Surgical Visualization Research Articles

Analyse blood loss in controlled hypotension for open repair fronto-orbital advancement

Background: Transoperative blood loss is a serious challenge during correction of craniosynostosis. Open cranial remodeling is standard treatment for craniosynostosis. 1917 cushing controlled hypotension is defined as a reduction in systolic blood pressure to 80–90 mmHg, proposed benefits of reduced blood loss, better surgical visualisation, less operative time and less requirement of transfusion. Objectives: To analyse blood loss and requirement of transfusion using hypotension for open repair fronto-orbital advancement. Methods: This institutional review analysed the records in infants with craniosynostosis who required fronto-orbital advance between 2013 and 2016 in Hospital Regional Materno Infantil de Alta especialidad. Five patients were selected for this study — two patients were four years old, one was one year old, one was nine months and one seven months. Findings: Five infants underwent fronto-orbital advancement, just one patient had an associated syndrome: Apert syndrome, intraoperative transfusion was required in all patients, with controlled systemic hypotension did not affect intraoperative blood loss, and requirement of transfusion. Conclusion: Fronto-orbital advancement is safe and acceptable treatment for correction of craniosynostosis whit few intraoperative complication, however use hypotensive anaesthesia did not affect intraoperative blood loss.

Urinary Phytoestrogen Concentrations Are Not Associated with Incident Endometriosis in Premenopausal Women

BackgroundPhytoestrogens have been associated with subtle hormonal changes, but their effects on endometriosis are largely unknown. ObjectiveWe assessed the association between urinary concentrations of phytoestrogens and incident endometriosis. MethodsWe included an operative sample of 495 premenopausal women aged 18–44 y undergoing laparoscopies and laparotomies at 14 clinical sites between 2007 and 2009 and a general population sample of 131 women from the same geographic area who were matched on age and menstruation status. Endometriosis in the surgical sample was assessed by surgical visualization (clinical gold standard), whereas disease in the general population sample was assessed with the use of a pelvic MRI. Urine concentrations of genistein, daidzen, O-desmethylangolensin, equol, enterodiol, and enterolactone were measured at baseline. Poisson regression with robust error variance was used to estimate the risk of an endometriosis diagnosis for each sample after adjusting for age and body mass index (in kg/m2). Separate models were run for each phytoestrogen. ResultsOverall geometric mean urine concentrations of phytoestrogens were as follows: genistein [88 nmol/L (95% CI: 72, 108 nmol/L)], daidzein [194 nmol/L (95% CI: 160, 236 nmol/L)], O-desmethylangolensin [4 nmol/L (95% CI: 3, 6 nmol/L)], equol [4 nmol/L (95% CI: 4, 6 nmol/L)], enterodiol [29 nmol/L (95% CI: 22, 38 nmol/L)], and enterolactone [355 nmol/L (95% CI: 395, 544 nmol/L)]. Geometric mean concentrations of phytoestrogens did not significantly differ by endometriosis status in either sample. Adjusted RRs for endometriosis ranged from 0.87 to 1.09 for the 6 phytoestrogens measured, with all CIs including a value ≥1. Phytoestrogens were not associated with the severity of endometriosis when restricting the analysis to women with moderate-to-severe disease per the revised American Society for Reproductive Medicine criteria. Furthermore, no associations were observed between self-reported high soy intake and endometriosis. ConclusionsDespite endometriosis being an estrogen-dependent disease, we found no evidence that urinary phytoestrogens were associated with a higher risk of an endometriosis diagnosis in either a sample of premenopausal women or in a surgical sample.

