Introduction: The Optiscan confocal laser microscope (CLM) is a handheld probe that enables real-time in vivo histological surface and sub-surface imaging at laparoscopy or laparotomy. It may provide immediate intra-operative assessment of histology, tumor margins and microvasculature. To date, there is no data on the intra-operative application of this technique. Aims: This study aimed to evaluate the clinical feasibility and utility of CLM during intra-abdominal surgery and to determine the quality of images acquired.
Methods: Intravenous fluorescein contrast was used. Ten procedures were performed and obtained confocal images of normal pancreas, bile duct, liver, omentum, lymph nodes and spleen, both from the serosal and cut surfaces. Chronic pancreatitis and pancreatic cancers were also assessed. Surgeons’ feedback was obtained.
Results: Confocal cellular and architectural features of intra-abdominal organs were described and found to be reproducible. Quality of the images improved with experience. Liver capsule prevented deep hepatic imaging. Normal pancreatic acini were obvious and differentiated from chronic pancreatitis and pancreatic cancer (figure). Bleeding impaired some surface imaging, especially from dysplastic tissues. The duration of confocal examination varied from 7 to 15 minutes and no adverse effect was observed. Intra-operative real time histology was possible without significant disruption of the operation and only minor equipment re-design was suggested. The disposable outer sheaths successfully maintained sterility.
Conclusions: Real-time “virtual histology” during intra-abdominal surgery is safe, feasible and reproducible. CLM has the potential to assist surgeons in diagnosing tissue pathology and guiding resection margins.