Preclinical feasibility of robot-assisted sentinel lymph node biopsy using multi-modality magnetic and fluorescence guidance in the head and neck

Giri Krishnan; Aidan Cousins; Nguyen Pham; Valentina Milanova; Melanie Nelson; Shridhar Krishnan; Nynke S van den Berg; Anil Shetty; Eben L Rosenthal; Peter-John Wormald; Benjamin Thierry; Andrew Foreman; Suren Krishnan

doi:10.1002/hed.27177

Preclinical feasibility of robot-assisted sentinel lymph node biopsy using multi-modality magnetic and fluorescence guidance in the head and neck

Head Neck. 2022 Dec;44(12):2696-2707. doi: 10.1002/hed.27177. Epub 2022 Sep 8.

Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia.
² Future Industries Institute, University of South Australia, Mawson Lakes Campus, Adelaide, South Australia, Australia.
³ Key Centre for Polymers and Colloids, School of Chemistry and University of Sydney Nano Institute, The University of Sydney, Sydney, New South Wales, Australia.
⁴ Ferronova Pty Ltd, Adelaide, South Australia, Australia.
⁵ Department of Oral and Maxillofacial Surgery, The University of Adelaide, Adelaide, South Australia, Australia.
⁶ Department of Otolaryngology-Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.

Abstract

Background: Sentinel lymph node biopsy (SLNB) is a staging procedure dependent on accurate mapping of draining lymphatics via tracers. Robot-assisted SLNB enables access to multiple neck levels with a single incision and intraoperative fluorescence guidance to the SLN.

Methods: Lymphatic mapping in swine was done using a magnetic tracer and fluorescent dye, injected into the tongue. MRI preoperatively mapped lymphatic spread of the magnetic tracer. Dissection was performed using a da Vinci Xi robot guided by fluorescence-imaging of the dye.

Results: Robot-assisted SLNB was successfully performed in all animals (n = 5). A novel MRI protocol differentiated SLNs (n = 6) from lower echelon nodes (n = 11) based on flow progression. Fluorescence imaging provided valuable intraoperative guidance and correlated with magnetic-positive nodes.

Conclusions: This study demonstrates preclinical feasibility of a robot-assisted approach to SLNB using magnetic and fluorescent tracers in the head and neck, enabling both preoperative mapping and intraoperative guidance.

Keywords: indocyanine green; magnetic nanoparticles; robotic surgery; sentinel lymph node biopsy; translational science.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Feasibility Studies
Fluorescence
Fluorescent Dyes
Indocyanine Green
Lymph Nodes / diagnostic imaging
Lymph Nodes / pathology
Lymph Nodes / surgery
Robotics*
Sentinel Lymph Node Biopsy* / methods
Swine

Substances

Indocyanine Green
Fluorescent Dyes