A DROP-IN Gamma Probe for Robot-assisted Radioguided Surgery of Lymph Nodes During Radical Prostatectomy

Dell’Oglio, Paolo; Meershoek, P.; Maurer, Tobias; Wit, Esther; Leeuwen, Pim J. van; Poel, Henk G. van der; Leeuwen, F.W.B. van; Oosterom, Matthias N. van

doi:10.1016/j.eururo.2020.10.031

Cited by 71 publications

(38 citation statements)

References 26 publications

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“…Recently, a new gamma-probe for image-guided robotic surgery was developed (i.e. DROP-IN probe) and implanted into clinical practice (24)(25)(26)(27). Its increased manoeuvrability yielded higher in vivo SNs detection rate compared to laparoscopic rigid gamma probe (25), suggesting that the impact of Hybrid SNB might be further improved in future studies that rely on DROP-IN probe as radio guidance in the robotic setting.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value, Oncologic Outcomes, and Safety Profile of Image-Guided Surgery Technologies During Robot-Assisted Lymph Node Dissection with Sentinel Node Biopsy for Prostate Cancer

et al. 2021

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Rationale: Despite good sensitivity and negative predictive value, the implementation of sentinel node biopsy (SNB) in robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (ePLND) for prostate cancer (PCa) is still controversial.Based on this premise, we aimed to define the added value of SNB (with different tracer modalities) to ePLND in the identification of nodal metastases. Complications rates and oncological outcomes were also assessed.Methods: From January 2006 to December 2019, prospectively collected data were retrospectively analyzed from a single institutional database regarding PCa patients all treated with RARP and ePLND with or without additional use of SNB, either with hybrid tracer indocyanine green (ICG)-99m Tc-nanocolloid (ICG-99mTc-nanocolloid) or free ICG.Multivariable logistic and Cox regression models tested the impact of adding SNB (either with hybrid tracer or free-ICG) on lymph nodal invasion detection, complications and oncological outcomes.Results: Overall, 1680 patients were included in the final analysis. 1,168 (69.5%) were in the non SNB-group, 161 (9.6%) in the ICG SNB-group and 351 (20.9%) patients in the Hybrid SNB-group. Hybrid SNB-group (OR 1.61, 95%CI 1.18-2.20, p=0.002) was an independent predictor of nodal involvement, while ICG SNB-group did not reach the independent predictor status when compared to non SNB group (OR 1.35, 95%CI 0.89-2.03, p=0.1). SNB techniques were not associated with higher rates of complications. Lastly, use of Hybrid SNB was associated with lower rates of biochemical recurrence (0.79, 95%CI 0.63-0.98) and of clinical recurrence (HR 0.76, p=0.035) compared to non SNB group. Conclusions:The implementation of hybrid sentinel node biopsy technique with ICG-99m Tc-nanocolloid in prostate cancer improves detection of positive nodes and potentially lowers recurrence rates with subsequent optimization of patient management, without harming patient safety.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Value, Oncologic Outcomes, and Safety Profile of Image-Guided Surgery Technologies During Robot-Assisted Lymph Node Dissection with Sentinel Node Biopsy for Prostate Cancer

et al. 2021

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“…Robot-assisted sentinel lymph node procedures [ 8 ] and PSMA-guided salvage resection of lymph nodes [ 9 ] have helped confirm that the tethered (DROP-IN) gamma-probe concept allows the detector to match the robotic instruments’ degrees of freedom and facilitates autonomous control by the operating surgeon [ 6 ]. In fact, the DROP-IN technology was shown to improve the nodal detection rates in relation to the rigid laparoscopic gamma probe [ 10 ]. Building on these pioneering efforts, there are now two companies that have started to commercialize the DROP-IN technology: Sensei (Lightpoint Medical Ltd.; single use) and DROP-IN CXS-OP-DP (Crystal Photonics GmbH; sterilizable).…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, our experience with indocyanine green (ICG)- 99m Tc-nanocolloid ( N > 1500) indicates that surgeons that have used this form of hybrid image guidance no longer want to proceed without the real-time high-resolution images, despite clear improvement in oncological outcome data [ 14 – 16 ]. Similarly, due to the abovementioned improvements, robotic surgeons that have used the DROP-IN gamma probe [ 9 , 10 ] no longer wish to convert back to using traditional laparoscopic gamma probes. These examples underscore that imaging guidance technologies apparently also just provide value by aiding decision-making and perhaps by enhancing surgical dexterity.…”

Section: Introductionmentioning

confidence: 99%

The Click-On gamma probe, a second-generation tethered robotic gamma probe that improves dexterity and surgical decision-making

