Nerve detection during surgery: optical spectroscopy for peripheral nerve localization
Precise nerve localization is of major importance in both surgery and regional anesthesia. Optically based techniques can identify tissue through differences in optical properties, like absorption and scattering. The aim of this study was to evaluate the potential of optical spectroscopy (diffuse reflectance spectroscopy) for clinical nerve identification in vivo. Eighteen patients (8 male, 10 female, age 53 ± 13 years) undergoing inguinal lymph node resection or resection or a soft tissue tumor in the groin were included to measure the femoral or sciatic nerve and the surrounding tissues. In vivo optical measurements were performed using Diffuse Reflectance Spectroscopy (400–1600 nm) on nerve, near nerve adipose tissue, muscle, and subcutaneous fat using a needle-shaped probe. Model-based analyses were used to derive verified quantitative parameters as concentrations of optical absorbers and several parameters describing scattering. A total of 628 optical spectra were recorded. Measured spectra reveal noticeable tissue specific characteristics. Optical absorption of water, fat, and oxy- and deoxyhemoglobin was manifested in the measured spectra. The parameters water and fat content showed significant differences (P < 0.005) between nerve and all surrounding tissues. Classification using k-Nearest Neighbor based on the derived parameters revealed a sensitivity of 85% and a specificity of 79%, for identifying nerve from surrounding tissues. Diffuse Reflectance Spectroscopy identifies peripheral nerve bundles. The differences found between tissue groups are assignable to the tissue composition and structure.
KeywordsNerves Nerve sparing Surgery Anesthesia Optical spectroscopy Spectroscopy
We would like to thank Arnold van Keersop (Philips Research) for his assistance in analyzing the data and Vishnu Pully and Christian Reich for technical support during the data collection. We acknowledge Marjolein van der Voort and Gerald Lucassen (Philips Healthcare) for their guidance in the overall study design, data analysis, and review of the manuscript.
For this study, The Netherlands Cancer Institute received an unrestricted grant from Philips Research. This research was further supported by a grant of the KWF-Alpe d’HuZes (NKI 2014-6596).
Compliance with ethical standards
Conflict of interest statement
The authors who are affiliated with Philips Research (M.M., T.B., B.H.) are employees of Philips. The prototype system described in this article is a research prototype. None of the other authors have any conflicts of interest.
This study was performed at The Netherlands Cancer Institute—Antoni van Leeuwenhoek hospital under approval of the protocol and ethics review board (NL40893.031.12).
Written informed consent was obtained from all individual participants included in the study.
- 1.Lange MM, van de Velde CJ (2010) Long-term anorectal and urogenital dysfunction after rectal cancer treatment. Sem Col Rec Surg, pp 87–94Google Scholar
- 5.Walker KJ, McGrattan K, Aas-Eng K, Smith AF (2009) Ultrasound guidance for peripheral nerve blockade. Cochrane Db Syst Rev 4:CD006459Google Scholar
- 13.Nachabé R, Evers DJ, Hendriks BH, Lucassen GW, van der Voort M, Rutgers EJ, Peeters M-JV, Van der Hage JA, Oldenburg HS, Wesseling J (2011) Diagnosis of breast cancer using diffuse optical spectroscopy from 500 to 1600 nm: comparison of classification methods. J Biomed Opt 16:087010–087012CrossRefPubMedGoogle Scholar
- 17.Getoor L, Taskar B (2007) Introduction to statistical relational learning. MIT press, LondonGoogle Scholar
- 19.Brady S, Siegel G, Albers RW, Price D (2007) Basic neurochemistry: molecular, cellular and medical aspects, 7th edn. Elsevier Academic Press, BurlingtonGoogle Scholar