Abstract
In this study, we integrate rapid evaporative ionization mass spectrometry (REIMS) with the Harmonic scalpel, an advanced laparoscopic surgical instrument that utilizes ultrasound energy to dissect and coagulate tissues. It provides unparalleled manipulation capability to surgeons and has superseded traditional electrosurgical tools particularly in abdominal surgery, but is yet to be validated with REIMS. The REIMS platform coupled with the Harmonic device was shown to produce tissue-specific lipid profiles through the analysis of porcine tissues in both negative and positive ionization modes. Comparison with other methods of electrosurgical dissection, such as monopolar electrosurgery and CO2 laser, showed spectral differences in the profile dependent on the energy device used. The Harmonic device demonstrated major spectral differences in the phospholipid region of m/z 600–1000 compared with the monopolar electrosurgical and CO2 laser-generated spectra. Within the Harmonic REIMS spectra, high intensities of diglycerides and triglycerides were observed. In contrast, monopolar electrosurgical and laser spectra demonstrated high abundances of glycerophospholipids. The Harmonic scalpel was able to differentiate between the liver, muscle, colon, and small intestine, demonstrating 100% diagnostic accuracy. The validation of the Harmonic device–mass spectrometry combination will allow the platform to be used safely and robustly for real-time in vivo surgical tissue identification in a variety of clinical applications.
Highlights
Precision surgery requires real-time analysis of tissue pathology to support intraoperative clinical decision making, safer surgery, and improved patient outcomes.[1]
Rapid evaporative ionization mass spectrometry (REIMS) was developed for in vivo classification of human tissues through analysis of aerosols released during electrosurgical dissection[3,4] and has demonstrated its ability in real-time cancer margin detection and tissue phenotyping
REIMS has not been applied in the minimally invasive surgical setting and it is unclear if this technology is effective for this purpose, in part because the laparoscopic instrument is fundamentally different in both its form and method of energy deployment (Figure 1). In this prospective ex vivo preclinical study, we demonstrate the feasibility of coupling the Harmonic scalpel to the REIMS interface for minimally invasive surgery
Summary
Precision surgery requires real-time analysis of tissue pathology to support intraoperative clinical decision making, safer surgery, and improved patient outcomes.[1]. A major advantage of this platform is that it does not interfere with the standard surgical workflow, and it can be flexibly deployed across energy devices where rapid tissue ablation is used, yielding an aerosol These energy devices include monopolar electrosurgical devices for open surgery[5] and endoscopic applications,[6] a bipolar handheld probe,[7,8] a cavitron ultrasonic surgical aspiration instrument,[9] and different surgical lasers.[10] Alternative mass spectrometry (MS) techniques used intraoperatively for real-time diagnostics include MassSpecPen[11] and SpiderMass.[12] MassSpecPen performs a surface tissue extraction using water, and the extract is transferred to the mass spectrometer for analysis using fluidics.
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