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Direct Administration of Nerve-Specific Contrast to Improve Nerve Sparing Radical Prostatectomy
Nerve damage remains a major morbidity following nerve sparing radical prostatectomy, significantly affecting quality of life post-surgery. Nerve-specific fluorescence guided surgery offers a potential solution by enhancing nerve visualization intraoperatively. However, the prostate is highly innerv...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Ivyspring International Publisher
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5327635/ https://www.ncbi.nlm.nih.gov/pubmed/28255352 http://dx.doi.org/10.7150/thno.17433 |
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author | Barth, Connor W. Gibbs, Summer L. |
author_facet | Barth, Connor W. Gibbs, Summer L. |
author_sort | Barth, Connor W. |
collection | PubMed |
description | Nerve damage remains a major morbidity following nerve sparing radical prostatectomy, significantly affecting quality of life post-surgery. Nerve-specific fluorescence guided surgery offers a potential solution by enhancing nerve visualization intraoperatively. However, the prostate is highly innervated and only the cavernous nerve structures require preservation to maintain continence and potency. Systemic administration of a nerve-specific fluorophore would lower nerve signal to background ratio (SBR) in vital nerve structures, making them difficult to distinguish from all nervous tissue in the pelvic region. A direct administration methodology to enable selective nerve highlighting for enhanced nerve SBR in a specific nerve structure has been developed herein. The direct administration methodology demonstrated equivalent nerve-specific contrast to systemic administration at optimal exposure times. However, the direct administration methodology provided a brighter fluorescent nerve signal, facilitating nerve-specific fluorescence imaging at video rate, which was not possible following systemic administration. Additionally, the direct administration methodology required a significantly lower fluorophore dose than systemic administration, that when scaled to a human dose falls within the microdosing range. Furthermore, a dual fluorophore tissue staining method was developed that alleviates fluorescence background signal from adipose tissue accumulation using a spectrally distinct adipose tissue specific fluorophore. These results validate the use of the direct administration methodology for specific nerve visualization with fluorescence image-guided surgery, which would improve vital nerve structure identification and visualization during nerve sparing radical prostatectomy. |
format | Online Article Text |
id | pubmed-5327635 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Ivyspring International Publisher |
record_format | MEDLINE/PubMed |
spelling | pubmed-53276352017-03-02 Direct Administration of Nerve-Specific Contrast to Improve Nerve Sparing Radical Prostatectomy Barth, Connor W. Gibbs, Summer L. Theranostics Research Paper Nerve damage remains a major morbidity following nerve sparing radical prostatectomy, significantly affecting quality of life post-surgery. Nerve-specific fluorescence guided surgery offers a potential solution by enhancing nerve visualization intraoperatively. However, the prostate is highly innervated and only the cavernous nerve structures require preservation to maintain continence and potency. Systemic administration of a nerve-specific fluorophore would lower nerve signal to background ratio (SBR) in vital nerve structures, making them difficult to distinguish from all nervous tissue in the pelvic region. A direct administration methodology to enable selective nerve highlighting for enhanced nerve SBR in a specific nerve structure has been developed herein. The direct administration methodology demonstrated equivalent nerve-specific contrast to systemic administration at optimal exposure times. However, the direct administration methodology provided a brighter fluorescent nerve signal, facilitating nerve-specific fluorescence imaging at video rate, which was not possible following systemic administration. Additionally, the direct administration methodology required a significantly lower fluorophore dose than systemic administration, that when scaled to a human dose falls within the microdosing range. Furthermore, a dual fluorophore tissue staining method was developed that alleviates fluorescence background signal from adipose tissue accumulation using a spectrally distinct adipose tissue specific fluorophore. These results validate the use of the direct administration methodology for specific nerve visualization with fluorescence image-guided surgery, which would improve vital nerve structure identification and visualization during nerve sparing radical prostatectomy. Ivyspring International Publisher 2017-01-07 /pmc/articles/PMC5327635/ /pubmed/28255352 http://dx.doi.org/10.7150/thno.17433 Text en © Ivyspring International Publisher This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license (https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions. |
spellingShingle | Research Paper Barth, Connor W. Gibbs, Summer L. Direct Administration of Nerve-Specific Contrast to Improve Nerve Sparing Radical Prostatectomy |
title | Direct Administration of Nerve-Specific Contrast to Improve Nerve Sparing Radical Prostatectomy |
title_full | Direct Administration of Nerve-Specific Contrast to Improve Nerve Sparing Radical Prostatectomy |
title_fullStr | Direct Administration of Nerve-Specific Contrast to Improve Nerve Sparing Radical Prostatectomy |
title_full_unstemmed | Direct Administration of Nerve-Specific Contrast to Improve Nerve Sparing Radical Prostatectomy |
title_short | Direct Administration of Nerve-Specific Contrast to Improve Nerve Sparing Radical Prostatectomy |
title_sort | direct administration of nerve-specific contrast to improve nerve sparing radical prostatectomy |
topic | Research Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5327635/ https://www.ncbi.nlm.nih.gov/pubmed/28255352 http://dx.doi.org/10.7150/thno.17433 |
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