Navigation of Fluorescence Cameras during Soft Tissue Surgery—Is it Possible to Use a Single Navigation Setup for Various Open and Laparoscopic Urological Surgery Applications?

No AccessJournal of UrologyNew Technology and Techniques1 Apr 2018Navigation of Fluorescence Cameras during Soft Tissue Surgery—Is it Possible to Use a Single Navigation Setup for Various Open and Laparoscopic Urological Surgery Applications? Matthias N. van Oosterom, Philippa Meershoek, Gijs H. KleinJan, Kees Hendricksen, Nassir Navab, Cornelis J.H. van de Velde, Henk G. van der Poel, and Fijs W.B. van Leeuwen Matthias N. van OosteromMatthias N. van Oosterom Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands , Philippa MeershoekPhilippa Meershoek Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands , Gijs H. KleinJanGijs H. KleinJan Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands , Kees HendricksenKees Hendricksen Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands , Nassir NavabNassir Navab Computer Aided Medical Procedures, Technische Universität München, Institut für Informatik, Garching bei München, Germany Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, Maryland , Cornelis J.H. van de VeldeCornelis J.H. van de Velde Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands , Henk G. van der PoelHenk G. van der Poel Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands , and Fijs W.B. van LeeuwenFijs W.B. van Leeuwen Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands View All Author Informationhttps://doi.org/10.1016/j.juro.2017.09.160AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Real-time visualization fluorescence imaging can guide surgeons during tissue resection. Unfortunately tissue induced signal attenuation limits the value of this technique to superficial applications. By positioning the fluorescence camera via a dedicated navigation setup we reasoned that the technology could be made compatible with deeper lesions, increasing its impact on clinical care. Such an impact would benefit from the ability to implement the navigation technology in different surgical settings. For that reason we evaluated whether a single fluorescence camera could be navigated toward targeted lesions during open and laparoscopic surgery. Materials and Methods: A fluorescence camera with scopes available for open and laparoscopic procedures was integrated with a navigation platform. Lymph nodes identified on SPECT/CT (single photon emission computerized tomography/computerized tomography) or free-hand single photon emission computerized tomography acted as navigation targets and were displayed as augmented overlays in the fluorescence camera video feed. The accuracy of this setup was evaluated in a phantom study of 4 scans per single photon emission computerized tomography imaging modality. This was followed by 4 first in human translations into sentinel lymph node biopsy procedures for penile (open surgery) and prostate (laparoscopic surgery) cancer. Results: Overall the phantom studies revealed a tool-target distance accuracy of 2.1 mm for SPECT/CT and 3.2 mm for freehand single photon emission computerized tomography, and an augmented reality registration accuracy of 1.1 and 2.2 mm, respectively. Subsequently open and laparoscopic navigation efforts were accurate enough to localize the fluorescence signals of the targeted tissues in vivo. Conclusions: The phantom and human studies performed suggested that the single navigation setup is applicable in various open and laparoscopic urological surgery applications. 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Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 199Issue 4April 2018Page: 1061-1068Supplementary Materials Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsemission-computedtomographysingle-photonsentinel lymph nodecomputer-assistedlaparoscopysurgeryoptical imagingAcknowledgmentsMichael Bruijns and Patrick van der Zwet, Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, assisted with phantom SPECT/CT acquisition. Michael Boonenkamp, Department of Technical Services, Development, Leiden University Medical Center, assisted with fabricating the phantom setup and geometrical calibrators. SurgicEye, Munich, Germany, assisted with operating prototype software on our declipseSPECT navigation system. Karl Storz Endoskope, Tuttlingen, Germany, provided the 0-degree laparoscope.MetricsAuthor Information Matthias N. van Oosterom Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author Philippa Meershoek Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands More articles by this author Gijs H. KleinJan Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands More articles by this author Kees Hendricksen Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands More articles by this author Nassir Navab Computer Aided Medical Procedures, Technische Universität München, Institut für Informatik, Garching bei München, Germany Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, Maryland Financial interest and/or other relationship with SurgicEye. More articles by this author Cornelis J.H. van de Velde Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands More articles by this author Henk G. van der Poel Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands More articles by this author Fijs W.B. van Leeuwen Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands More articles by this author Expand All Advertisement PDF downloadLoading ...