Utilizing confocal laser endomicroscopy for evaluating the adequacy of laparoscopic liver ablation

作者：Schneider Crispin; Johnson Sean P; Walker Samuel Simon; Gurusamy Kurinchi; Clarkson Matthew J; Thompson Stephen; Song Yi; Totz Johannes; Cook Richard J; Desjardins Adrien E; Hawkes David J; Davidson Brian R

来源：Lasers in Surgery and Medicine, 2016, 48(3): 299-310.

DOI：10.1002/lsm.22464

• confocal laser endomicroscopy
• liver ablation imaging
• liver cancer
• virtual histology

BackgroundLaparoscopic liver ablation therapy can be used for the treatment of primary and secondary liver malignancy. The increased incidence of cancer recurrence associated with this approach, has been attributed to the inability of monitoring the extent of ablated liver tissue.
MethodsThe feasibility of assessing liver ablation with probe-based confocal laser endomicroscopy (CLE) was studied in a porcine model of laparoscopic microwave liver ablation. Following the intravenous injection of the fluorophores fluorescein and indocyanine green, CLE images were recorded at 488nm and 660nm wavelength and compared to liver histology. Statistical analysis was performed to assess if fluorescence intensity change can predict the presence of ablated liver tissue.
ResultsCLE imaging of fluorescein at 488nm provided good visualization of the hepatic microvasculature; whereas, CLE imaging of indocyanine green at 660nm enabled detailed visualization of hepatic sinusoid architecture and interlobular septations. Fluorescence intensity as measured in relative fluorescence units was found to be 75-100% lower in ablated compared to healthy liver regions. General linear mixed modeling and ROC analysis found the decrease in fluorescence to be statistically significant.
ConclusionLaparoscopic, dual wavelength CLE imaging using two different fluorophores enables clinically useful visualization of multiple liver tissue compartments, in greater detail than is possible at a single wavelength. CLE imaging may provide valuable intraoperative information on the extent of laparoscopic liver ablation. Lasers Surg. Med. 48:299-310, 2016.

• 出版日期2016-3