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首页> 外文期刊>Surgical Endoscopy >Intraoperative confocal laser endomicroscopy for real-time in vivo tissue characterization during surgical procedures
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Intraoperative confocal laser endomicroscopy for real-time in vivo tissue characterization during surgical procedures

机译：术中共聚焦激光子宫内膜检查外科手术过程中实时体内组织表征

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Introduction Probe-based confocal laser endomicroscopy (pCLE) is an innovative technique providing real-time, in vivo optical biopsies. A previous ex vivo phase of the study (PERSEE) allowed identifying accurate pCLE criteria for the diagnosis of hepatic and peritoneal surgical specimens. This study aimed at evaluating the pCLE role for in vivo intra-abdominal tissue characterization during digestive cancer surgical procedures. Methods Between October 2014 and July 2015, consecutive patients diagnosed with digestive cancers and scheduled for a surgical resection or an exploratory laparoscopy were prospectively enrolled. Endomicroscopic images were acquired using a motorized Confocal Miniprobe? with a bending distal tip providing easy access to abdominal organs. It was connected to an endomicroscopy system that allowed near-infrared illumination (at a wavelength of 785 nm) in conjunction with indo-cyanine green for contrast agent. A live audiovisual transmission was established between the surgeon and the pathologist for real-time interpretation of optical biopsies. Intraoperative pCLE performance for the diagnosis of suspicious nodules was assessed using corresponding surgical histopathology as reference standard. Results 21 consecutive patients were successfully enrolled. Live audiovisual transmission between the surgeon and the pathologist was successfully established in all cases. 62 pCLE sequences were acquired from different tissues [peritoneum (n = 27), liver (n = 21), lymph node (n = 4), diaphragm (n = 3), colon (n = 3), stomach (n = 2), and adrenal gland (n = 2)]. Malignant tissues were identified by fluorescently enhanced irregular cancerous tubes contrasting with dark glandular lumen and extracellular matrix. pCLE sensitivities and specificities were 67% and 100%, and 38% and 100% for peritoneal and hepatic carcinogenesis, respectively. One benign incident was reported during the trial with no patient consequence. Conclusions Real-time intraoperative pCLE with near-infrared illumination is feasible and safe, provides additional information in terms of tissue characterization, and, in combination with telepathology, allows interactive collaboration between the surgeon and the pathologist during surgical procedures. Trial registration clinicaltrials.gov Identifier: NCT02312167.
机译：介绍探针的共聚焦激光端子显微镜（PCE）是一种创新技术，提供实时，体内光学活组织检查。前一阶段的研究（Persee）允许识别肝癌和腹膜外科标本的准确循环标准。本研究旨在评估消化癌症手术手术过程中体内腹部组织表征的皮秒作用。方法在2015年10月至2015年7月期间，诊断有消化癌症和预定用于手术切除或探索性腹腔镜检查的连续患者进行了初步纳入。使用电动的共焦微型裂隙获得了端子显微镜图像？使用弯曲的远端尖端，可容易地进入腹部器官。它连接到内胚盘系统，其允许与造影剂的印度 - 青色绿色结合近红外照明（波长为785nm）。外科医生与病理学家之间建立了实时视听传播，用于实时解释光学活检。使用相应的外科手术组织病理学作为参考标准评估用于诊断可疑结节的术术治疗。结果21例连续患者成功注册。在所有情况下成功建立了外科医生与病理学家之间的现场视听传播。从不同的组织中获得62个循环序列[腹膜（n = 27），肝（n = 21），淋巴结（n = 4），隔膜（n = 3），结肠（n = 3），胃（n = 2 ）和肾上腺（n = 2）]。通过荧光增强的不规则癌症管鉴定恶性组织与深色腺体腔和细胞外基质对比。腹膜和肝癌的PCE敏感性和特异性分别为67％和100％，38％和100％。在试验期间报告了一个良性事件，没有患者后果。结论具有近红外照明的实时术中PCE是可行和安全的，在组织表征方面提供了额外的信息，并且与远程传神，允许在外科手术期间外科医生和病理学家之间的交互式协作。试验登记ClinicalTrials.gov标识符：NCT02312167。

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