title: Improved Intraoperative Visualization of Nerves through a Myelin-Binding Fluorophore and Dual-Mode Laparoscopic Imaging.
abstract: The ability to visualize and spare nerves during surgery is critical for avoiding chronic morbidity, pain, and loss of function. Visualization of such critical anatomic structures is even more challenging during minimal access procedures because the small incisions limit visibility. In this study, we focus on improving imaging of nerves through the use of a new small molecule fluorophore, GE3126, used in conjunction with our dual-mode (color and fluorescence) laparoscopic imaging instrument. GE3126 has higher aqueous solubility, improved pharmacokinetics, and reduced non-specific adipose tissue fluorescence compared to previous myelin-binding fluorophores. Dosing and kinetics were initially optimized in mice. A non-clinical modified Irwin study in rats, performed to assess the potential of GE3126 to induce nervous system injuries, showed the absence of major adverse reactions. Real-time intraoperative imaging was performed in a porcine model. Compared to white light imaging, nerve visibility was enhanced under fluorescence guidance, especially for small diameter nerves obscured by fascia, blood vessels, or adipose tissue. In the porcine model, nerve visualization was observed rapidly, within 5 to 10 minutes post-intravenous injection and the nerve fluorescence signal was maintained for up to 80 minutes. The use of GE3126, coupled with practical implementation of an imaging instrument may be an important step forward in preventing nerve damage in the operating room.
authors.affiliation: Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America.
authors.forename: Victoria E
authors.initials: VE
authors.lastname: Cotero
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
authors.forename: Simon Y
authors.initials: SY
authors.lastname: Kimm
authors.affiliation: Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America.
authors.forename: Tiberiu M
authors.initials: TM
authors.lastname: Siclovan
authors.affiliation: Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America.
authors.forename: Rong
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America.
authors.forename: Evgenia M
authors.initials: EM
authors.lastname: Kim
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Gondo
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Scardino
authors.affiliation: Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America.
authors.forename: Siavash
authors.initials: S
authors.lastname: Yazdanfar
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America.
authors.forename: Vincent P
authors.initials: VP
authors.lastname: Laudone
authors.affiliation: Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America.
authors.forename: Cristina A
authors.initials: CA
authors.lastname: Tan Hehir
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism; D000818:Animals; D002490:Central Nervous System / Q000502:physiology*; D003952:Diagnostic Imaging; D005456:Fluorescent Dyes / Q000737:chemistry; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D051379:Mice; D009186:Myelin Sheath / Q000502:physiology; D010525:Peripheral Nerves / Q000502:physiology*; D051381:Rats; D017207:Rats, Sprague-Dawley; D013050:Spectrometry, Fluorescence / Q000379:methods; D013194:Staining and Labeling / Q000379:methods*; D013552:Swine; D020196:Trauma, Nervous System / Q000517:prevention & control*
chemical_list: D005456:Fluorescent Dyes