Steerable DROP-IN radioguidance during minimal-invasive non-robotic cervical and endometrial sentinel lymph node surgery

Matthias N van Oosterom; Berta Diaz-Feijóo; Maria Isabel Santisteban; Núria Sánchez-Izquierdo; Andrés Perissinotti; Ariel Glickman; Tiermes Marina; Aureli Torné; Fijs W B van Leeuwen; Sergi Vidal-Sicart

doi:10.1007/s00259-023-06589-3

Steerable DROP-IN radioguidance during minimal-invasive non-robotic cervical and endometrial sentinel lymph node surgery

Eur J Nucl Med Mol Imaging. 2024 Jan 18. doi: 10.1007/s00259-023-06589-3. Online ahead of print.

Authors

Matthias N van Oosterom¹, Berta Diaz-Feijóo^{2

3

4}, Maria Isabel Santisteban^{5

6}, Núria Sánchez-Izquierdo^{3

5}, Andrés Perissinotti^{3

5}, Ariel Glickman², Tiermes Marina², Aureli Torné^{2

3

4}, Fijs W B van Leeuwen⁷, Sergi Vidal-Sicart^{3

5}

Affiliations

¹ Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. m.n.van_oosterom@lumc.nl.
² Gynecology Oncology Unit, Institute Clínic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain.
³ Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Spain.
⁴ Faculty of Medicine, University of Barcelona, Barcelona, Spain.
⁵ Nuclear Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain.
⁶ Nuclear Medicine Department, Hospital Universitario Puerta del Mar, Cádiz, Spain.
⁷ Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.

PMID: 38233608
DOI: 10.1007/s00259-023-06589-3

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-^99mTc-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.

Keywords: Cervical cancer; Endometrial cancer; Laparoscopic surgery; Radioguided surgery; Sentinel lymph node; Steerable instruments.

Associated data

ClinicalTrials.gov/NCT04492995

Abstract

Associated data

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