Optical navigation of a DROP-IN gamma probe as a means to strengthen the connection between robot-assisted and radioguided surgery.

Rationale: With translation of the DROP-IN gamma probe, radioguidance has advanced into laparoscopic robot-assisted surgery. ‘GPS-like’ navigation further enhances the symbiosis between nuclear medicine and surgery. Therefore, we developed a fluorescence-video-based tracking method that integrates the DROP-IN with navigated-robotic surgery. Methods: Fluorescent markers, integrated into the DROP-IN, were automatically detected using a daVinci Firefly laparoscope. Subsequently, a declipseSPECT-navigation platform calculated the DROP-IN’s location within the surgical field. Using a phantom (n = 3), we pursued robotic-navigation on single-photon emission computed tomography/computed tomography (SPECT/CT), while intraoperative feasibility was validated during porcine surgery (n = 4). Results: Video-based tracking allowed for navigation of the DROP-IN towards all lesions detected on SPECT/CT (external-iliac and common-iliac artery regions). Augmented-reality visualization in the surgical console, indicated the distance to these lesions in real-time, confirmed by the DROP-IN read-out. Porcine surgery underlined the feasibility of the concept. Conclusion: Optical navigation of a DROP-IN probe provides a next step towards connecting nuclear-medicine with robotic surgery.