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van Oosterom MN, Simon H, Mengus L, et al. Revolutionizing (robot-assisted) laparoscopic gamma tracing using a drop-in gamma probe technology. Am J Nucl Med Mol Imaging. 2016;6(1):1-17
van Oosterom, M. N., Simon, H., Mengus, L., Welling, M. M., van der Poel, H. G., van den Berg, N. S., & van Leeuwen, F. W. (2016). Revolutionizing (robot-assisted) laparoscopic gamma tracing using a drop-in gamma probe technology. American journal of nuclear medicine and molecular imaging, 6(1), 1-17.
van Oosterom, Matthias N, et al. "Revolutionizing (robot-assisted) laparoscopic gamma tracing using a drop-in gamma probe technology." American journal of nuclear medicine and molecular imaging vol. 6,1 (2016): 1-17.
van Oosterom MN, Simon H, Mengus L, Welling MM, van der Poel HG, van den Berg NS, van Leeuwen FW. Revolutionizing (robot-assisted) laparoscopic gamma tracing using a drop-in gamma probe technology. Am J Nucl Med Mol Imaging. 2016 Jan 28;6(1):1-17. eCollection 2016. PMID: 27069762; PMCID: PMC4749501.
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Am J Nucl Med Mol Imaging. 2016 Jan 28;6(1):1-17. eCollection 2016.

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

American journal of nuclear medicine and molecular imaging

Matthias N van Oosterom, Hervé Simon, Laurent Mengus, Mick M Welling, Henk G van der Poel, Nynke S van den Berg, Fijs Wb van Leeuwen

Affiliations

  1. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center (LUMC) Leiden, The Netherlands.
  2. Eurorad S.A. Eckbolsheim, France.
  3. Department of Urology, Antoni van Leeuwenhoek Hospital-Netherlands Cancer Institute (AVL-NKI) Amsterdam, The Netherlands.
  4. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center (LUMC)Leiden, The Netherlands; Department of Urology, Antoni van Leeuwenhoek Hospital-Netherlands Cancer Institute (AVL-NKI)Amsterdam, The Netherlands.

PMID: 27069762 PMCID: PMC4749501

Abstract

In complex (robot-assisted) laparoscopic radioguided surgery procedures, or when low activity lesions are located nearby a high activity background, the limited maneuverability of a laparoscopic gamma probe (LGP; 4 degrees of freedom (DOF)) may hinder lesion identification. We investigated a drop-in gamma probe (DIGP) technology to be inserted via a trocar, after which the laparoscopic surgical tool at hand can pick it up and maneuver it. Phantom experiments showed that distinguishing a low objective from a high background source (1:100 ratio) was only possible with the detector faced >90° from the high background source. Signal-low-objective-to-background ratios of 3.77, 2.01 and 1.84 were found for detector angles of 90°, 135° and 180°, respectively, whereas detector angles of 0° and 45° were unable to distinguish the sources. This underlines the critical role probe positioning plays. We then focused on engineering of the gripping part for optimal DIGP pick-up with a conventional laparoscopic forceps (4 DOF) or a robotic forceps (6 DOF). DIGPs with 0°, 45°, 90°, and 135° -grip orientations were designed, and their maneuverability- and scanning direction were evaluated and compared to a conventional LGP. The maneuverability- and scanning direction of the DIGP was found highest when using the robotic forceps, with the largest effective scanning direction range obtained with the 90° -grip design (0-180° versus 0-111°, 0-140°, and 37-180° for 0°, 45° and 135° -grip designs, respectively). For the laparoscopic forceps, the scan direction directly translated from the angle of the grip design with the advantage that the 135° -gripped DIGP could be faced backwards (not possible with the conventional LGP). In the ex vivo clinical setup, the surgeon rated DIGP pick-up most convenient for the 45°-grip design. Concluding, the DIGP technology was successfully introduced. Optimization of the grip design and grasping angle of the DIGP increased its utility for (robot-assisted) laparoscopic gamma tracing.

Keywords: Radioguided surgery; gamma probe; interventional molecular imaging; laparoscopic surgery; robot-assisted surgery; sentinel lymph node biopsy; urology

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