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Steerable DROP-IN radioguidance during minimal-invasive non-robotic cervical and endometrial sentinel lymph node surgery
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Steerable DROP-IN radioguidance during minimal-invasive non-robotic cervical and endometrial sentinel lymph node surgery
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Journal Article
Steerable DROP-IN radioguidance during minimal-invasive non-robotic cervical and endometrial sentinel lymph node surgery
2024
Overview
Purpose
The recently introduced tethered DROP-IN gamma probe has revolutionized the way robotic radioguided surgery is performed, fully exploiting the nature of steerable robotic instruments. Given this success, the current first-in-human study investigates if the DROP-IN can also provide benefit in combination with steerable non-robotic instruments during conventional laparoscopic surgery, showing equivalence or even benefit over a traditional rigid gamma probe.
Methods
The evaluation was performed in ten patients during laparoscopic cervical (
n
= 4) and endometrial (
n
= 6) cancer sentinel lymph node (SLN) procedures. Surgical guidance was provided using the hybrid, or bi-modal, SLN tracer ICG-
99m
Tc-nanocolloid. SLN detection was compared between the traditional rigid laparoscopic gamma probe, the combination of a DROP-IN gamma probe and a steerable laparoscopic instrument (LaproFlex), and fluorescence imaging.
Results
The gynecologists experienced an enlarged freedom of movement when using the DROP-IN + LaproFlex combination compared to the rigid laparoscopic probe, making it possible to better isolate the SLN signal from background signals. This did not translate into a change in the SLN find rate yet. In both cervical and endometrial cancer combined, the rigid probe and DROP-IN + LaproFlex combination provided an equivalent detection rate of 96%, while fluorescence provided 85%.
Conclusion
We have successfully demonstrated the in-human use of steerable DROP-IN radioguidance during laparoscopic cervical and endometrial cancer SLN procedures, expanding the utility beyond robotic procedures. Indicating an improved surgical experience, these findings encourage further investigation and consideration on a path towards routine clinical practice and improved patient outcome.
Trial registration
HCB/2021/0777 and NCT04492995;
https://clinicaltrials.gov/study/NCT04492995
Publisher
Springer Berlin Heidelberg,Springer Nature B.V
Subject
/ Aged
/ Cancer
/ Endometrial Neoplasms - diagnostic imaging
/ Endometrial Neoplasms - pathology
/ Endometrial Neoplasms - surgery
/ Female
/ Humans
/ Imaging
/ Medicine
/ Oncology
/ Original
/ Patients
/ Robotics
/ Sentinel Lymph Node - diagnostic imaging
/ Sentinel Lymph Node - surgery
/ Sentinel Lymph Node Biopsy - instrumentation
/ Sentinel Lymph Node Biopsy - methods
/ Surgery
/ Surgery, Computer-Assisted - instrumentation
/ Surgery, Computer-Assisted - methods
