Endoscopic confocal laser-microscopy for the intraoperative nerve recognition: is it feasible?
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David Benjamin Ellebrecht
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Sönke von Weihe
Abstract
Surgeons lose most of their tactile tissue information during minimal invasive surgery and need an additional tool of intraoperative tissue recognition. Confocal laser microscopy (CLM) is a well-established method of tissue investigation. The objective of this study was to analyze the feasibility and diagnostic accuracy of CLM nervous tissue recognition. Images taken with an endoscopic CLM system of sympathetic ganglions, nerve fibers and pleural tissue were characterized in terms of specific signal-patterns ex-vivo. No fluorescent dye was used. Diagnostic accuracy of tissue classification was evaluated by newly trained observers (sensitivity, specificity, PPV, NPV and interobserver variability). Although CLM images showed low CLM image contrast, assessment of nerve tissue was feasible without any fluorescent dye. Sensitivity and specificity ranged between 0.73 and 0.9 and 0.55–1.0, respectively. PPVs were 0.71–1.0 and the NPV range was between 0.58 and 0.86. The overall interobserver variability was 0.36. The eCLM enables to evaluate nervous tissue and to distinguish between nerve fibers, ganglions and pleural tissue based on backscattered light. However, the low image contrast and the heterogeneity in correct tissue diagnosis and a fair interobserver variability indicate the limit of CLM imaging without any fluorescent dye.
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Research funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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Informed consent: Not applicable.
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Ethical approval: The research related to human use has complied with all the relevant national regulations, institutional policies, and in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ Institutional Review Board or equivalent committee (ethics committee of the University of Luebeck; Reg.-No.: 20-427).
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© 2021 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Research Articles
- Analysis of objective quality metrics in computed tomography images affected by metal artifacts
- Endoscopic confocal laser-microscopy for the intraoperative nerve recognition: is it feasible?
- A fuzzy sensitivity analysis approach to estimate brain effective connectivity and its application to epileptic seizure detection
- Comparative study of platinum electroplating to improve micro gold electrode arrays with LCP laminate
- Stresses and deformations of an osteosynthesis plate in a lateral tibia plateau fracture
- Biomechanical influence of thread form on stress distribution over short implants (≤6 mm) using finite element analysis
Artikel in diesem Heft
- Frontmatter
- Research Articles
- Analysis of objective quality metrics in computed tomography images affected by metal artifacts
- Endoscopic confocal laser-microscopy for the intraoperative nerve recognition: is it feasible?
- A fuzzy sensitivity analysis approach to estimate brain effective connectivity and its application to epileptic seizure detection
- Comparative study of platinum electroplating to improve micro gold electrode arrays with LCP laminate
- Stresses and deformations of an osteosynthesis plate in a lateral tibia plateau fracture
- Biomechanical influence of thread form on stress distribution over short implants (≤6 mm) using finite element analysis
