Scientists develop new technology to solve common surgical problem of nerve damage

Scientists develop new technology to solve common surgical problem of nerve damage

  • Technology
  • June 2, 2022
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  • 5 minutes read


A research collaboration that includes scientists at Oregon State University has developed a new technology to help surgeons know where a patient’s nerves are, reducing the chances of nerve damage.

The technology is based on hydrogels, three-dimensional networks of polymers that absorb and retain large amounts of water, and aim for a widespread and persistent surgical complication.

According to the procedure, Adam Alani of the OSU, a patient may face a double-digit percentage probability of suffering a nerve injury.

For example, he points out, people who need thyroid gland removal are observing a 15% chance of voice changes as a result of recurrent laryngeal nerve damage.

Apply these probabilities to the 12% of the U.S. population that is likely to develop thyroid disease, for which thyroidectomy is a common treatment, and the figures for this type of surgery are only staggering.

Nerve saving techniques have been around for decades, but identifying and saving nerves remains a major challenge, with success rates strongly correlated with the skill and experience of an individual surgeon. Intraoperative nerve damage affects all surgical specialties and poses a major problem even for all-time surgeries such as prostatectomies, hysterectomies, hernia repairs and thyroidectomies. “


Adam Alani, researcher, OSU College of Pharmacy

Alani, an adjunct professor at Oregon University of Health and Science, worked with fellow OHSU Summer Gibbs on the study, funded by the National Institutes of Health. The findings were published in Biomaterials.

Research is an important step toward improving a nerve-saving technique called fluorescence-guided surgery or FGS. Specific tissues, in this case the nerves, can be better detected if they are fluorescent, that is, they emit light after absorbing light or some other type of electromagnetic radiation.

For tissues to do this, they must be treated with a fluorophore, microscopic molecules that absorb and send light of specific wavelengths.

In collaboration with OHSU and Intuitive Surgical scientists, Alani’s lab developed an effective hydrogel fluorophore based on compounds called pluronics. Also known as poloxamers, pluronics are polymers synthesized by the condensation of ethylene oxide and propylene oxide.

“Hydrogels have been used successfully to provide contrast agents in imaging technologies such as MRI and CT,” Alani said. “And pluronics are already used as a drug delivery agent in products approved by the Food and Drug Administration. The physical characteristics of our pluronic-based formulation allow the solution of specific nerve spots to be applied with relative ease. as a liquid, and then stays in place after forming an ice almost instantly. “

Successful testing on two animal models, the mouse and the pig, suggests the new technology is “a clinically viable method for fluorescence-guided nerve saving during thyroidectomy and other procedures,” Alani said.

And because pluronics already have FDA approval, the technology is eligible for rapid regulation according to the agency’s guidelines for “new exploratory research drugs.” The guidelines allow for exploratory approaches to early phase 1 clinical trials that involve safe microdoses of potential drug candidates, allowing researchers to move faster than usual.

“Direct administration of a contrast agent to the treatment area is an attractive alternative to systemic administration of fluorescent probes,” Alani said. “Selectively labeling tissues only within the surgical field requires a significantly lower dose than systemic administration.”

Vidhi Shaw, Adel Al-Fatease, and Syed Zaki Husain Rizvi of OSU College of Pharmacy also contributed to the study.

Alexander Antaris and Jonathan Sorger represented Intuitive Surgical, the developer of the widely used Da Vinci robotic surgical system, with which the new technology is compatible, Alani said.

Source:

Magazine reference:

Barth, CW, et al. (2022) A clinically relevant formulation for the direct administration of nerve-specific fluorophores to mitigate iatrogenic nerve injury. Biomaterials. doi.org/10.1016/j.biomaterials.2022.121490.



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