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FIGURE 6.6 Excised and stained lens capsule samples from (top) a manual capsulorhexis and (bottom) a laser capsulotomy with clearly improved boundaries of lens capsule cutting with optical coherence tomography (OCT)-guided femtosecond laser surgery. SOURCE: Reprinted with permission from Friedman, N.J., D.V. Palanker, G. Schuele, D. Andersen, G. Marcellino, B.S. Seibel, J. Batlle, R. Feliz, J.H. Talamo, M.S. Blumenkranz, and W.W. Culbertson. 2011. Femtosecond laser capsulotomy. Journal of Cataract and Refractive Surgery 37(7):1189-1198.

need to remove the tumor completely versus the desire to maintain the integrity and function of the surrounding tissue. This is of particular importance in organs such as the brain, liver, and pancreas. Currently many surgical procedures require the excision of a sample portion of the affected organ, which is then sent to the pathology lab for analysis to determine the tumor boundaries, which then help guide the surgeon’s decision as to how much tissue to remove. This process is time-consuming and is typically performed while the patient is anesthetized. New optical techniques are being developed24 that provide real-time images of the tumor boundaries. These techniques employ fluorescent biomarkers (see Figure 6.7), which selectively bind to the tumor cells, providing a clear demarcation between the healthy and diseased tissues that can be visualized directly by the surgeon during the operation. Similar techniques can be used to highlight nearby nerves

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24 For additional information, see Appendix C.



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