Video-Assisted Thoracoscopic Removal of a Paraspinal Neuroblastoma Presenting as a Parotid Mass

Introduction: Neuroblastoma is the most common extracranial cancer in childhood. Paravertebral neuroblastomas arise from the paravertebral sympathetic ganglia. The cancer metastasizes through both lymphatic and hematogenous routes to bone, skin, and liver. The video demonstrates an atypical presentation of a paraspinal neuroblastoma with surgical resection of the primary paraspinal lesion. Materials and Methods: The patient presented with increased swelling over the right mandible for 2 weeks despite antibiotic treatment for presumed parotitis. Preoperative computed tomography (CT) imaging of the mass revealed a lytic lesion. CT-guided fine needle aspiration revealed neuroblastoma. CT of head/chest/abdomen/pelvis was performed for staging that revealed a left paraspinal mass measuring 2.5 × 3.0 × 1.3 cm adjacent to T10–T11. A bone scan and metaiodobenzylguanidine (MIBG) scan showed metastatic disease consistent with Stage IV neuroblastoma. After four cycles of chemotherapy, the patient had a >50% reduction in the primary paraspinal lesion. Video-assisted thoracoscopic surgery (VATS) was performed. The mass and accompanying lymph node were excised without complication. Results and Conclusion: Final pathology demonstrated a 1.5 × 1.2 × 0.8 cm neuroblastic tumor with treatment effect with involvement of the margin. The accompanying lymph node was negative for tumor involvement. The patient underwent subsequent chemotherapy under the guidance of pediatric oncology. Repeat CT, bone scan, and MIBG scan at 1-year follow-up were negative for disease recurrence. Parotid metastases of neuroblastoma are rare with fewer than five case reports have been published in the past several decades.1 Common causes of parotid masses include salivary gland tumors and parotitis. Typically, metastatic disease in the parotid gland arises from nearby head and neck neoplasms. For a practicing clinician, it is important to keep in mind this rare entity when apparent parotitis does not respond to conventional antibiotic treatment. For Stage IV neuroblastoma, chemotherapy and immunomodulatory therapy are critical. Surgical resection is attempted with the goal of removal of the entire tumor and histologic staging; however, negative microscopic tumor margins are not necessary.2 Currently, open thoracotomy has been the standard procedure for thoracic disease in children, whereas VATS has remained controversial.3 However, recently, VATS for neurogenic tumors has shown to give good results with minimal postoperative complications. Major advantages include avoidance of open thoracotomy complications and enhanced surgical visualization.4 Several other advantages include decreased morbidity and duration of hospital stay. The case presented demonstrates an atypical presentation of paraspinal neuroblastoma with metastasis to the parotid gland. VATS procedure was used for removal of the primary paraspinal mass. This case shows that the VATS procedure is a safe and effective method of surgery for thoracic masses in children. No competing financial interests exist. Runtime of video: 5 mins 29 secs

The application of interactive dynamic virtual surgical simulation visualization method

In this paper, an interactive dynamic simulation method is proposed to solve computational models of soft tissue undergoing large deformation, collision detection, and volume conservation in medical surgical simulation visualization. During the process of implementation of the interactive dynamic simulation method, the point-based method is used to simulate the elastic solids undergoing large deformations and the position-based method is used to simulate the objects collision, friction and volume conservation. Numerical results demonstrate that the proposed method improves the efficiency and stability of the response of heterogeneous soft tissue undergoing contact or even the multi-organs interactions, and it can be extended to interactive biopsy and cutting simulation.

In-vivo Endoscopic Visualization of Pain Generators in the Lumbar Spine

In-vivo Endoscopic Visualization of Pain Generators in the Lumbar Spine

Evaluation of effectiveness of subepithelial connective tissue graft in combination with coronally positioned flap in the treatment of isolated gingival recession in esthetic areas by using surgical microscope

