Intraperitoneal virtual biopsy by fibered optical coherence tomography (OCT) at natural orifice transluminal endoscopic surgery (NOTES).
BACKGROUND
Fibered optical coherence tomography (OCT) in conjunction with natural orifice transluminal endoscopic surgery (NOTES) could provide a facility for rapid, in situ pathological diagnosis of intraperitoneal tissues in a truly minimally invasive fashion.


METHODS
A large porcine model was established to test this hypothesis. A standard double channel gastroscope (Olympus) was used to achieve a transgastric access to the peritoneum and initiate the pneumoperitoneum. Magnetic retraction was used to display the sigmoid colon along with its mesentery. A commercially available fibered OCT probe (NIRIS system, Imalux) was inserted via a working channel of the gastroscope and used to assess intraperitoneal tissues. Separately, OCT images of human tissue specimens ex vivo were contrasted with representative standard histopathological slides.


RESULTS
Intraperitoneal OCT provided clear real-time images of both the serosal and muscularis propria mural layers as well as the submucosal-muscularis interface. Examination of mesenteric lymph nodes (including sentinel nodes) allowed visualization of their subcapsular sinus. Comparison of representative cross-sections however failed to evince sufficient resolution for confident diagnosis.


CONCLUSIONS
This approach is technically feasible and, if the technology is advanced and proven accurate in human patients, could potentially be used to individualize operative extent prior to definitive resection.
Cahill
Ronan A
RA
European Institute of Surgical Research of Innovation, Dublin, Ireland. cahillra@gmail.com
Asakuma
Mitsuhiro
M
Trunzo
Joseph
J
Schomisch
Steven
S
Wiese
David
D
Saha
Sukamal
S
Dallemagne
Bernard
B
Marks
Jeff
J
Marescaux
Jacques
J
D000818:Animals; D005240:Feasibility Studies; D005336:Fiber Optic Technology; D020699:Gastroscopes; D006801:Humans; D066298:In Vitro Techniques; D023421:Models, Animal; D010537:Peritoneum / Q000601:surgery*; D021701:Sentinel Lymph Node Biopsy; D013552:Swine; D041623:Tomography, Optical Coherence / Q000295:instrumentation*