title: Image navigation as a means to expand the boundaries of fluorescence-guided surgery.
abstract: Hybrid tracers that are both radioactive and fluorescent help extend the use of fluorescence-guided surgery to deeper structures. Such hybrid tracers facilitate preoperative surgical planning using (3D) scintigraphic images and enable synchronous intraoperative radio- and fluorescence guidance. Nevertheless, we previously found that improved orientation during laparoscopic surgery remains desirable. Here we illustrate how intraoperative navigation based on optical tracking of a fluorescence endoscope may help further improve the accuracy of hybrid surgical guidance. After feeding SPECT/CT images with an optical fiducial as a reference target to the navigation system, optical tracking could be used to position the tip of the fluorescence endoscope relative to the preoperative 3D imaging data. This hybrid navigation approach allowed us to accurately identify marker seeds in a phantom setup. The multispectral nature of the fluorescence endoscope enabled stepwise visualization of the two clinically approved fluorescent dyes, fluorescein and indocyanine green. In addition, the approach was used to navigate toward the prostate in a patient undergoing robot-assisted prostatectomy. Navigation of the tracked fluorescence endoscope toward the target identified on SPECT/CT resulted in real-time gradual visualization of the fluorescent signal in the prostate, thus providing an intraoperative confirmation of the navigation accuracy.
authors.affiliation: Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Oscar R
authors.initials: OR
authors.lastname: Brouwer
authors.forename: Tessa
authors.initials: T
authors.lastname: Buckle
authors.forename: Anton
authors.initials: A
authors.lastname: Bunschoten
authors.forename: Joeri
authors.initials: J
authors.lastname: Kuil
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Vahrmeijer
authors.forename: Thomas
authors.initials: T
authors.lastname: Wendler
authors.forename: Renato A
authors.initials: RA
authors.lastname: Valdés-Olmos
authors.forename: Henk G
authors.initials: HG
authors.lastname: van der Poel
authors.forename: Fijs W B
authors.initials: FW
authors.lastname: van Leeuwen
mesh_terms: D004724:Endoscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D019047:Phantoms, Imaging; D049268:Positron-Emission Tomography; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D013050:Spectrometry, Fluorescence; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed