Fluorescence-guided Surgery of Head and Neck Cancer
Results will be presented from ongoing clinical trials evaluating the ability of fluorescently labeled antibodies to enhance surgical resection in head and neck patients. Additionally, the inherent benefit of the technology will be examined during various stages of the surgical treatment workflow. Individual cases demonstrating patient benefit will be presented. In order to advance the field of fluorescence-guided surgery for oncologic resection, it is critical to investigate all areas of clinical application to maximize patient benefit.
October 24, 2019 @ 7:00am EST
Jason M. Warram, Ph.D.
Associate Professor, Departments of Otolaryngology, Surgery, Radiology, and Biomedical Engineering
Associate Scientist — O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham
Tumor - Targeted Fluorescent Dyes for Fluorescence - Guided Surgery
Complete surgical resection of all malignant tissue remains the most reliable cure for cancer. To facilitate quantitative removal of all cancer lesions, we have developed low molecular weight ligand-targeted fluorescent dyes that bind to receptors on cancer cells and thereby illuminate tumor tissue without highlighting normal tissue. With the aid of these dyes surgeons have been able to i) find and resect more malignant lesions, ii) detect and remove positive tumor margins, iii) more accurately stage cancer patients, and iv) locate and resect more malignant lymph nodes than was previously possible using standard surgical methods of palpation and visual inspection.
In this presentation, Dr. Low will summarize both preclinical and clinical data on the design, synthesis and use of ligand-targeted fluorescent dyes for intra-operative imaging of cancers and various inflammatory diseases. Data will also be presented on new targeting ligands that selectively deliver attached near infrared dyes to tumor stromal cells that have heretofore been difficult to visualize (e.g. tumor fibroblasts, tumor-associated macrophages, MDSCs, T cells, etc.). Finally, mention will also be made of novel near infrared fluorescent imaging agents that allow imaging of ureters and blood vessels at emission wavelengths that are distinct from those used in cancer imaging. Taken together, these new reagents should allow the assembly of a new toolbox of different colored NIR dyes for the imaging of diseased tissues that need to be resected as well as healthy tissues that need to be preserved during fluorescence guided surgery.
Thursday, November 21st @ 7am EST
Philip S. Low, MD
Presidential Scholar for Drug Discovery and the Ralph C.Corley Distinguished Professor of Chemistry at Purdue University, On Target Laboratories, West Lafayette, IN 47907 and Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
RCT and Cholangiogram
With over 750,000 procedures performed annually, laparoscopic cholecystectomy is the most common ambulatory surgical procedure performed in the USA.
Despite its proven safety record, the incidence of common bile duct injuries and conversions remain at an unacceptable high rate. The introduction of laparoscopic cholecystectomy has increased the number of common bile duct injuries to approximately 4 to 8 in 1000 cases. Conversions are estimated between 4% to 8 %. The most common reason for CBDI is surgeons misidentification of the biliary tree anatomy. Near infrared fluorescent cholangiography is a new, non invasive imaging modality that will allow surgeons to identify the biliary tree before dissection is performed without the need of radiation or to do an incision. The RCT of fluorescent cholangiography has shown that NIRFC is safe, efficacious, cost effective and should be use routinely during laparoscopic cholecystectomy.
July 25, 2019 @ 7:00am EST
Raul J. Rosenthal, MD, FACS, FASMBS
Director Professor of Surgery and Chairman, Department of General Surgery Director, General Surgery Residency Program Director, The Bariatric and Metabolic Institute Cleveland Clinic Florida Co-Editor in Chief, Surgery for Obesity and Related Diseases President, South Florida Chapter of the American College of Surgeons
Preventing Postoperative Hypocalcemia in Thyroid Surgery with Fluorescence Visualization of Parathyroid Glands
Dr Fernando Dip will be showing us the results of a study that was recently published. The effectiveness of using near-infrared light (NIRL) intraoperatively for parathyroid gland identification was demonstrated. He will be showing us how the technology can be used in order to decrease the rate of hypocalcemia after thyroidectomies.
August 22, 2019 @ 7:00am EST
Fernando D. Dip, MD
Staff Surgical Oncology, Hospital de Clínicas Buenos Aires Chief of Surgical Reaseach, University of Buenos Aires Affiliated Surgeon, Cleveland Clinic Florida
Use of Fluorescence in Abdominal Wall Reconstruction
Objectives
- Recognize the soft tissue challenges in abdominal wall reconstruction
- Understand the options to evaluate perfusion of the abdominal wall
- Become familiar with the steps to use of fluorescence in the assessment of abdominal wall perfusion
September 19, 2019 @ 7:00am EST
Emanuele Lo Menzo, MD
Director for Clinical Research at Cleveland Clinic Florida, Associate Program Director of General Surgery Residency and Director of the Clinical Clerkship for Medical Students.