Objectives: When maximum precision is required in performing periodontal surgery to satisfy particular esthetic demands, a surgical microscope that enhances complete visualization of the operative field may represent a useful tool. The aim of this case series was to assess clinical outcome of isolated gingival recession treated by using subepithelial connective tissue graft (SCTG) in combination with coronally positioned flap (CPF) in esthetic areas by using surgical microscope. Study Design: A total of 3 cases of isolated gingival recession (Class I and II) located on mandibular incisors were treated by using SCTG in combination with CPF with the aid of a surgical microscope. Gingival recession, probing pocket depth, clinical attachment loss, and width of keratinized gingiva were recorded at baseline, before surgery and at 6 months following surgery. Results: Prior to surgery, there were 2 mm gingival recession (REC), 3 mm clinical attachment loss (CAL) with PPD of 1 mm in two cases while one case had 3 mm gingival recession, 4 mm clinical attachment loss with PPD of 1 mm. 6 months post surgery, 2 cases showed 2 mm reduction of gingival recession indicating 100% root coverage while one case showed 80% of root coverage (2 mm reduction of gingival recession). Conclusion: In the present case report, qualitative aesthetic evaluation of the treated cases showed better searing and marginal profile. This could be due to an atraumatic surgical approach and excellent visualization of the operative field by using surgical microscope. Microsurgery enhances normal vision through magnification and favorable lightening which would lead to an improvement in cosmetic results and patient comfort level.

Reliability of Percutaneous Pulmonary Vent and Coronary Sinus Cardioplegia in the Setting of Minimally Invasive Aortic Valve Replacement

Objectives Evaluating the efficacy of 2 new percutaneous devices specifically designed to be placed through the right internal jugular vein, therefore named “necklines,” for achieving retrograde cardioplegia and pulmonary venting in the setting of minimally invasive aortic valve replacement (MIAVR). Design Case series. Setting University-affiliated private hospital. Participants Patients undergoing MIAVR. Interventions Necklines were placed by the anesthesiologist using transesophageal electrocardiography, with pressure guidance before the surgical procedure was initiated. Measurements and Main Results The records of 51 consecutive patients who underwent MIAVR with necklines placement were reviewed retrospectively. The access for MIAVR was through either a J-hemisternotomy or a right anterior thoracotomy. The efficacy of the 2 catheters, successful placement rate, time needed to deploy catheters, and perioperative complications were recorded. Necklines were placed successfully in all patients in 23±13 minutes. A total of 110 doses of retrograde cardioplegia were delivered at a mean flow rate of 173±35 mL/min and a mean pressure of 41±6 mmHg. The pulmonary catheter ensured venting of the heart that was graded by surgeons as “excellent” in 33 patients, “sufficient” in 12 patients, and “not adequate” in 2 patients. There were no major adverse events or deaths. Conclusions Necklines ensure effective retrograde cardioplegia and venting of the heart, provide optimal surgical vision and access during MIAVR, and allow surgeons to operate in an unobstructed surgical field. Nevertheless, additional studies are required to determine whether the use of necklines is associated with better outcomes than those with conventional methods.

Advancement of Surgical Visualization Methods: A Comparison Study between Traditional Microscopic Surgery, the Endoscope and a Novel Robotic Optoelectronic Visualization Tool for them Transnasal Transsphenoidal Approach to the Sellar Region

With the entrance of the video microscope over the recent few years into the microsurgery optical field, a third modality has emerged alongside the endoscope and operating microscope to accomplish some of the microsurgical procedures. One such approach that could potentially utilize any of the three is the transnasal transsphenoidal (TNTS) approach that provides access to the anterior brainstem, the anterior skull base, and of course the sellar region. Here, we provide a descriptive comparison of the three modalities on cadaveric specimens with joint ENT and neurosurgery teams performing the approach. Each provides unique advantages and disadvantages as part of the surgeon’s optical armamentarium. As more optical devices become available to surgeons, selection of the optimal device can present a challenge best compared by head-to-head comparison. The aim of this paper is to compare these modalities for the TNTS approach.

Intranasal atomised dexmedetomidine optimises surgical field visualisation with decreased blood loss during endoscopic sinus surgery: a randomized study

Safe and effective endoscopic sinus surgery (ESS) depends on distinct surgical visibility. Various interventions are proposed to reduce intranasal bleeding. This study investigated whether intranasal atomised dexmedetomidine (DEX) provided optimal surgical conditions and decreased blood loss. ASA I or II patients undergoing ESS were randomly assigned to receive either 2 μg/kg intranasal DEX (group D) or the same volume of saline (group N) 15 min before induction. Lund-Mackay (LM) scores represented the extent of the preoperative surgical lesion and were obtained based on the computed tomographic scans. Estimated blood loss was recorded. The visibility of the surgical field was rated by surgeons on a numerical rating scale (NRS) or assessed using Boezaart score. Median blood loss in groups D and N was 75 and 100 ml, respectively. NRS and Boezaart score for surgical condition were lower in group D than in group N. LM score showed a positive correlation between NRS and Boezaart score in group N but not in group D. Intranasal atomised DEX resulted in improved surgical conditions with less bleeding during ESS despite the severity of the preoperative surgical lesion.

