Confocal and Fluorescence-Guided Micro-Endoscopy: Translation and Introduction in the Surgical Setting

Dear Colleagues,

Tumor diagnosis and the definition of tumor borders intraoperatively are based on visualization modalities used by surgeons as well as on the histopathologic examination of a limited number of biopsy specimens. Furthermore, optimal surgical therapy is the combination of maximal near-total resection and minimal injury of normal tissues, achieved only if it is possible to identify intraoperative cellular structures and differentiate tumor tissue from normal functional tissue so as to resect a tumor completely and protect the normal tissue. To achieve this goal, we need new technological equipment combined with new surgical concepts.

The principle of confocal laser endomicroscopy (CLE), based on the extreme miniaturization of the microscope imaging head offers the possibility of in vivo microscopy with subcellular and subnuclear resolution. Clear visualization of the cytoarchitecture can be achieved with a 400-fold to 1000-fold magnification. Recently, different fluorescence techniques play an important role in the identification of margins via oncological surgery. Indocyanine green and 5-aminolevulin acid play increasingly central roles in it.

In oncological diagnosis and surgery, CLE would enable, on the one hand, intraoperative detection and differentiation of single tumor cells (without the need of fast biopsies), and, on the other hand, the definition of borders between tumor and normal tissue on a cellular level, making surgical resection much more accurate than ever before. The application and implementation of fluorescence and CLE-assisted surgery in surgical oncology increases not only the diagnostic but also the therapeutic options by extending the resection borders of cancer on a cellular level and, more importantly, by protecting the functionality of normal tissues.

For this Special Issue, we aim to publish studies from authors working on implementing in vivo and ex vivo surgical and clinical concepts and techniques of fluorescence-guided and confocal laser endomicroscopy in their treatments.

Potential topics of interest include, but are not limited to, the following:

• Confocal-assisted surgery for oncologic brain and head and neck surgery as well as for other disciplines related to oncological surgery.
• New frontiers in fluorescence-guided microscopy and endoscopy used for surgical oncology.
• Advances in intraoperative visualization modalities regarding tumor differentiation.
• Implementation of fluorescence and cell imaging in different oncologic working disciplines.
• New concept of cellular surgical cancer therapies in the operation theatre.
• Embedded technological systems for tumor margins differentiation and cellular analysis in thoracic, abdominal, and urological diseases.
• Deep machine learning techniques for fluorescence-guided, navigated, confocal microscopy and endoscopy in pathology.

Prof. Dr. Cleopatra Charalampaki
Guest Editor

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