Nerve-Illuminating Agent May Provide Safe Intraoperative Nerve Identification

Gold SA, Pere MM, Assel M, et al. Rizedisben in Minimally Invasive Surgery: A Nonrandomized Clinical Trial. JAMA Surg. 2025; in press.

Atkinson RB, Sheu EG. I Can See (Myelin) Clearly Now. JAMA Surg. 2025; in press.

A novel myelin-targeting fluorophore emitting in the blue light spectrum offers a promising opportunity to improve intraoperative nerve identification.

In a phase 1, single-arm, open-label clinical trial, Samuel Gold, from Memorial Sloan Kettering Cancer Center in New York, New York, and colleagues from the US, Australia, and Chile, tried to determine the optimal safe and clinically effective dose of rizedisben for sustained intraoperative fluorescence of nerve structure. 

The study was conducted in 38 eligible patients undergoing robot-assisted laparoscopic radical prostatectomy at an urban academic cancer center in New York City between January 2023 and October 2024.

The researchers determined that the 3.0 mg/kg dose was shown to be generally well tolerated and clinically effective, with a rapid onset (less than 15 minutes) and a durable effect (more than 3.5 hours) of illuminating the obturator nerves. 

In an accompanying invited commentary, Atkinson and Sheu wrote that if the sensitivity and specificity of rizedisben can be improved to reliably provide sustained fluorescence of smaller nerves at greater risk of injury, “It could potentially reduce rates of iatrogenic nerve injury [and its] application would then extend far beyond pelvic surgery, potentially transforming dissection in cases such as inguinal hernia repairs and esophageal or hiatal operations.”