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Near-infrared intraoperative imaging of pelvic autonomic nerves: a pilot study

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Abstract

Background

The pelvic autonomic nerves control and regulate anorectal and urogenital function. The dysfunction of pelvic autonomic nerves lead to disorders of anorectum, bladder and male sex organs. Thus the intraoperative identification of pelvic autonomic nerves could be crucial in complications prevention and diseases treatment. Our clinical trial aims at estimating the effectiveness and validity of intraoperative indocyanine green fluorescence imaging in pelvic autonomic nerves identification.

Methods

Intraoperative fluorescence imaging using indocyanine green was performed in ten patients and the feasibility was determined. From February 2019 to June 2019, the seven patients undergoing laparoscopic colorectal resection was administrated 4.5 mg/Kg indocyanine green 24 h before surgery. The near-infrared fluorescence imaging was conducted during surgery. A novel white light and near-infrared dual-channel laparoscopic equipment was applied. For each patient, signal–background ratio values for pelvic autonomic nerves were recorded and analyzed.

Results

We confirmed the dose and timing of indocyanine green administration was 4.5 mg/Kg and 24 h before surgery. Using the dual laparoscopic equipment, we could observe the splanchnic plexus, inferior mesenteric artery plexus, and sacral plexus successfully with a high signal background ratio value of 3.18 (standard deviation: 0.48).

Conclusion

This pilot trial shows feasibility of intraoperative indocyanine green fluorescence imaging in pelvic autonomic nerves observation. It demonstrates that nerves can be visualized using alternative imaging techniques but it is not ready yet for prime time. This technique might aid observation with white light alone.

Registration number: ChiCTR1900025336.

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Abbreviations

FDA:

Food and Drug Administration

ICG:

Indocyanine green

NIR:

Near-infrared

ROI:

Region of interest

SBR:

Signal-to-background ratio

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Acknowledgements

We thank Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University) for providing the necessary support for our study. This work has been supported by Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University) and the CAS Key laboratory of molecular imaging, Chinese Academy of Sciences.

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Authors and Affiliations

  1. The Second Department of General Surgery, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong Province, 519000, China

    Hao Jin

  2. The Department of Clinical Laboratory, The Fifth People’s Hospital of Zhuhai, Zhuhai, Guangdong Province, 519000, China

    Li Zheng

  3. Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong Province, 519000, China

    Ligong Lu & Min Cui

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  1. Hao Jin
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Contributions

CM and LLG proposed the study. LLG, CM, ZL and JH performed the research and wrote the first draft. All authors contributed to the design and interpretation of the study and to further drafts. LLG and CM are the guarantors.

Corresponding authors

Correspondence to Ligong Lu or Min Cui.

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Disclosure

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Hao Jin, Li Zheng, Ligong Lu, and Min Cui have no conflict of interest or financial ties to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review boards of Zhuhai People's Hospital (Zhuhai, China) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from the individual participant included in the study. The participants gave consent for his personal and clinical details along with any identifying images to be published in this study.

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Cite this article

Jin, H., Zheng, L., Lu, L. et al. Near-infrared intraoperative imaging of pelvic autonomic nerves: a pilot study. Surg Endosc 36, 2349–2356 (2022). https://doi.org/10.1007/s00464-021-08512-z

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  • DOI: https://doi.org/10.1007/s00464-021-08512-z

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