V12-04: Intraoperative nerve visualization with GE3126

Video

INTRODUCTION

Iatrogenic nerve injury is a leading cause of morbidity associated with many common surgical procedures, including radical prostatectomy, herniorrhaphy, thyroidectomy, hysterectomy, and colectomy. Nerve-sparing techniques rely primarily upon white light optical identification of nerves, with varied results. There are currently no approved intraoperative agents to aid in the identification of vital nerve structures. GE3126 is a fluorophore that binds to myelin-basic protein and produces fluorescence in myelinated nerves. The objective of this video is to demonstrate the use of this nerve visualization technology in a porcine model.

METHODS

Laparoscopy was performed in adult Yorkshire pigs under general anesthesia. GE3126 was administered intravenously at a concentration of 1.0 mg/kg. A modified commercially-available laparoscopic imaging system was used for white-light and blue-light illumination. Optical filters were used to tailor the xenon excitation light and to optimize the detection of emitted light according to the characteristics of the fluorophore.

RESULTS

Real-time enhanced intraoperative visualization of nerves was consistently achieved in the porcine model. The modified commercially-available laparoscopic equipment camera system proved to be a feasible platform for continued use.

CONCLUSION

Research in human subjects is warranted, and the first-in-human study of GE3126 in men undergoing minimally invasive radical prostatectomy at Memorial Sloan Kettering Cancer Center is expected in 2018. The potential also exists for use of this nerve visualization technology in other disciplines to minimize nerve injury at multiple anatomic sites.

Funding: This study was supported by the Sidney Kimmel Cancer for Prostate and Urologic Cancers, the NIH/NCI Cancer Centre Support Grant P30CA008747, and by David H. Koch through the Prostate Cancer Foundation.