Navigation of Fluorescence Cameras during Soft Tissue Surgery: Is It Possible to Use a Single Navigation Setup for Various Open and Laparoscopic Urological Surgery Applications?

By providing real-time visualization fluorescence imaging can guide surgeons during tissue resection. Unfortunately tissue induced signal attenuation limits the value of this technique to superficial applications. By positioning the fluorescence camera via a dedicated navigation setup we reasoned that the technology could be made compatible with deeper lesions, increasing its impact on clinical care. Such an impact would benefit from the ability to implement the navigation technology in different surgical settings. For that reason we evaluated whether a single fluorescence camera could be navigated toward targeted lesions during open and laparoscopic surgery.

A fluorescence camera with scopes available for open and laparoscopic procedures was integrated with a navigation platform. Single photon emission computerized tomography/computerized tomography or freehand single photon emission computerized tomography based navigation targets were shown as augmented reality overlays in the fluorescence camera video feed. The accuracy of this setup was evaluated in a phantom study of 4 examples per single photon emission computerized tomography imaging option. This was followed by 4 first in human translations into sentinel lymph node biopsy procedures for penile (open surgery) and prostate (laparoscopic surgery) cancer.

Overall the phantom studies revealed a tool-target distance accuracy of 2.1 mmfor single photon emission computerized tomography/computerized tomography and 3.2 mm for freehand single photon emission computerized tomography, and an augmented reality registration accuracy of 1.1 and 2.2 mm, respectively. Subsequently open and laparoscopic navigation efforts were accurate enough to localize the fluorescence signals of the targeted tissues in vivo.

The phantom and human studies performed suggested that the single navigation setup is applicable in various open and laparoscopic urological surgery applications. Further evaluation, including in larger patient groups with a greater variety of malignancies, is recommended to strengthen these results.

The Journal of urology. 2017 Nov 22 [Epub ahead of print]

Matthias N van Oosterom, Philippa Meershoek, Gijs H KleinJan, Kees Hendricksen, Nassir Navab, Cornelis J H van de Velde, Henk G van der Poel, Fijs W B van Leeuwen

Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Computer Aided Medical Procedures, Technische Universität München, Institut für Informatik, Garching bei München, Germany; Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, Maryland., Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: .

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