Application of a new dye for near‐infrared fluorescence laparoscopy of the ureters 81 Table 6.1 Intraoperative observations Experiment Concentration of administered CW800‐CA (mg/ml) Amount of dye injected (ml) No. of ureters found Time to ureter visualization (min) 1 0.25 1 0 ‐ 2 1.0 3 2 10 Quantitative fluorescence image analysis For objective assessment of the degree of fluorescence illumination in the ureters, OsiriX 5.5.1 Imaging Software was used. The fluorescence images were analyzed by determining target‐to‐background ratio (TBR), as previously described8. TBR was defined as the mean fluorescence intensity (FI; in arbitrary units, A.U.) of three point regions of interest (ROIs) in the target (i.e., ureter) minus the mean FI of three background (BG) ROIs, divided by the mean FI of the three BG ROIs; in formula: TBR = (FI of target ‐ FI of BG)/FI of BG. Results In the first experiment no fluorescence identification of the ureters could be obtained. Up to 120 minutes after administration visualization remained unsuccessful. During the second experiment (dose of 3.0 mg CW800‐CA) a clear delineation of the course of both ureters was visualized with the fluorescence mode of the laparoscope, even in those areas where conventional imaging did not reveal the ureters yet. The snap‐shots in Figure 6.1 were obtained ten minutes after dye administration and show the fluorescence images of the left and right ureter, with corresponding conventional images. A short narrated video demonstrating the procedure is included as a supplement with the online version of this technical note. Target‐to‐background‐ratio The target‐to‐background‐ratio (TBR) of the left and right ureter amounted respectively 1.6 and 3.5, ten minutes after dye injection. Complications No intra‐ or postoperative complications regarding the ureters occurred. None of the pigs developed any adverse reactions to the injected CW800‐CA. No interference with intraoperative monitoring of Saturation of peripheral Oxygen (SpO2) was observed.
proefschrift_Schols_SLV
To see the actual publication please follow the link above