Additional 2019-20 Webinar Series topic details will be added here as soon as they become available.
Past 2018-19 Webinar Topics
Impact of incisionless fluorescent cholangiography
Fluorescent insicionless cholangiography during laparoscopic cholecystectomy. Is this a New Gold Standard?
This presentation is aimed to reinforce the impact of this novel technology that might transform Laparoscopic Cholecystectomy into one of the safest surgical procedures. Despite the major advances in Laparoscopic Cholecystectomy over the past two decades, patients undergoing the procedure may still face life-threatening complications due to misidentification of the bile duct anatomy.
With the routine use of near infrared (NIR) guided surgery, surgeons have the possibility to increase the range of visualization and understanding of the extrahepatic bile ducts and avoid injuries due to misidentification. This lecture will provide a clear understanding of the basic principles of this novel and simple technique. In addition, there will be an opportunity to learn surgical tips and review the most important data from the literature.
Raul J. Rosenthal, MD, FACS, FASMBS
Director Professor of Surgery and Chairman, Department of General Surgery Director, General Surgery Residency Program Director, The Bariatric and Metabolic Institute Cleveland Clinic Florida Co-Editor in Chief, Surgery for Obesity and Related Diseases President, South Florida Chapter of the American College of Surgeons
New frontiers in fluorescent guided endocrine surgery
Endocrine procedures like thyroidectomies and adrenalectomies are commonly performed by general and endocrine surgeons around the world. Unfortunately during the surgeries patients might be at risk of suffering complications like hypocalcemia after thyroidectomies due to parathyroid glands injuries, or bleeding during a laparoscopic adrenalectomies to difficulties during adrenal vessels identification. An accurate visualization of the glands like parathyroid glands, tumors or adrenal glands are key steps in order to perform a safe procedure. In the last years the use of fluorescence allowed surgeons to better understand the anatomy and visualize the localization and vascularization of the glands avoiding complications. The audience will be able to understand the basic concepts of the method and to learn technical tips of the technology. A literature review of clinical outcomes in endocrine fluorescence guided surgery will be performed.
Fernando D. Dip, MD
Staff Surgical Oncology, Hospital de Clínicas Buenos Aires Chief of Surgical Reaseach, University of Buenos Aires Affiliated Surgeon, Cleveland Clinic Florida
Role of FIGS in colorectal surgery
Anastomotic leak is one of the most feared complications in colorectal surgery, with significant resultant morbidity and mortality. Etiologies of anastomotic leaks are varied, multifactorial, and have been well described in the literature (C01, C02). Several methods have been described in the quest to minimize rates of anastomotic leak in colorectal surgery; the most promising technology is definitely the real-time intraoperative perfusion assessment of the anastomosis using fluorescence angiography (C03, C04).
Table 1 summarizes most of the major studies evaluating colorectal anastomosis perfusion using ICG based fluorescence angiography. (Table 1)
There are a variety of NIR systems currently on the market, however all of them have been shown to be accurate and with technical success approaching 100% in most publications.
The dosage of ICG that has been reported varies significantly between different publications and ranges from 3.75-10mg or in the range of in the range of 0.1–0.3 mg/kg. However, the dose administered has not affected the technical success of the fluorescence angiography, and probably is not of significant importance as the maximal safe dose of ICG (2 mg/kg) has not been administered. Use of ICG based fluorescence angiography is perhaps surprisingly safe with no significant adverse effects reported.
Review of the current literature regarding perfusion assessment in colorectal surgery demonstrates that fluorescence angiography is usually associated with low rates of anastomotic leak. As shown in table 1, the combined average leak rate in more than 2000 patients who underwent fluorescence angiography 2.9%, and change in surgical plans (mainly change in resection point) happened in 9.4% of the patients.
There was one major multicenter prospective randomized trials evaluating fluorescence angiography in colorectal surgery. The Pillar III trial intended to evaluate approximately 550 patients undergoing open or minimally invasive proctectomy for rectosigmoid cancer, with a planned anastomosis of ≤10 cm from the anal verge. The primary end point was a reduction in leak rate and the secondary end points included technical feasibility and change in surgical plan. However, unfortunately, this trial was terminated after 330 patients.
We believe that there is enough evidence to support the claim that fluorescence angiography plays a significant role in reduction of anastomotic leaks in colorectal surgery, and we are confident that the results from both prospective randomized trials will reflect our opinion.
References
C01. Shogan BD, Carlisle EM, Alverdy JC, et al. Do we really know why colorectal anastomoses leak? J Gastrointest Surg. 2013;17(9):1698–1707.
C02. Al Asari S, Cho MS, Kim NK. (2015) Safe anastomosis in laparoscopic and robotic low anterior resection for rectal cancer: a narrative review and outcomes study from an expert tertiary center. Eur J Surg Oncol 41(2):175–185
C03. Chadi, S.A., et al., Emerging Trends in the Etiology, Prevention, and Treatment of Gastrointestinal Anastomotic Leakage. J Gastrointest Surg, 2016. 20(12): p. 2035-2051.
