title: Laparoscopic Confocal Laser Microscopy Without Fluorescent Injection: A Pilot Ex Vivo Study in Colon Cancer.
abstract: Introduction Histological analysis of surgical specimen is the gold standard for cancer classification. In particular, frozen histological diagnosis of vague peritoneal spots or uncertain excision of tumors plays a crucial role for proceeding with or without change of the operation procedure. Confocal laser microscopy (CLM) enables in vivo and real-time high-resolution tissue analysis. To evaluate a novel technique of CLM without any fluorescent dye, this pilot ex vivo study demonstrates a CLM camera device for minimal invasive surgical approach. Methods In 5 cases, a laparoscopic CLM camera was used for examining colon and rectum specimen. Images of nonmalignant and malignant intestinal mucosa were characterized in terms of specific signal-patterns. No fluorescent dye was used. Correlations to findings in conventional histology were systematically recorded and described. Results Using this CLM camera device, it is possible to analyze colon specimen mucosa. Nonmalignant and malignant intestinal mucosa show specific signal patterns. Nonmalignant mucosa is defined by honeycomb structure. There is deregulated structure in colon and rectum carcinoma mucosa. The inside lumen is irregular. The radial border appears swollen with reduced contrast. Discussion This pilot study shows that the assessment of colon mucosa with a prototype of CLM camera for minimally invasive surgical approach without any fluorescent dye is feasible. It is possible to differentiate between benign and malignant mucosa in colon specimen by easy to evaluate and reproducible parameters. These first steps of this pioneering achievement to establish CLM in minimal invasive surgical procedures show a great potential for a more reliable intraoperative evaluation of suspect foci.
authors.affiliation: University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany david.ellebrecht@uksh.de.
authors.forename: David B
authors.initials: DB
authors.lastname: Ellebrecht
authors.affiliation: University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Maximilian P E
authors.initials: MP
authors.lastname: Gebhard
authors.affiliation: University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Horn
authors.affiliation: University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Keck
authors.affiliation: University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Kleemann
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003082:Colectomy; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005456:Fluorescent Dyes; D006801:Humans; D010535:Laparoscopy; D018613:Microscopy, Confocal; D010865:Pilot Projects; D046509:Tissue Culture Techniques
chemical_list: D005456:Fluorescent Dyes
keywords: confocal laser microscopy; frozen section; medical engineering; minimal invasive surgery; peritoneal carcinomatosis