Background
Current cancer management faces several challenges, including the occurrence of a
residual tumor after resection, the use of radioactive materials or high concentrations
of blue dyes for sentinel lymph node biopsy, and the use of bulky systems in surgical
suites for image guidance. To overcome these limitations, we developed a real-time,
intraoperative imaging device that, when combined with near infrared fluorescent molecular
probes, can aid in the identification of tumor margins, guide surgical resections,
map sentinel lymph nodes, and transfer acquired data wirelessly for remote analysis.
Methods
We developed a new compact, wireless, wearable, and battery-operated device that allows
for hands-free operation by surgeons. A charge-coupled device–based, consumer-grade
night vision viewer was used to develop the detector portion of the device, and the
light source portion was developed from a compact headlamp. This piece was retrofitted
to provide both near infrared excitation and white light illumination simultaneously.
Wireless communication was enabled by integrating a battery-operated, miniature, radio-frequency
video transmitter into the system. We applied the device in several types of oncologic
surgical procedures in murine models, including sentinel lymph node mapping, fluorescence-guided
tumor resection, and surgery under remote expert guidance.
Results
Unlike conventional imaging instruments, the device displays fluorescence information
directly on its eyepiece. When employed in sentinel lymph node mapping, the locations
of sentinel lymph nodes were visualized clearly, even with tracer level dosing of
a near infrared fluorescent dye (indocyanine green). When used in tumor resection,
tumor margins and small nodules invisible to the naked eye were visualized readily.
In a simulated, point-of-care setting, tumors were located successfully and removed
under remote guidance using the wireless feature of the device. Importantly, the total
cost of this prototype system ($1200) is substantially less than existing imaging
instruments.
Conclusion
Our results demonstrate the feasibility of using the new device to aid surgical resection
of tumors, map sentinel lymph nodes, and facilitate telemedicine.
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Article info
Publication history
Accepted:
February 10,
2011
Footnotes
Supported in part by the U.S. National Institutes of Health grants R01 EB008111 and EB 008458, by the U.S. Department of Defense Breast Cancer Research Program Predoctoral Traineeship Award (W81XWH-11-1-0059; to. Y.L.), and by the National Center for Research Resources Award K01RR026095 (to W.A.).
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
