Imagin Medical

Richard (Rick) Mills
Ahead of the Herd

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As a general rule, the most successful man in life is the man who has the best information

 

Minimally invasive therapy is becoming more and more common in hospitals. These procedures are performed through tiny incisions (instead of one large opening) or our body’s natural orifices.

 

A long, thin tube with a miniature camera attached at the end, an endoscope, is passed into the body. Images from the endoscope are projected onto monitors in specialized examination rooms and O.R.’s (operating room) so doctors and surgeons can get a magnified view.

 

There are many different types of endoscopes (Cystoscopes, Bronchoscopes, Gastroscopes, Laporascopes and others) and depending on the site in the body, and the type of procedure, endoscopy may be performed by a doctor or a surgeon, and the patient may be fully conscious or under general anesthetic.

 

Endoscopies are commonly performed in the diagnosis of cancer; for taking samples of tissue, called biopsies to find out whether it is cancerous, as well as for complete excision - the cutting out - of suspicious lesions.

 

Endoscopes are also used in laparoscopic surgery in which a small puncture is made, usually in the navel, through which a camera is inserted. This allows the doctor to examine the abdominal and pelvic organs on a video monitor connected to the tube.

 

Laparoscopes are utilized in surgery to visualize various organs and tissues within the body during surgical removal and to avoid damage to adjacent organ and vascular systems and other critical structures. Laparoscopy is less invasive than regular open abdominal surgery.

 

Because of the endoscope biopsies of the intestines or lungs can be done without the need for major surgery.

 

Patients, physicians, providers, and payers have wholeheartedly embraced minimally invasive therapy for many reasons:

  • Minimally invasive therapy obviates the need for major open-surgery procedures.
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  • Minimally invasive therapy eliminates the need for general anesthesia.
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  • Minimally invasive therapy produces much less of the sequelae (a condition that is the consequence of a previous disease or injury) of open surgery procedures.
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  • Minimally invasive therapy leaves minute scars versus open-surgery procedures.
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  • Minimally invasive therapy results in shorter hospital stays and reduced outpatient treatments.
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  • Minimally invasive therapy results in a much more rapid return to normal activity.
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  • Reductions in length of hospitalization and the ability to return to work much sooner are economically attractive.

The endoscope is the main or central technological component of minimally invasive therapy.

 

Good news - minimally invasive therapy, and the evolution of the endoscope, are about to be fast forwarded. Interdisciplinary and inter-institutional forces have been working together to bring forth a new generation of endoscopy technology.

 

But before we get to new technological advances let’s look at current endoscope technology as it involves cancer.

 

White Light and Cancer

 

White light is the standard convention and it’s what’s commercially available in all endoscope devices manufactured today. White light has been utilized in endoscopes for decades to guide the physician and surgeon so they can see cancerous growths that protrude above an organs surface, do biopsies and remove suspicious growths. 

 

White light is comprised of energy in the form of electromagnetic radiation that vibrates at many different wavelengths. Wavelengths between 390 nm and 780 nm are visible to the human eye and produce the different colors of the spectrum.

 

http://aheadoftheherd.com/Newsletter/2015/AOTH-BSS-Life-Sciences_files/image003.jpg

 

White light has limitations in visualizing certain cancer types because:

  • White light cannot pass through tissue or blood
  • White light cannot illuminate tumors beneath the skin surface.  
  • White light is not effective in visualizing the borders of the tumor to determine where it begins and ends (the margins), especially after the initial removal of the main mass. If the surgeon does not remove all the cancerous growth, and a few cancerous cells remain, the tumor can grow back and spread, or metastasize to other parts of the body
  • Malignant and premalignant tumors that are flat or very small may look similar to normal tissues. As a result, a physician may not be able to identify some aggressive cancers. In order to be safe, they may collect random and repeat biopsies as the only possible way to ensure that cancer is not missed in high-risk patients

To summarize, white light has visualization limitations for all cancer types because white light cannot pass through tissue or blood and cannot illuminate tumors beneath the skin surface. White light is also not effective in visualizing the borders or margins of the tumor to determine where it starts and ends especially after the initial removal of the main mass. 

 

Blue Light

 

Because of the limitations with using white light for visualizing cancers, various companies have begun using blue light (white light with blue filter) in conjunction with chemical tumor targeting/imaging agents. This improved technology introduces a red fluorescence to the tumor and has improved the ability to visualize cancers and margins.

 

Tumor visualization with endoscope using white light (left) and blue light (right) with Photocure’s chemical called Cysview).

 

Unfortunately these chemical agents can cause various adverse effects - including anaphylaxis shock and hypersensitivity reactions - with repeated usage at the high doses currently required for visualization. The FDA has limited use of these chemical tumor targeting/imaging agents to just once per patient. Doctors and surgeons cannot repeatedly examine a patient using these chemical imaging agents. This creates a huge problem treating patients with multiple tumors and those with recurrent tumors.


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To contact us please email rick@aheadoftheherd.com

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