conceivable in the laparoscopic low anterior resection, in order to prevent pelvic nerve injury. 25
proefschrift_Schols_SLV
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