Flexible intraoperative detectors for robotic and laparoscopic image-guided surgery: a systematic review

This systematic review provides a comprehensive overview of flexible intraoperative detector technologies for robotic and laparoscopic image-guided surgery, with a focus on their clinical applications and impact. Additionally, it offers a perspective on future directions in the field.

The review was conducted according to PRISMA guidelines. A systematic search of PubMed and Google Scholar was performed up to June 2024 and updated through May 2025. Of 539 records initially identified, 90 studies met the inclusion criteria after screening and full-text assessment.

Of the included studies, 61 involved human applications. Flexible detectors were classified into ultrasound (n = 29), radioactivity (gamma and beta, n = 38), optical (n = 19: fluorescence, endomicroscopy, Raman), and miscellaneous technologies (n = 4). Flexible ultrasound and radioactivity probes were the most employed in clinical settings, they were shown to enhance intraoperative dexterity with equivalent performance to conventional rigid probes. They enabled previously unfeasible procedures, such as robotic PSMA-targeted radioguided surgery. In contrast, optical and miscellaneous probes, though applied in human studies, remain largely at an early or conceptual stage, with limited demonstration of direct clinical impact.

Flexible sensing technologies offer advantages in size, flexibility, ergonomics, and integration with robotic platforms, enabling and/or improving image-guided surgery within the field of minimally-invasive interventions. The ultrasound and radioactivity ones showed the strongest utility, while optical and miscellaneous require further clinical evaluation. Overall, broader clinical adoption requires more rigorous, prospective trials to establish their efficacy and impact on surgical performance and outcomes.