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Technical Feasibility of Confocal LASER Endomicroscopy in Laparoscopic Surgery: the Persee Project
Brice Gayet*2, Pierre Validire1, Angelo Pierangelo1, Abdelali Benali1, David Fuks2
1Pathology department, Institut Mutualiste Montsouris, Paris, France; 2Department of Digestive diseases, Institut Mutualiste Montsouris, Paris, France
Rationale: Confocal laser endomicroscopy (CLE) is a novel imaging technique routinely used in endoscopic examinations in the area of gastroenterology and pulmonology for in vivo real time microscopic characterization of the mucosa. The same technique would be helpful during laparoscopic surgery for both real time detection of peritoneal carcinomatosis and real time evaluation of surgical margins.
Objective: To evaluate the feasibility and safety of an innovative confocal endomicroscopic device dedicated to the in vivo imaging of tissue for surgical applications during laparoscopic surgery for digestive cancer.
Methods: Real time images were obtained as the result of: (a) a robotized confocal mini-probe with a bending distal tip providing access and imaging of peritoneal nodules or a confocal mini-probe including a 19G needle for needle-based CLE (nCLE); (b) a dual wavelength endomicroscopy system that allowed imaging at 2 different wavelengths in the near infrared: 640nm and 785nm (ICG was applied interstitially for lymph nodes staining (1.25 mg/ml) and topically for surface staining (0.25 mg/ml); (c) an audio-visual datalink between the surgeon and the pathologist enabling both real-time transmission of macroscopic and microscopic information and interpretation of "optical biopsies".
Results: nCLE and pCLE were successfully performed and endomicroscopic images were obtained on the peritoneum (including normal and fibrous nodules), on the liver and in 2 lymph nodes. No adverse event was reported. The robotized miniprobe enabled easy manipulation by the surgeon and stable images improving image quality. The audio-visual connection between the OR and the pathologist room enabled an efficient real-time information sharing.
Conclusion: These preliminary results suggest a promising introduction of robotized CLE in laparoscopic surgery leading to a new way of collaboration between the surgeon and the pathologist.
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