title: Feasibility of intraoperative navigation to the sentinel node in the groin using preoperatively acquired single photon emission computerized tomography data: transferring functional imaging to the operating room.
abstract: OBJECTIVE
  We explored the clinical feasibility and accuracy of intraoperative navigation based on preoperatively acquired 3-dimensional functional imaging data.
  
  
  METHODS
  Ten patients with penile carcinoma scheduled for sentinel node biopsy were prospectively included in study. After tracer injection preoperative single photon emission computerized tomography/computerized tomography was performed with a reference target fixed on the patient. Repositioning a sterile reference target shortly before surgery allowed 3-dimensional single photon emission computerized tomography/computerized tomography mixed reality based navigation of the γ probe (also containing a reference target) to the sentinel node. The accuracy of the declipse®SPECT navigation approach was determined in relation to the incision site indicated by the conventional γ probe in the coronal plane and the depth estimation measured on axial computerized tomography slices in the sagittal/axial plane.
  
  
  RESULTS
  The 3-dimensional mixed reality approach enabled γ probe navigation toward the sentinel node in all 10 patients. The average ± SD navigation error in the coronal and saggital/axial planes was 5.0 ± 3.9 and 5.3 ± 3.9 mm, respectively.
  
  
  CONCLUSIONS
  To our knowledge this is the first study demonstrating the feasibility of intraoperative navigation based on preoperatively acquired 3-dimensional single photon emission computerized tomography/computerized tomography images. Although confirmation of successful target localization (eg using γ tracing or fluorescence imaging) remains indispensable, this opens the way to translate 3-dimensional functional imaging data to the operating room.
authors: Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: o.r.brouwer@lumc.nl.
authors: Oscar R
authors: OR
authors: Brouwer
authors: 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.
authors: Nynke S
authors: NS
authors: van den Berg
authors: Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Hanna M
authors: HM
authors: Mathéron
authors: Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; SurgicEye GmBH, Munich, Germany.
authors: Thomas
authors: T
authors: Wendler
authors: Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors: Henk G
authors: HG
authors: van der Poel
authors: Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors: Simon
authors: S
authors: Horenblas
authors: Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Renato A
authors: RA
authors: Valdés Olmos
authors: Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Fijs W B
authors: FW
authors: van Leeuwen
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D007264:Inguinal Canal; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D025321:Surgery, Computer-Assisted; D015899:Tomography, Emission-Computed, Single-Photon
keywords: biopsy; computer-assisted; emission-computed; lymph node; single-photon; surgery; tomography; urology