Early detection of cancer is crucial for improving patient survival. High resolution optical imaging is ideal to image cellular abnormalities indicative of early cancer. For tissues located deep within the body, such as the pancreato-biliary ducts, high resolution imaging must be implemented endoscopically due to the limited penetration depth of light. We are developing a minimally invasive high numerical aperture (HNA) microendoscope system capable of simultaneous co-registered multiphoton imaging (two-photon excited fluorescence, second harmonic generation, three-photon excited fluorescence, and third harmonic generation) of small diameter ductal tissues, such as the pancreato-biliary ducts. Imaging of the epithelial layer is achieved via helical scanning of the 1.5 mm diameter endoscope with a fixed focus. The endoscope distal end optics act as both the illumination and collection mechanism, with the core of the dual clad fiber (DCF) carrying femtosecond laser excitation light, and the inner cladding of the DCF carrying multiphoton emission. Designing HNA optics at the 1 mm diameter size scale is challenging, time consuming, and may be expensive. To complete development of the proximal components of the system, we designed a low numerical aperture (LNA) reflectance & single photon fluorescence system using low cost off the shelf optical components to aid in the development of software and the testing of proximal system hardware components. Additionally, rapid, low-cost design and fabrication of HNA optics with 3D printing is presented.

High grade serous ovarian cancer is the most deadly gynecological cancer, and it is now believed that most cases originate in the fallopian tubes (FTs). Early detection of ovarian cancer could double the 5-year survival rate compared with late-stage diagnosis. Autofluorescence imaging can detect serous-origin precancerous and cancerous lesions in ex vivo FT and ovaries with good sensitivity and specificity. Multispectral fluorescence imaging (MFI) can differentiate healthy, benign, and malignant ovarian and FT tissues. Optical coherence tomography (OCT) reveals subsurface microstructural information and can distinguish normal and cancerous structure in ovaries and FTs. Aim:We developed an FT endoscope, the falloposcope, as a method for detecting ovarian cancer with MFI and OCT. The falloposcope clinical prototype was tested in a pilot study with 12 volunteers to date to evaluate the safety and feasibility of FT imaging prior to standard of care salpingectomy in normal-risk volunteers. In this manuscript, we describe the multiple modifications made to the falloposcope to enhance robustness, usability, and image quality based on lessons learned in the clinical setting.Approach: The ∼0.8 mm diameter falloposcope was introduced via a minimally invasive approach through a commercially available hysteroscope and introducing a catheter. A navigation video, MFI, and OCT of human FTs were obtained. Feedback from stakeholders on image quality and procedural difficulty was obtained. Results:The falloposcope successfully obtained images in vivo. Considerable feedback was obtained, motivating iterative improvements, including accommodating the operating room environment, modifying the hysteroscope accessories, decreasing endoscope fragility and fiber breaks, optimizing software, improving fiber bundle images, decreasing gradient-index lens stray light, optimizing the proximal imaging system, and improving the illumination. Conclusions:The initial clinical prototype falloposcope was able to image the FTs, and iterative prototyping has increased its robustness, functionality, and ease of use for future trials.

High grade serous ovarian cancer is the most deadly gynecological cancer, and it is now believed that most originate in the fallopian tubes (FTs). We developed a FT endoscope, the falloposcope, as a method for detecting ovarian cancer. The falloposcope clinical prototype is being implemented in a pilot study with 20 volunteers (12 enrolled to date) to evaluate the safety and feasibility of FT imaging prior to standard of care salpingectomy in normal-risk volunteers. The falloposcope is approximately 0.8 mm in diameter and is introduced via a minimally invasive approach through a commercially available hysteroscope and introducing catheter. To date, FT navigation video, multispectral reflectance and fluorescence images, and optical coherence tomography (OCT) of human FT have successfully been acquired. This manuscript describes the fabrication improvements and iterative design changes that have been introduced to improve usability and reduce failure points based on clinical implementation. We discuss falloposcope improvements made with respect to the following subjects: improving perceived image quality with the fiber bundle, GRIN lens stray light, and improving the proximal imaging system. Navigation and MFI are limited by the 3,000 element fiber bundle and lens working distance (WD). A future system is being developed with a 10,000 element fiber bundle, more uniform illumination, a closer WD lens, and wire cytology instead of OCT probe.

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Intratubal teratoma is a very rare condition. The authors believe to present the first case of a completely intratubal mature cystic teratoma with a contralateral intraovarian teratoma. Preoperative ultrasound examination allowed the intraoperative diagnosis of this rare condition, hence allowing appropriate surgical management. Materials and Methods: A 19-year-old woman presented with a history of pelvic pain and severe dysmenorrhea. Ultrasound examination initially suggested bilateral ovarian dermoids. Upon laparoscopy, the distal left fallopian tube was obstructed and contained an inflammatory mass adhered to the rectosigmoid. The left ovary was entirely normal. A contralateral intraovarian dermoid was also identified. Conclusion: Although rare, when an intratubal mass is identified, consideration of intratubal dermoid should be given. Preoperative ultrasound can be of critical importance to the intraoperative diagnosis.