Shining a Light on the Subject – Fluorescence in Surgery

Shining a Light on the Subject – Fluorescence in Surgery

University of California San Diego (UCSD) has created a new department, the Center for Fluorescence-Guided Surgery. 

According to a news release from UCSD, Fluorescence-Guided Surgery, or FGS, can be used in open, laparoscopic and robotic surgeries to identify critical structures, tumor margins and blood flow in tissues, in real-time. FGS is typically performed by injecting contrast agents or targeted imaging probes into the b3lood stream of patients just before surgery. Using specialized cameras and light sources that can detect light in multiple wavelengths, surgeons can visualize tumor anatomy or other critical structures for more precise surgery.

In 2004, surgeon Quyen Nguyen, MD, PhD, Otolaryngologist and Professor of Surgery at UCSD School of Medicine, and Nobel Laureate Roger Tsien, PhD teamed up to develop one of the first targeted injectable fluorescent molecules to specifically highlight tumors and hard-to-see peripheral nerves. Tsien, Nguyen and colleagues used synthetic molecules called activatable cell penetrating peptides (ACPPs) and microscopic nanoparticles to develop probes carrying fluorescent and magnetic tags. These tags make tumors visible to MRI and allow the tumors to “glow” on the operating table. The team wanted to see if the probes could aid surgeons in seeing more of the tumor, particularly the margins.

UC San Diego completed the first-in-human Phase I clinical trial of Tsien and Nguyen’s fluorescent peptides targeted for tumor margins in 2017. The study allowed breast tumors to be visualized in the operating room. 

“The use of fluorescence is an absolute game-changer for cancer surgeries,” said Anne Wallace, MD, principal investigator and director of the Comprehensive Breast Health Center at UC San Diego Health. “The evolution of Dr. Tsien’s work in the lab to our operating rooms at UC San Diego Health is a combination of translational and personalized medicine at its best.”

Besides breast cancer, fluorescence is being used in surgeries for colorectal cancer, nerve preservation in tumor dissection and, as fluorescence imaging evolves and advances, researchers say more targeted molecules will be developed and designed to individual patients’ disease profiles.

“While many operations at UC San Diego Health use fluorescence guidance now, imaging techniques and molecule development continue to progress through the research of the Center for the Future of Surgery at the T. Denny Sanford Medical Education and Telemedicine Center,” said Santiago Horgan, MD, the center’s director and chief of minimally invasive surgery. “This is the first dedicated center in the country to deliver a new caliber of surgical accuracy, allowing UC San Diego Health doctors to treat patients with tumors and complex diseases of all types with GPS-like precision, easily identifying cancerous or critical tissues throughout the body because they literally glow.”