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

Abstract

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.

How molecular imaging will enable robotic precision surgery

“…In the framework of surgical navigation based on preoperative imaging, AI also has the potential to assist in surgical planning by providing (semi-)automatic segmentation of the structures of importance [219]. Various technologies are already used to register these roadmaps to the patient in the operating room, but to not overly complicate logistics, we expect that in the robotic setting, these registration technologies will eventually converge to such which are directly integrated into the robotic platforms (e.g., laparoscopic video-based and US-based registrations) [67,78]. However, due to patient deformation and repositioning, accurate registration of preoperatively acquired roadmaps remains challenging in soft-tissue anatomies.…”

“…This still leaves a lot of room to investigate the value of alternative approaches using, for example, PET-based signals (i.e., beta plus or high-energy gamma emissions), beta minus emissions, or SPION detection, as well as alternative hybrid approaches with Cerenkov, multispectral/multiwavelength fluorescence, MSOT, and Raman spectrometry [16]. To make these imaging modalities, which often find their origin in open surgery, compatible with (laparoscopic) robotic surgery, we observe trends such as miniaturization, tethering, and positional tracking (e.g., [33,78,105,222]). A likely future scenario is that more image-guidance modalities will eventually be wholly integrated into the robotic platform as done for fluorescence imaging.…”

“…Simultaneously, the real-time feedback of the molecular detection modality allows for correction and confirmation of the actual tissue targets once close enough. This concept has been shown in vivo using gamma probes (e.g., [74]) and fluorescence cameras [75][76][77], and preclinically even using robotic DROP-IN gamma probes [78] and robotic fluorescence cameras [33]. In our view, with the current status of this field, intraoperative imaging (e.g., ultrasound, freehand SPECT, fluorescence laparoscopy) remains indispensable in soft tissue environments.…”

“…However, the laparoscopic setting application is more challenging, where the limited movement of a laparoscopic probe restricts signal acquisition, and with that, reduces the quality of the freehand SPECT scan. Therefore, first steps are taken to translate the freehand imaging method towards robotic surgery using a tracked DROP-IN gamma probe [78,124,125]. Robotic SPECT has also been performed in a slightly different setting, using a robotic arm to autonomously create scans [126,127].…”

Artificial Intelligence‐Supported Video Analysis as a Means to Assess the Impact of DROP‐IN Image Guidance on Robotic Surgeons: Radioguided Sentinel Lymph Node versus PSMA‐Targeted Prostate Cancer Surgery

“…To this end, marker‐based video tracking of da Vinci instruments has been exploited in the form of patterned‐ [ 13 ] and fluorescent markers. [ 14 ] There is a growing body of evidence suggesting that such approaches can be used to monitor instrument use, [ 15 ] to compare the performance difference between experts and novices, [ 16 ] to perform scoring during virtual simulation training, [ 17 ] to generate freehand scans, [13a,18] and to assess how image guidance technologies effect performance [14b,16a,19] . To make video‐based instrument tracking accessible for a global audience of robotic surgeons, markerless detection algorithms are needed that can automatically extract the required data out of endoscopic videostreams.…”