Advancement of Surgical Visualization Methods: Comparison Study Between Traditional Microscopic Surgery and a Novel Robotic Optoelectronic Visualization Tool for Spinal Surgery

The operating microscope (OM) has become instrumental in aiding surgeons during key microdissection with greater safety and detail. An exoscope offers similar detail with improved functionality and greater implications for live teaching and improved operating room flow. Eleven senior neurosurgery residents and fellows performed unilateral, single-level laminotomies on fresh cadavers using an OM and exoscope. Three attending spine surgeons blinded for the visualization technique used then reviewed and graded each decompression. Data points gathered included time of procedure, grading of decompression (1-5), and complications, including dural tear, nerve root injury, and pars fracture. Operative times between the 2 systems were not significantly different (14.9 minutes OM vs. 15.6 minutes exoscope, P= 0.766). Despite high variability between evaluators in assessing complications and adequacy of decompression, there was no significant difference between either system. Postprocedural surveys indicated greater comfort with the exoscope, greater ease of use, and superior teaching potential for the exoscope over the standard OM. In our simulated operating room model, an exoscope is a valid alternative to the standard OM that affords the surgeon greater comfort with greater teaching potential while maintaining many of the microscope's benefits.

Reliability of Percutaneous Pulmonary Vent and Coronary Sinus Cardioplegia in the Setting of Minimally Invasive Aortic Valve Replacement: A Single-Center Experience

Evaluating the efficacy of 2 new percutaneous devices specifically designed to be placed through the right internal jugular vein, therefore named "necklines," for achieving retrograde cardioplegia and pulmonary venting in the setting of minimally invasive aortic valve replacement (MIAVR). Case series. University-affiliated private hospital. Patients undergoing MIAVR. Necklines were placed by the anesthesiologist using transesophageal electrocardiography, with pressure guidance before the surgical procedure was initiated. The records of 51 consecutive patients who underwent MIAVR with necklines placement were reviewed retrospectively. The access for MIAVR was through either a J-hemisternotomy or a right anterior thoracotomy. The efficacy of the 2 catheters, successful placement rate, time needed to deploy catheters, and perioperative complications were recorded. Necklines were placed successfully in all patients in 23±13 minutes. A total of 110 doses of retrograde cardioplegia were delivered at a mean flow rate of 173±35 mL/min and a mean pressure of 41±6 mmHg. The pulmonary catheter ensured venting of the heart that was graded by surgeons as "excellent" in 33 patients, "sufficient" in 12 patients, and "not adequate" in 2 patients. There were no major adverse events or deaths. Necklines ensure effective retrograde cardioplegia and venting of the heart, provide optimal surgical vision and access during MIAVR, and allow surgeons to operate in an unobstructed surgical field. Nevertheless, additional studies are required to determine whether the use of necklines is associated with better outcomes than those with conventional methods.

Robot-assisted laparoscopic partial nephrectomy using renal artery cold perfusion for completely intraparenchymal tumors: the outcome and initial experience

Objective To investigate the safety and feasibility of robot-assisted laparoscopic partial nephrectomy using renal artery cold perfusion for completely intraparenchymal tumors. Methods From March 2013 to May 2016, a total of 10 patients underwent robot-assisted laparoscopic partial nephrectomy using renal artery cold perfusion for completely intraparenchymal tumors were analyzed. These included 6 males and 4 female with a mean age of 53 years old( rang from 46 to 70 years old). The average tumor size was 2.8 cm (rang from 2.0 to 4.0 cm). Preoperative CT scan or MRI scan showed the renal tumors were completely endophytic and 3 of them were solitary kidney. The mean R. E.N.A.L. score was 9.8 (rang from 9 to 10). A double lumen balloon-tipped angio-catheter was passed into the renal artery through a femoral puncture preoperatively. The renal artery was occluded by an intraluminal balloon and the renal vein was clipped by Bulldog. Ringer lactate at 4℃ was perfused into kidney drained through the gonadal vein on the left side and through incision of renal vein on the right side, which established a cold ischemia.Intraoperative ultrasound was used to guide tumor enbloc resection with negative margin. Two layers renorrhaphy were performed using 1-0 Quill string and he vessels or collecting system need to be repaired if open. Results All the operations were successfully performed, with a mean operation time of 152 min( rang from 78 to 184 min) and a mean cold ischemia time of 61 min (ranging from 35 to 102 min). The mean estimated blood loss was 265 ml (rang from 100 to 500 ml). The mean postoperative hospital stay was 8.6 days (rang from 4 to 14 days). No positive margin was found. Hematuria occurred in one patient and disappeared three days later. Urinary leakage occurred in one patient and relieved in one week. The pathological diagnosis confirmed 9 clear cell renal cell carcinoma and 1angioleiomyolipoma. The mean preoperative GFR of the affected kidney was 53.9 (rang from 42.3 to 61.9 ml/min). The mean postoperative GFR of the affected kidney 3 moths after surgery was 41.2 (rang from 31.4 to 57.1 ml/min), slightly lower than that before the surgery. No recurrence or metastasis was observed during a median follow-up of 23.5 moths (rang from 3 to 37 moths). Conclusions Robot-assisted laparoscopic partial nephrectomy using renal artery cold perfusion take the advantage of cold ischemia for renal function protecting using renal artery cold perfusion and enhancing surgical visualization and precision of robotic surgery.It is safe and feasible to use this technique for completely endophytic renal tumors. The tumor control and renal function reservation are satisfactory in short term follow-up. However, further investigation with a larger population and longer follow up were required. Key words: Kidney neoplasms; Endophytic renal tumor; Nephron sparing surgery; Renal artery cold perfusion; Robot-assisted laparoscopic technique

Live volumetric (4D) visualization and guidance of in vivo human ophthalmic surgery with intraoperative optical coherence tomography.

Minimally-invasive microsurgery has resulted in improved outcomes for patients. However, operating through a microscope limits depth perception and fixes the visual perspective, which result in a steep learning curve to achieve microsurgical proficiency. We introduce a surgical imaging system employing four-dimensional (live volumetric imaging through time) microscope-integrated optical coherence tomography (4D MIOCT) capable of imaging at up to 10 volumes per second to visualize human microsurgery. A custom stereoscopic heads-up display provides real-time interactive volumetric feedback to the surgeon. We report that 4D MIOCT enhanced suturing accuracy and control of instrument positioning in mock surgical trials involving 17 ophthalmic surgeons. Additionally, 4D MIOCT imaging was performed in 48 human eye surgeries and was demonstrated to successfully visualize the pathology of interest in concordance with preoperative diagnosis in 93% of retinal surgeries and the surgical site of interest in 100% of anterior segment surgeries. In vivo 4D MIOCT imaging revealed sub-surface pathologic structures and instrument-induced lesions that were invisible through the operating microscope during standard surgical maneuvers. In select cases, 4D MIOCT guidance was necessary to resolve such lesions and prevent post-operative complications. Our novel surgical visualization platform achieves surgeon-interactive 4D visualization of live surgery which could expand the surgeon’s capabilities.

Modified anconeus flap approach for intercondylar humerus fractures

Objective To report a new surgical approach(modified anconeus flap approach)in which the anconeus and part of triceps are reflected in the treatment of distal intercondylar humerus fracture(AO type C). Methods To design the modified anconeus flap approach, the anatomy of the distal tendon of the triceps brachii and the anconeus was studied using 15 cadaveric adult specimens(30 sides). The new surgical approach was compared with the triceps-reflecting anconeus pedicle(TRAP)approach in terms of the area of exposure at the distal humeral articular surface. Furthermore, the new surgical approach was applied in 16 patients who had been treated for intercondylar humerus fracture(AO type C)from May 2005 to May 2013. The clinical outcomes were evaluated using the Mayo elbow performance score(MEPS)and Broberg-Morrey scoring systems. Results The blood supply and innervation of the anconeus was interrupted minimally during incision along the radical edge of triceps tendon. The area of exposure at the distal humeral articular surface provided by the part triceps and anconeus reflecting approach and the medial humerus approach was 42. 66% ±0. 03% at the elbow flexion from 0° to 50°. This was significantly smaller than that provided by the TRAP approach(46. 11% ± 0. 03%)(P< 0. 05). Of the 16 patients, 15 obtained complete follow-ups from 6 months to 4 years(average, 16. 5 months). The mean MEPS at the last follow-up was 90. 5 points(range, from 82 to 93 points), with 10 excellent and 4 good cases and one poor case. The Broberg & Morrey score system showed 11 patients with no articular cartilage degeneration(level-0), 3 patients with level-1 degeneration, and 2 patients with level-2 degeneration. Conclusion The modified anconeus flap approach proposed in the present study provides clear surgical vision and needs no olecranon osteotomy or olecranon dissection or ablation of the major triceps brachii tendon for intercondylar humerus fractures, thereby leading to early active motion and satisfactory clinical outcomes. Key words: Humeral fractures; Autopsy; Therapies, investigational; Surgical approach

Optical Coherence Tomography for Retinal Surgery: Perioperative Analysis to Real-Time Four-Dimensional Image-Guided Surgery.

Magnification of the surgical field using the operating microscope facilitated profound innovations in retinal surgery in the 1970s, such as pars plana vitrectomy. Although surgical instrumentation and illumination techniques are continually developing, the operating microscope for vitreoretinal procedures has remained essentially unchanged and currently limits the surgeon's depth perception and assessment of subtle microanatomy. Optical coherence tomography (OCT) has revolutionized clinical management of retinal pathology, and its introduction into the operating suite may have a similar impact on surgical visualization and treatment. In this article, we review the evolution of OCT for retinal surgery, from perioperative analysis to live volumetric (four-dimensional, 4D) image-guided surgery. We begin by briefly addressing the benefits and limitations of the operating microscope, the progression of OCT technology, and OCT applications in clinical/perioperative retinal imaging. Next, we review intraoperative OCT (iOCT) applications using handheld probes during surgical pauses, two-dimensional (2D) microscope-integrated OCT (MIOCT) of live surgery, and volumetric MIOCT of live surgery. The iOCT discussion focuses on technological advancements, applications during human retinal surgery, translational difficulties and limitations, and future directions.

Combination of the non-invasive tests for the diagnosis of endometriosis.

Combination of the non-invasive tests for the diagnosis of endometriosis.

Surgical Vision: Google Glass and Surgery.

Google Glass is, in essence, a smartphone in the form of a pair of spectacles. It has a display system, a bone conduction "speaker," video camera, and connectivity via WiFi or Bluetooth technologies. It can also be controlled by voice command. Seizing Google Glass' capabilities as windows of opportunity, surgeons have been the first group of doctors trying to incorporate the technology into their daily practices. Experiences from different groups have demonstrated Google Glass' potential in improving perioperative care, intraoperative communication and documentation, surgical outcome as well as surgical training. On the other hand, the device has technical limitations, notably suboptimal image qualities and a short battery life. Its operational functions also bring forth concerns on the protection of patient privacy. Nonetheless, the technological advances that this device embodies hold promises in surgical innovations. Further studies are required, and surgeons should explore, investigate, and embrace similar technologies with keen and informed anticipation.