Azargoshasb

Alphen

Slof

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose Decision-making and dexterity, features that become increasingly relevant in (robot-assisted) minimally invasive surgery, are considered key components in improving the surgical accuracy. Recently, DROP-IN gamma probes were introduced to facilitate radioguided robotic surgery. We now studied if robotic DROP-IN radioguidance can be further improved using tethered Click-On designs that integrate gamma detection onto the robotic instruments themselves. Methods Using computer-assisted drawing software, 3D printing and precision machining, we created a Click-On probe containing two press-fit connections and an additional grasping moiety for a ProGrasp instrument combined with fiducials that could be video tracked using the Firefly laparoscope. Using a dexterity phantom, the duration of the specific tasks and the path traveled could be compared between use of the Click-On or DROP-IN probe. To study the impact on surgical decision-making, we performed a blinded study, in porcine models, wherein surgeons had to identify a hidden 57Co-source using either palpation or Click-On radioguidance. Results When assembled onto a ProGrasp instrument, while preserving grasping function and rotational freedom, the fully functional prototype could be inserted through a 12-mm trocar. In dexterity assessments, the Click-On provided a 40% reduction in movements compared to the DROP-IN, which converted into a reduction in time, path length, and increase in straightness index. Radioguidance also improved decision-making; task-completion rate increased by 60%, procedural time was reduced, and movements became more focused. Conclusion The Click-On gamma probe provides a step toward full integration of radioguidance in minimal invasive surgery. The value of this concept was underlined by its impact on surgical dexterity and decision-making.

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“…Interventional-molecular imaging can help achieve this: radioguided surgery is one of the most used image-guided surgery techniques (1). Unfortunately, the use of laparoscopic gamma probes is cumbersome with the robot (2). To overcome these limitations, tethered DROP-IN gamma and beta probes have been introduced for sentinel lymph node (2,3) and prostate-specific membrane antigen (PSMA)-targeted resections (4,5).…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, the use of laparoscopic gamma probes is cumbersome with the robot (2). To overcome these limitations, tethered DROP-IN gamma and beta probes have been introduced for sentinel lymph node (2,3) and prostate-specific membrane antigen (PSMA)-targeted resections (4,5). These robottailored modalities allow the surgeon to autonomously position the detector to localize lesions during surgery.…”

Section: Introductionmentioning

confidence: 99%

Optical Navigation of the Drop-In γ-Probe as a Means to Strengthen the Connection Between Robot-Assisted and Radioguided Surgery

et al. 2021

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Rationale: With translation of the DROP-IN gamma probe, radioguidance has advanced into laparoscopic robot-assisted surgery. 'GPS-like' navigation further enhances the symbiosis between nuclear medicine and surgery. Therefore, we developed a fluorescence-video-based tracking method that integrates the DROP-IN with navigated-robotic surgery.Methods: Fluorescent markers, integrated into the DROP-IN, were automatically detected using a daVinci Firefly laparoscope. Subsequently, a declipseSPECT-navigation platform calculated the DROP-IN's location within the surgical field. Using a phantom (n=3), we pursued robotic-navigation on single-photon emission computed tomography/computed tomography (SPECT/CT), while intraoperative feasibility was validated during porcine surgery (n=4).Results: Video-based tracking allowed for navigation of the DROP-IN towards all lesions detected on SPECT/CT (external-iliac and common-iliac artery regions). Augmented-reality visualization in the surgical console, indicated the distance to these lesions in real-time, confirmed by the DROP-IN read-out. Porcine surgery underlined the feasibility of the concept. Conclusions:Optical navigation of a DROP-IN probe provides a next step towards connecting nuclearmedicine with robotic surgery.

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A DROP-IN Gamma Probe for Robot-assisted Radioguided Surgery of Lymph Nodes During Radical Prostatectomy

Cited by 71 publications

References 26 publications

Diagnostic Value, Oncologic Outcomes, and Safety Profile of Image-Guided Surgery Technologies During Robot-Assisted Lymph Node Dissection with Sentinel Node Biopsy for Prostate Cancer

Diagnostic Value, Oncologic Outcomes, and Safety Profile of Image-Guided Surgery Technologies During Robot-Assisted Lymph Node Dissection with Sentinel Node Biopsy for Prostate Cancer

The Click-On gamma probe, a second-generation tethered robotic gamma probe that improves dexterity and surgical decision-making

Optical Navigation of the Drop-In γ-Probe as a Means to Strengthen the Connection Between Robot-Assisted and Radioguided Surgery

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