C04. Vallance, A., et al., A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery. Colorectal Dis, 2017. 19(1): p. O1-O12.
Steven Wexner, MD, PhD (Hon)
Role of fluorescence in organ perfusion
The webinar will describe the basic principles of fluorescence guided surgery with special interest in the field of organ perfusion control using fluorescent angiography. An extensive review of the available literature will also be discussed.
Luigi Boni, MD, FACS
Role of FIGS in liver surgery
Recently, in vivo fluorescence imaging using indocyanine green (ICG) has actively been applied to open and then laparoscopic HPB surgery, for intraoperative visualization of biological structures and assessment of blood perfusion. This webinar will discuss the methods and results.
Intraoperative fluorescence imaging will develop into an essential navigation tool enabling surgeons to identify the extent of cancer spread, anatomical variations, and a risk of postoperative complications in each individual case, enhancing accuracy and safety of HPB surgery.
Takeaki Ishizawa MD, PhD, FACS
Lector at Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, University of Tokyo Hospital, Tokyo, Japan
Importance of fluorescence in lymph surgery
Surgery on lymph system has become an important long-term treatment of lymphedema. The performance of this demanding surgical procedure is increasing all over the world. In order to be able to assess the situation of the lymphedema and to decide on the lymph surgery an assessment of the lymphatics is necessary. The fluorescence angiography allows you to visualize the functionality, individual physiology, velocity of the lymphatics and thus severity of a lymphedema. Having the real-time picture of the patient’s lymphatics surgeon can decide on the best suitable surgical procedure. This presentation will show the use of fluorescence lymphangiography and different surgical procedures on lymphedema treatment.
WEBINAR: 5 November, 2018
Prof. Jaume Masia
Fluorescence visualization of flap perfusion
The assessment of the flap perfusion in reconstruction surgery is mostly based on clinical evaluation. Unfortunately, surgeons still face some risk of complications if the flap tissue is not well perfused. Indocyanine Green (ICG) angiography allows the surgeon to define the boundaries of the perforator perfusion zones of a flap with high sensitivity, avoiding partial flap loss and fat necrosis. With the combination of preoperative Computed Tomography Angiography (CTA) and intraoperative ICG, we can define the post-dissection vascular re-balance, speed up the flap dissection and avoid post-operative flap complications. This lecture will provide you a clear understanding of the procedure and benefits of the fluorescence diagnostic method used in flap reconstruction surgery.
WEBINAR: 12 November, 2018
Dr. Gemma Pons
Fluorescent guided surgery with augmented reality for personalized surgical navigation
Frank Papay, MD
Use of near-infrared guided surgery in esophageal resections
Esophagectomy for esophageal cancer is still associated with a high morbidity and mortality. Anastomotic leaks are a major source of morbidity after esophagectomy with gastric pull-up. In large part they occur as a consequence of poor blood perfusion in the gastric graft. Risk factors like nicotine, neoadjuvant radiotherapy, hypertension and diabetes are considered to increase anastomotic leakage rate. Ongoing challenge is to improve technical options for better patients’ outcome. Because of knowledge that quality of gastric tube perfusion is obviously related with anastomotic healing the use of fluorescence controlled construction of gastric tube makes this procedure safer for our patients.
This lecture gives an overview of this approach and current literature.
Sylke Schneider, MD
Senior Consultant Dept. visceral surgery
Klinikum Südstadt Rostock, Germany
Specialist for general, visceral and bariatric surgery
The use of ICG in endocrine surgery
Indocyanine Green (ICG) is being utilized to identify both normal parathyroid glands during thyroidectomy and also to identify parathyroid adenomas during parathyroidectomy for primary or secondary hyperparathyroidism. The use of ICG allows for assessment of parathyroid perfusion. By using ICG, surgeons may be able to reduce the incidence of hypoparathyroidism following thyroidectomy and also may find it useful to identify parathyroid adenomas. For adrenal surgery, ICG allows identification of the blood supply and venous drainage of the tumor that at times can be challenging. This lecture will provide you a clear understanding of the use and benefits of the use if ICG in endocrine surgery.
Michael Bouvet, MD, FACS
Professor of Surgery
Director of Endocrine Surgery
Division of Surgical Oncology
Department of Surgery
University of California San Diego
Moores Cancer Center
Future of NIR Guided Surgery
Future of NIR Guided Surgery
Webinar description coming soon…
Michele Diana, MD
Research Director of the Endo-Laparoscopic Procedures Unit at the IHU-Strasbourg, Institute of Image-Guided Surgery Senior Researcher and Faculty Member at the IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France