Percutaneous renal access remains the cornerstone initial step in varied clinical settings. For obtaining the best surgical outcome and minimizing patient morbidity, an appropriate access to the target calyx is needed. In our study, we built a forward-view endoscopic OCT system for PCN guidance. Pig kidneys were imaged to demonstrate the feasibility of the imaging system. Different parts of pig kidneys (cortex, medulla and renal pelvis) can be clearly differentiated. Furthermore, machine learning based computer aided diagnosis platform was developed to distinguish different tissue types automatically and the accuracy of recognition was as high as 90%.
Detecting important anatomic structures including ureters and mesenteric vessels is of utmost importance to preventing unintended injury, facilitating intraoperative decision making, and potentially reducing operative time, in minimally invasive procedures performed in the abdomen. Diffuse reflectance spectroscopy (DRS) has been investigated previously for augmenting surgeon’s knowledge of tissue types intraoperatively. The potential of detecting a hollow structure by DRS is not only bounded by the parametric differences between that hollow structure and peripheral tissues including solid organs, but also determined by the relative scale between the hollow structure and the sampling depth of the probe. We have developed an applicator-probe with a 10mm source-detector distance that can be mounted on an 8mm laparoscopic instrument and passed through a 12mm trocar port for laparoscopic operability. The 10mm source-detector separation of this laparoscopically adaptable applicator probe renders sampling depth of a few millimeters for the potential of better discrimination between a hollow structure and a solid tissue parenchyma. DRS using this applicator-probe was performed on a number of hollow structures and solid organs intraoperatively in pigs. The hollow structures included urinary bladder, ureter, large intestine, small intestine, stomach, gallbladder, and mesenteric vessel. The solid organs or tissues included kidney, liver, and ovary. The ratio between the model-based normalized DRS signals at 700nm and 800nm was used as an index. An index value of 1 separates the hollow structures including ureter, bladder, and stomach (between 1 and 2) from other hollow structures including intestines and mesenteric vessel and solid organs (less than 0.7).
Inadvertent injury to important anatomic structures including major vasculature is a significant risk in minimally invasive surgery that potentially requires conversion to open surgery and results in increased morbidity and mortality. The concern of unintended injury to important anatomic structures also potentially increases operative time, which in turn lengthens a patient’s exposure to anesthesia, and increases overall cost. Surgeons operating minimal-invasively currently do not have an easy-to-use, real-time device to aid in intraoperative identification of important anatomic structures that underlie tissue planes that must be carefully dissected in a stepwise layer-by-layer fasion to avoid injury to these structures. We demonstrate a simple method of freehand diffuse optical spectroscopy imaging (freeDOSi) for the potential of intra-operatively identifying significant anatomic structures including veins and arteries underlying the plane of dissection in minimally invasive surgery. An applicator-probe that can be adaptable to and detached from an 8mm instrument for laparoscopic or robotic-assisted DOS operation has been developed. The 10mm source-detector separation renders diffuse sampling of tissue heterogeneities a few millimeters deep. Consecutively acquired DOS spectra during freehand movement of the probe on tissue surface are displayed as a time-spectral image providing spatially-resolved identification of underlying structures presenting DOS heterogeneity. Identifications of vena cava and aorta underlying fat of up to 4mm were demonstrated repeatedly in multiple pigs in vivo.
Inadvertent injury to important anatomic structures is a significant risk in minimally invasive surgery (MIS) that potentially requires conversion to an open procedure, which results in increased morbidity and mortality. Surgeons operating minimal-invasively currently do not have an easy-to-use, real-time device to aid in intraoperative identification of important anatomic structures that underlie tissue planes. We demonstrate freehand diffuse optical spectroscopy (DOS) imaging for intraoperatively identifying major underlying veins and arteries. An applicator probe that can be affixed to and detached from an 8-mm laparoscopic instrument has been developed. The 10-mm DOS source–detector separation renders sampling of tissue heterogeneities a few millimeters deep. DOS spectra acquired consecutively during freehand movement of the applicator probe on the tissue surface are displayed as a temporal and spectral image to assist in spatially resolved identification of the underlying structures. Open surgery identifications of the vena cava and aorta underlying peritoneal fat of ∼4 mm in thickness using the applicator probe under room light were demonstrated repeatedly in multiple pigs in vivo.
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