Robotic radioguided surgery: toward full integration of radio- and hybrid-detection modalities

Abstract

Purpose Increasingly more laparoscopic surgical procedures are performed with robotic platforms, even becoming the standard for some indications. While providing the surgeon with great surgical dexterity, these systems do not improve surgical decision making. With unique detection capabilities and a plurality of tracers available, radioguidance could fulfill a crucial part in this pursuit of precision surgery. There are, however, specific restrictions, limitations, but also great potentials, requiring a redesign of traditional modalities. Methods This narrative review provides an overview of the challenges encountered during robotic laparoscopic surgery and the engineering steps that have been taken toward full integration of radioguidance and hybrid guidance modalities (i.e., combined radio and fluorescence detection). Results First steps have been made toward full integration. Current developments with tethered DROP-IN probes successfully bring radioguidance to the robotic platform as evaluated in sentinel node surgery (i.e., urology and gynecology) as well as tumor-targeted surgery (i.e., PSMA primary and salvage surgery). Although technically challenging, preclinical steps are made toward even further miniaturization and integration, optimizing the surgical logistics and improving surgical abilities. Mixed-reality visualizations show great potential to fully incorporate feedback of the image-guided surgery modalities within the surgical robotic console as well. Conclusion Robotic radioguidance procedures provide specific challenges, but at the same time create a significant growth potential for both image-guided surgery and interventional nuclear medicine.