We describe the development and performance analysis of two clinical near-infrared fluorescence image-guided surgery
(FIGS) devices that aim to overcome some of the limitations of current FIGS systems. The devices operate in a
widefield-imaging mode and can work (1) in conjunction with a laparoscope, during minimally invasive surgery, and (2)
as a hand-held, open surgery imaging system. In both cases, narrow-band excitation light, delivered at multiple
wavelengths, is efficiently combined with white reflectance light. Light is delivered to ~100 cm2 surgical field at 1-2
mW/cm2 for white light and 3-7 mW/cm2 (depending on wavelength) of red - near infrared excitation, at a typical
working distance of 350 mm for the hand-held device and 100 mm for the laparoscope. A single, sensitive, miniaturized
color camera collects both fluorescence and white reflectance light. The use of a single imager eliminates image
alignment and software overlay complexity. A novel filtering and illumination arrangement allows simultaneous
detection of white reflectance and fluorescence emission from multiple dyes in real-time. We will present both
fluorescence detection sensitivity modeling and practical performance data. We have demonstrated the efficiency and the
advantages of the devices both pre-clinically and during live surgery on humans. Both the hand-held and the
laparoscopic systems have proved to be reliable and beneficial in an ongoing clinical trial involving sentinel lymph node
detection in gynecological cancers. We will show preliminary results using two clinically approved dyes, Methylene blue
and indocyanine green. We anticipate that this technology can be integrated and routinely used in a larger variety of
surgical procedures.
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