New Fluorescent Drug Enhances Nerve Visualization in Surgery

A groundbreaking advancement in surgical technology has emerged with the development of a novel drug known as bevonescein, which allows nerve tissue to fluoresce, thus enhancing visibility during surgical procedures. This innovation, spearheaded by a team at the University of New Mexico (UNM), represents a significant step forward in minimizing surgical risks associated with nerve damage.

Surgeons often face the daunting task of dissecting tissue while avoiding critical nerve structures. Traditional methods rely heavily on electrophysical monitors and the surgeon's anatomical knowledge, which can lead to complications if nerves are inadvertently cut. According to Dr. Ryan Orosco, an associate professor and otolaryngologist at UNM, the introduction of bevonescein could markedly improve surgical outcomes. "If we can help surgeons see things better, they can perform faster, more efficient, and safer surgeries," Orosco stated in a recent interview.

The recent study published in **Nature Communications** involved a small Phase 1–2 trial, which assessed the safety and efficacy of bevonescein on 27 cancer patients undergoing neck dissections, parotid surgery, or thyroid surgery. The findings indicated that the drug is safe and significantly improves the visualization of nerves, showing longer nerve segments than those visible to the naked eye (Lee et al., 2025). This capability is crucial in surgeries where preserving nerve function is paramount to patient recovery.

Dr. Quyen Nguyen, a key figure in the drug's development, conducted extensive research at the University of California, San Diego, where her work contributed to the foundational technology behind bevonescein. Nguyen collaborated closely with the late Roger Tsien, Ph.D., a Nobel laureate recognized for his discovery of green fluorescent protein, which has been instrumental in bioluminescent imaging techniques.

The current Phase 3 trial is expected to provide further insights into the clinical benefits of bevonescein. This study, which includes multiple sites across the United States, will assess whether the use of this imaging agent can meaningfully improve overall surgical outcomes. As noted by Orosco, "The Phase 3 trial will determine if the use of bevonescein leads to better patient outcomes, something our initial trial was not designed to evaluate."

In this trial, patients will receive an intravenous infusion of the drug prior to surgery. Notably, bevonescein is quickly cleared from the body by the kidneys, allowing for imaging several hours after administration while still binding to nerve tissues. Surgeons utilize specialized microscopes equipped with filters that cause the drug to fluoresce, presenting nerves as yellowish-green structures against surrounding tissues.

Looking ahead, the next phase of research will explore the feasibility of utilizing modified headband-mounted magnifying loupes, an innovation that could further enhance real-world applications of this technology in surgical settings. Orosco emphasized the importance of this practical step: "Testing those loupes in a spinoff trial is critical for real-world implementation."

If the Phase 3 trial demonstrates clear benefits, the FDA may grant approval for bevonescein, paving the way for broader applications in various surgical procedures. As Orosco further elaborated, once approved, "surgeons can also use it off-label, which raises questions about its adoption across different surgical specialties and practices."

The implications of this development extend beyond surgical efficiency; they also touch upon patient safety and recovery outcomes. With nerve damage being a significant concern in many surgical operations, the ability to visualize and protect these structures could revolutionize surgical practices and improve the quality of patient care.

The potential for bevonescein to impact surgical procedures is significant, and as research progresses, the medical community eagerly anticipates the results of ongoing trials. The move towards integrating fluorescence-guided techniques into mainstream surgery could represent a pivotal shift in enhancing surgical safety and efficacy.