Fluorescent Affibody Molecule Administered In Vivo at a Microdose Level Labels EGFR Expressing Glioma Tumor Regions

PurposeFluorescence guidance in surgical oncology provides the potential to realize enhanced molecular tumor contrast with dedicated targeted tracers, potentially with a microdose injection level. For most glioma tumors, the blood brain barrier is compromised allowing some exogenous drug/molecule delivery and accumulation for imaging. The aberrant overexpression and/or activation of epidermal growth factor receptor (EGFR) is associated with many types of cancers, including glioblastoma, and so the use of a near-infrared (NIR) fluorescent molecule targeted to the EGFR receptor provides the potential for improving tumor contrast during surgery. Fluorescently labeled affibody molecule (ABY-029) has high EGFR affinity and high potential specificity with reasonably fast plasma clearance. In this study, ABY-29 was evaluated in glioma versus normal brain uptake from intravenous injection at a range of doses, down to a microdose injection level.ProcedureNude rats were inoculated with the U251 human glioma cell line in the brain. Tumors were allowed to grow for 3–4 weeks. ABY-029 fluorescence ex vivo imaging of brain slices was acquired at different time points (1–48 h) and varying injection doses from 25 to 122 μg/kg (from human protein microdose equivalent to five times microdose levels).ResultsThe tumor was most clearly visualized at 1-h post-injection with 8- to 16-fold average contrast relative to normal brain. However, the tumor still could be identified after 48 h. In all cases, the ABY-029 fluorescence appeared to localize preferentially in EGFR-positive regions. Increasing the injected dose from a microdose level to five times, a microdose level increased the signal by 10-fold, and the contrast was from 8 to 16, showing that there was value in doses slightly higher than the microdose restriction. Normal tissue uptake was found to be affected by the tumor size, indicating that edema was a likely factor affecting the expected tumor to normal tissue contrast.ConclusionThese results suggest that the NIR-labeled affibody molecules provide an excellent potential to increase surgical visualization of EGFR-positive tumor regions.

Appropriate Bowel Preparation for Laparotomy Gynecologic Surgery: A Prospective, Surgeon-Blinded Randomized Study

Objective: To compare the surgeon's satisfaction during gynecological laparotomy surgery and patient's satisfaction as well as quality of life (QOL) among 3 groups of bowel preparations: no enema vs. sodium chloride enema vs. soap-suds enema (SSE). Materials and Method: Three hundred and thirty three women undergoing gynecological laparotomy surgery and without risks to bowel lumen entry between November 2014 and October 2015 were randomized to receive no enema (n = 111), sodium chloride enema (n = 111) or SSE (n = 111) for bowel preparation. Surgeons, who were blinded for the type of bowel preparation, assessed the surgical visualization and the efficacy of bowel packing. The patients' satisfaction and the QOL were also assessed on the days of admission, operation, post-operation, and discharge. Results: The patients' features of the 3 groups were well balanced. The surgeon's satisfaction was rated excellent as 56.8, 63.1 and 65.8% in the no-enema, sodium chloride and SSE groups (p = 0.830), respectively. The patients in the no-bowel-preparation group were satisfied more significantly than the other groups (p = 0.001). No significant differences in QOL were observed among the 3 groups. Conclusion: The type of bowel preparation for exploratory gynecologic surgery did not affect the surgical visualization and the QOL of the patients.

Comprehensive phantom for interventional fluorescence molecular imaging.

Fluorescence imaging has been considered for over a half-century as a modality that could assist surgical guidance and visualization. The administration of fluorescent molecules with sensitivity to disease biomarkers and their imaging using a fluorescence camera can outline pathophysiological parameters of tissue invisible to the human eye during operation. The advent of fluorescent agents that target specific cellular responses and molecular pathways of disease has facilitated the intraoperative identification of cancer with improved sensitivity and specificity over nonspecific fluorescent dyes that only outline the vascular system and enhanced permeability effects. With these new abilities come unique requirements for developing phantoms to calibrate imaging systems and algorithms. We briefly review herein progress with fluorescence phantoms employed to validate fluorescence imaging systems and results. We identify current limitations and discuss the level of phantom complexity that may be required for developing a universal strategy for fluorescence imaging calibration. Finally, we present a phantom design that could be used as a tool for interlaboratory system performance evaluation.