Direct Administration of Nerve-Specific Contrast to Improve Nerve Sparing Radical Prostatectomy

被引:48
作者
Barth, Connor W. [1 ]
Gibbs, Summer L. [1 ,2 ,3 ]
机构
[1] Oregon Hlth & Sci Univ, Dept Biomed Engn, Portland, OR 97201 USA
[2] Oregon Hlth & Sci Univ, Knight Canc Inst, Portland, OR 97201 USA
[3] Oregon Hlth & Sci Univ, OHSU Ctr Spatial Syst Biomed, Portland, OR 97201 USA
来源
THERANOSTICS | 2017年 / 7卷 / 03期
关键词
nerve sparing radical prostatectomy; fluorescence image-guided surgery; nerve-specific fluorophore; prostate cancer; direct administration; NEAR-INFRARED FLUORESCENCE; OPTICAL COHERENCE TOMOGRAPHY; IMAGE-GUIDED SURGERY; CAVERNOUS NERVES; NILE RED; SURGICAL-TREATMENT; LASER STIMULATION; CANCER; RADIOTHERAPY; MORTALITY;
D O I
10.7150/thno.17433
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Nerve damage remains a major morbidity following nerve sparing radical prostatectomy, significantly affecting quality of life post-surgery. Nerve-specific fluorescence guided surgery offers a potential solution by enhancing nerve visualization intraoperatively. However, the prostate is highly innervated and only the cavernous nerve structures require preservation to maintain continence and potency. Systemic administration of a nerve-specific fluorophore would lower nerve signal to background ratio (SBR) in vital nerve structures, making them difficult to distinguish from all nervous tissue in the pelvic region. A direct administration methodology to enable selective nerve highlighting for enhanced nerve SBR in a specific nerve structure has been developed herein. The direct administration methodology demonstrated equivalent nerve-specific contrast to systemic administration at optimal exposure times. However, the direct administration methodology provided a brighter fluorescent nerve signal, facilitating nerve-specific fluorescence imaging at video rate, which was not possible following systemic administration. Additionally, the direct administration methodology required a significantly lower fluorophore dose than systemic administration, that when scaled to a human dose falls within the microdosing range. Furthermore, a dual fluorophore tissue staining method was developed that alleviates fluorescence background signal from adipose tissue accumulation using a spectrally distinct adipose tissue specific fluorophore. These results validate the use of the direct administration methodology for specific nerve visualization with fluorescence image-guided surgery, which would improve vital nerve structure identification and visualization during nerve sparing radical prostatectomy.
引用
收藏
页码:573 / 593
页数:21
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