In a nutshell: Ex-vivo KLM

Quick findings directly from the OR: KLM delivers high-resolution tissue images in just 2–5 minutes - instead of 24-48 hours for conventional histology.
Less effort, more efficiency: no formalin, no embedding, no manual incisions - tissue is scanned live, findings are available immediately.
Digital workflow with future potential: real-time images enable AI-supported analyses, telepathology and later integration of immunofluorescence markers.

10.06.2025

Imagine being able to zoom into the tissue in real time during an operation - this is exactly what ex-vivo confocal laser scanning microscopy (KLM) makes possible. KLM supplements conventional histology with fast, digital imaging directly on the tissue: while conventional methods require 24-48 hours for fixation, embedding and staining, KLM delivers high-resolution sectional images within a few minutes.

Technology in practice

Graphic illustration of how confocal laser scanning microscopy works step by step

The two lasers scan the tissue so that a digital image can be created using the signals obtained.

At its core, ex vivo confocal laser scanning microscopy works in such a way that the fresh tissue is not cut into thin slices, but simply scanned with two different lasers. The signals obtained in this way are combined to form a digital image that looks similar in color to conventional H&E staining (hematoxylin stains cell nuclei blue-violet, eosin marks cytoplasm pink), but does not require any formalin.
The lasers penetrate up to 0.2 millimetres deep into the tissue and capture even the finest details of less than a tenth of a millimetre in size. The result can be seen on the monitor within just two to five minutes, allowing doctors and laboratory teams to continue working immediately.

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Advantages of confocal laser scanning microscopy & technical limits

Advantages

Intraoperative imaging in a few minutes
High digital resolution without tissue loss
Elimination of time-consuming preparation steps
Direct integration into OR and laboratory work

Technical limitations

No immunohistochemistry during the live scan
Limited penetration depth of 0.2 millimeters
Manual preparation of large samples remains time-consuming
Need for broader multicenter studies

Real-time histology 2.0: outlook and integration into the laboratory

AI-supported analysis: in future, algorithms could quickly quantify patterns such as tumor thickness or invasiveness - a relief for pathologists and laboratory staff.
Telepathology: Live streaming of ex vivo confocal KLM images to external experts enables ultra-fast second opinions, regardless of the location of the laboratory.
Interdisciplinary applications: Initial studies are testing the use in urology, neurosurgery and oncology (breast, bladder cancer). This could also improve intra-operative decisions in areas that have not been histologically well developed to date.
Immunofluorescence enhancement: In future, fluorescence-labeled antibodies could be used to visualize immunohistochemical markers in real time - a milestone prospect for diagnostic diversity in the laboratory.

A woman looks at a tissue sample through a microscope, what she sees is shown in a close-up on the adjacent monitor

By combining KLM with AI-supported image analysis using lasers, quantitative parameters such as tumor thickness or cell invasiveness could be determined automatically in the future.

This not only saves laboratories time, but also improves data quality. The combination of confocal laser scanning microscopy with AI-supported image analysis using lasers opens up the potential to automatically determine quantitative parameters such as tumor thickness or cell invasiveness. For laboratories, this means a reduction in routine pathological tasks and a more objective diagnosis. At the same time, telepathology allows digital scans to be sent to experts worldwide in real time - ideal for complex cases or second opinions without the need for logistics.

Initial pilot projects in urology, neurosurgery and oncology (e.g. breast and bladder cancer) show that ex vivo confocal laser scanning microscopy is also practicable outside of dermatology. The possibility of using fluorescence-labeled antibodies for immunohistochemical markers in the future could further expand diagnostics and provide immunohistochemistry information in real time.

What is the added value for patients?

Intraoperative KLM reduces waiting times and follow-up operations, as surgeons can see during the operation whether all tumour cells have been removed, thus minimizing risks, pain and treatment time. Patients also benefit from an earlier start to treatment, as findings are available immediately, as well as less tissue loss thanks to precise incision control, which leads to faster healing processes and improved well-being.

Key findings on digital tissue diagnostics

Ex-vivo confocal laser scanning microscopy is more than a technological add-on: it provides laboratories and pathology departments with ultra-fast, digital and high-resolution real-time histology that optimally complements conventional methods. With AI support, telepathology and immunofluorescence-based enhancements, the confocal laser scanning microscopy is representative of the next generation of diagnostic tools - ready to decisively accelerate and refine the intraoperative care processes of tomorrow.

Laser technologies at COMPAMED for better diagnostics

Smiling woman with red hair and glasses - Melanie Prüser; This portrait was AI-generated.

Author: Melanie Prüser | Editorial team MEDICA-tradefair.com

Melanie Prüser has been writing about the exciting interface between medicine and technology for MEDICA-tradefair.com since 2019. She is always on the lookout for the stories behind devices and applications to show how innovations directly change the everyday lives of medical professionals and patients.