Abstract
Intraoperative peripheral nerve lesions are common complications due to misidentification and limitations of surgical nerve identification. This study validates a real-time non-invasive intraoperative method of nerve identification. Long working distance collimated polarized light imaging (CPLi) was used to identify peripheral radial nerve branches in a human cadaver hand by their nerve specific anisotropic optical reflection. Seven ex situ and six in situ samples were examined for nerves, resulting after histological validation, in a 100% positive correct score (CPLi) versus 77% (surgeon). Nerves were visible during a clinical in vivo observation using CPLi. Therefore CPLi is a promising technique for intraoperative nerve identification.
Highlights
Perioperative peripheral nerve injuries are a known and commonly encountered complication of surgical interventions [1]
Intraoperative identification using collimated polarized light imaging (CPLi) was correct in 100% of the samples regarding the presence of nerve tissue, as confirmed by histopathological examination
Fresh frozen human tissue was suitable for this experiment, due to the fact that freezing had no adverse effect on the anisotropic optical reflection of the nerve tissue of the thawed pig tissue
Summary
Perioperative peripheral nerve injuries are a known and commonly encountered complication of surgical interventions [1]. Even when an intervention seems successful at first glance, this could be complicated by unexpected neural injury. One of the main reasons of accidental nerve injuries during a surgical intervention is the difficulty in distinguishing different tissue types, such as connective tissue and nerves [2, 3]. Small cutaneous sensory branches of peripheral nerves are difficult to identify intraoperatively [4]. Kretschmer et al showed that the percentage of iatrogenic nerve injuries reaches 17% of the total amount of nerve injuries reported. Their report indicates a substantial number of patients with iatrogenic nerve injury considering the millions of operations that are performed worldwide [5]
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