Robot-assisted laparoscopic surgery using DROP-IN radioguidance: first-in-human translation

Abstract

Purpose Radioguided surgery has been widely used for clinical procedures such as sentinel node resections. In the (robotassisted) laparoscopic setting radioguidance is realized using laparoscopic gamma probes, which have limited maneuverability. To increase the rotational freedom, a tethered DROP-IN gamma probe was designed. Here we present the first in vivo feasibility study of this technology in prostate cancer patients. Methods Ten patients scheduled for a sentinel node procedure received four injections into the prostate with (indocyanine green-) 99mTechnetium-nanocolloid and underwent preoperative imaging (lymphoscintigraphy and SPECT/CT). The DROP-IN probe was inserted via the assistant port, still permitting the insertion and usage of additional laparoscopic tools. Results The sentinel nodes were resected using the da Vinci ® Si robot under guidance of DROP-IN gamma tracing and fluorescence imaging. The surgeon was able to independently maneuver the DROP-IN probe using the ProGrasp® forceps of the da Vinci® robot and distinguish sentinel nodes from background signal (such as the injection site). Conclusions Overall the DROP-IN design proves to be a valuable tool for robot-assisted radioguided surgery approaches.

99mTc-68Ga-ICG-Labelled Macroaggregates and Nanocolloids of Human Serum Albumin: Synthesis Procedures of a Trimodal Imaging Agent Using Commercial Kits

“…Another practical application of our trimodal compounds might be their use in robotic surgery. Identification of the exact site of the lesion is greatly enhanced if ICG fluorescence is combined with a radioactive signal from the same probe [33,34]. In particular, the Da Vinci robot can be equipped with a fluorescence imager and radioactivity detection system, thus avoiding problems related to the use of halogen lamps, as occurs during open surgery.…”

A DROP-IN beta probe for robot-assisted 68Ga-PSMA radioguided surgery: first ex vivo technology evaluation using prostate cancer specimens

“…In this study the rst steps are made towards integration of beta radioguided surgery within the robot-assisted setting. Using the DROP-IN concept, the surgeon has full control of probe placement, yielding autonomy and great maneuverability during radioguidance (8)(9)(10)(11). Direct beta detection provides, thanks to its speci city and sensitivity, a useful way to probe prostate margins and suspect lymph nodes.…”

“…tissue only provides marginal attenuation of gamma-ray emissions). Recently, the introduction of the DROP-IN gamma (DROP-IN g ) probe concept helped to make radioguidance compatible with robotic surgery (8)(9)(10)(11).…”

Prostate-Specific Membrane Antigen–Guided Surgery

“…Careful selection of patients with locoregional recurrence based on PSMA-ligand PET and suitable clinical characteristics is mandatory (57). With the development of drop-in g-probes for robot-assisted minimally invasive surgery, patient discomfort and morbidity are likely to decrease, fueling further demand for such molecularly targeted approaches to achieve effective precision surgery with improved outcomes (41,42). Modifications and further developments of PSMA-directed tracers, especially in combination with fluorescence, will enable visual or even bimodal tracking by fluorescence cameras and g-probes (46,47,49,50).…”