Click-on fluorescence detectors: using robotic surgical instruments to characterize molecular tissue aspects.

Area of Science:

• Surgical technology
• Medical imaging
• Biomedical engineering

Background:

• Current fluorescence imaging in surgery requires switching between imaging modes.
• Dissecting safely under fluorescence guidance remains a challenge.

Purpose of the Study:

• To engineer 'click-on' fluorescence detectors for robotic surgical instruments.
• To enable near-infrared (NIR) fluorescence detection within a white-light setting.

Main Methods:

• Developed press-fit NIR fluorescence detectors for da Vinci robot forceps.
• Characterized system performance in phantom studies (spectral properties, sensitivity, attenuation).
• Evaluated performance in robotic surgery in pigs and human specimen analysis.

Main Results:

• Achieved NIR indocyanine green (ICG) signal detection down to 4.77 × 10^-6 mg/ml.
• Preserved instrument's grasping and movement capabilities after attachment.
• Successfully identified blood vessels, assessed vascularization, and localized lymph nodes in vivo.
• Distinguished sentinel from non-sentinel lymph nodes in human specimens.

Conclusions:

• The 'Click-On' device integrates NIR fluorescence detection into standard robotic instruments.
• This innovation facilitates molecular tissue characterization during surgery.
• Enables safer and more informed surgical decisions by providing real-time fluorescence feedback.