Intraoperative determination of nerve location

• US 10,265,419 B2
• Filed: 09/01/2006
• Issued: 04/23/2019
• Est. Priority Date: 09/02/2005
• Status: Active Grant

• Current Assignee: Stryker Corporation
• Original Assignee: Novadaq Technologies ULC (Stryker Corporation)
• Inventors: Golijanin, Dragan
• Primary Examiner(s): Nguyen, Hien
• Application Number:
  US11/515,419
• Publication Number:
  US 20070122345A1
• Time in Patent Office: 4,617 Days
• Field of Search: 600312, 600310, 600407, 600431, 424 96, 604 20
• CPC Class Codes: A61B 1/00052 positioned at proximal end of the endoscope body
• CPC Class Codes: A61B 1/313 for introducing through surgical openings, e.g. laparoscopes
• CPC Class Codes: A61B 1/3132 for laparoscopy
• CPC Class Codes: A61B 5/0059 using light, e.g. diagnosis by transillumination, diascopy, fluorescence A61B5/0093, A61B5/1455, A61B5/02416 and A61B5/0261 take precedence
• CPC Class Codes: A61B 5/0071 by measuring fluorescence emission
• CPC Class Codes: A61K 49/0034 Indocyanine green, i.e. ICG, cardiogreen
• CPC Class Codes: A61N 5/00 Radiation therapy ultrasound therapy A61N7/00; devices or apparatus applicable to both therapy and diagnosis A61B6/00

Abstract

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.

Claims

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.