Click-on fluorescence detectors: using robotic surgical instruments to characterize molecular tissue aspects
Journal of Robotic Surgery, vol. 17, pp. 131–140
Abstract
Abstract Fluorescence imaging is increasingly being implemented in surgery. One of the drawbacks of its application is the need to switch back-and-forth between fluorescence- and white-light-imaging settings and not being able to dissect safely under fluorescence guidance. The aim of this study was to engineer ‘click-on’ fluorescence detectors that transform standard robotic instruments into molecular sensing devices that enable the surgeon to detect near-infrared (NIR) fluorescence in a white-light setting. This NIR-fluorescence detector setup was engineered to be press-fitted onto standard forceps instruments of the da Vinci robot. Following system characterization in a phantom setting (i.e., spectral properties, sensitivity and tissue signal attenuation), the performance with regard to different clinical indocyanine green (ICG) indications (e.g., angiography and lymphatic mapping) was determined via robotic surgery in pigs. To evaluate in-human applicability, the setup was also used for ICG-containing lymph node specimens from robotic prostate cancer surgery. The resulting Click-On device allowed for NIR ICG signal identification down to a concentration of 4.77 × 10–6 mg/ml. The fully assembled system could be introduced through the trocar and grasping, and movement abilities of the instrument were preserved. During surgery, the system allowed for the identification of blood vessels and assessment of vascularization (i.e., bowel, bladder and kidney), as well as localization of pelvic lymph nodes. During human specimen evaluation, it was able to distinguish sentinel from non-sentinel lymph nodes. With this introduction of a NIR-fluorescence Click-On sensing detector, a next step is made towards using surgical instruments in the characterization of molecular tissue aspects.
Authors 13
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Matthias N. van Oosterom Aachen Interventional Molecular Imaging Laboratory Department of Radiology, Leiden University Medical Center
Leiden University · Leiden University Medical Center · The Netherlands Cancer Institute
Affiliation as printed
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Sven I. van Leeuwen corresponding Aachen Interventional Molecular Imaging Laboratory Department of Radiology, Leiden University Medical Center
Leiden University · Leiden University Medical Center
Affiliation as printed
Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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IRCCS Ospedale San Raffaele · ORSI Academy
Affiliation as printed
Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
ORSI Academy, Melle, Belgium
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Paolo Dell’Oglio Aachen Interventional Molecular Imaging Laboratory Department of Radiology, Leiden University Medical Center
Leiden University · Leiden University Medical Center · The Netherlands Cancer Institute · Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda · ORSI Academy
Affiliation as printed
Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
ORSI Academy, Melle, Belgium
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Tessa Buckle Aachen Interventional Molecular Imaging Laboratory Department of Radiology, Leiden University Medical Center
Leiden University · Leiden University Medical Center · The Netherlands Cancer Institute
Affiliation as printed
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Florian van Beurden Aachen Interventional Molecular Imaging Laboratory Department of Radiology, Leiden University Medical Center
Leiden University · Leiden University Medical Center · The Netherlands Cancer Institute
Affiliation as printed
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Design & Prototyping, Department of Medical Technology, Leiden University Medical Center, Leiden, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Design & Prototyping, Department of Medical Technology, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation as printed
ORSI Academy, Melle, Belgium
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Affiliation as printed
Eurorad, Eckbolsheim, France
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Pim J. van Leeuwen corresponding
The Netherlands Cancer Institute
Affiliation as printed
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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The Netherlands Cancer Institute
Affiliation as printed
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Fijs W. B. van Leeuwen corresponding Aachen Interventional Molecular Imaging Laboratory Department of Radiology, Leiden University Medical Center
Leiden University Medical Center · The Netherlands Cancer Institute · ORSI Academy
Affiliation as printed
Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. f.w.b.van_leeuwen@lumc.nl
Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. f.w.b.van_leeuwen@lumc.nl
ORSI Academy, Melle, Belgium. f.w.b.van_leeuwen@lumc.nl
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