Intraoperative determination of nerve location
View Patent ↗The invention provides methods for intraoperatively determining the location of nerves by use of fluorescent dyes. The methods are particularly useful for locating the cavernous nerves innervating the penis.
1. A method of determining the location of a cavernous nerve in a subject during a surgical operation, comprising:
a) between 1 hour and 30 hours prior to said surgical operation, injecting indocyanine green (ICG) into a cavernous body of a penis or a clitoris or an epidural space, wherein the ICG is taken up by or proceeds along the path of said cavernous nerve;
b) exposing said cavernous nerve to illumination comprising an excitation wavelength of ICG, thereby causing said ICG in or along the nerve or portion thereof to fluoresce; and
c) detecting the fluorescence of said ICG, thereby determining the location of said nerve during said surgical operation.
2. The method of claim 1 , wherein said injection into said cavernous body is into a crus of said cavernous body.
3. The method of claim 1 , wherein said determination of the location of said nerve is used to avoid transecting said nerve.
4. The method of claim 1 , wherein said surgical operation is a radical prostatectomy.
5. The method of claim 1 , wherein said surgical operation is a radical hysterectomy.
6. The method of claim 1 , wherein said nerve or said portion of said nerve is visualized on a image display, thereby permitting determination of the location of said nerve or portion of said nerve.
7. The method of claim 1 , wherein said exposing of said nerve to excitation wavelength is by a laparoscopic instrument.
8. The method of claim 1 , wherein said dye is a dye which fluoresces when exposed to near infrared light.
9. The method of claim 1 , wherein the subject is a human.
10. The method of claim 1 , wherein said ICG is administered between about 18 hours and about 24 hours before said surgical operation.
11. The method of claim 1 , wherein said ICG is administered between about 6 hours and about 24 hours before said surgical operation.
12. The method of claim 3 , wherein the cavernous nerve is the small cavernous nerve.
13. The method of claim 3 , wherein the cavernous nerve is the large cavernous nerve.