Steerable DROP-IN Radioguidance During Minimal-invasive Non-robotic Cervical and Endometrial Sentinel Lymph Node Surgery

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2024 Jan 17

PMID 38233608

Authors

Matthias N van Oosterom

Berta Diaz-Feijoo

Maria Isabel Santisteban

Nuria Sanchez-Izquierdo

Andres Perissinotti

Ariel Glickman

Tiermes Marina

Aureli Torne

Fijs W B van Leeuwen

Sergi Vidal-Sicart

Affiliations

Soon will be listed here.

Abstract

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-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.

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