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Revolutionizing (robot-assisted) laparoscopic gamma tracing using a drop-in gamma probe technology.

Matthias N van Oosterom1, Hervé Simon2, Laurent Mengus2

  • 1Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center (LUMC) Leiden, The Netherlands.

American Journal of Nuclear Medicine and Molecular Imaging
|April 13, 2016
PubMed
Summary

A new drop-in gamma probe (DIGP) offers improved maneuverability in laparoscopic surgery. This technology enhances lesion identification by allowing better positioning, especially in complex cases with low-activity targets near high background radiation.

Keywords:
Radioguided surgerygamma probeinterventional molecular imaginglaparoscopic surgeryrobot-assisted surgerysentinel lymph node biopsyurology

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Area of Science:

  • Minimally Invasive Surgery
  • Nuclear Medicine
  • Surgical Instrumentation

Background:

  • Laparoscopic gamma probes (LGPs) have limited maneuverability (4 degrees of freedom), hindering lesion identification in complex surgeries.
  • Identifying low-activity lesions near high-activity backgrounds is challenging with conventional LGPs.

Purpose of the Study:

  • To investigate a novel drop-in gamma probe (DIGP) technology for enhanced maneuverability in laparoscopic radioguided surgery.
  • To evaluate the impact of DIGP grip design and orientation on pick-up, maneuverability, and scanning capabilities with laparoscopic and robotic forceps.

Main Methods:

  • Phantom experiments were conducted to assess the DIGP's ability to distinguish low-activity targets from high-activity backgrounds at various detector angles.
  • DIGP prototypes with different grip orientations (0°, 45°, 90°, 135°) were engineered and tested for pick-up and maneuverability using conventional laparoscopic (4 DOF) and robotic (6 DOF) forceps.
  • Ex vivo clinical setup evaluation by a surgeon assessed the convenience of DIGP pick-up.

Main Results:

  • Phantom studies demonstrated that DIGP could distinguish sources only when the detector was positioned >90° from the background, highlighting the importance of probe positioning.
  • The DIGP exhibited superior maneuverability and scanning direction range with robotic forceps, particularly the 90° grip design (0-180° range).
  • The 45° grip design was rated most convenient for pick-up by the surgeon in the ex vivo setup.

Conclusions:

  • The drop-in gamma probe (DIGP) technology offers a viable solution to overcome the maneuverability limitations of conventional laparoscopic gamma probes.
  • Optimizing DIGP grip design and grasping angle significantly enhances its utility for both conventional and robot-assisted laparoscopic gamma tracing.
  • DIGP technology improves lesion detection accuracy in challenging surgical scenarios.