Published in:
Open Access
01-12-2021 | Original Article
The Click-On gamma probe, a second-generation tethered robotic gamma probe that improves dexterity and surgical decision-making
Authors:
Samaneh Azargoshasb, Simon van Alphen, Leon J. Slof, Giuseppe Rosiello, Stefano Puliatti, Sven I. van Leeuwen, Krijn M. Houwing, Michael Boonekamp, Jeroen Verhart, Paolo Dell’Oglio, Jos van der Hage, Matthias N. van Oosterom, Fijs W. B. van Leeuwen
Published in:
European Journal of Nuclear Medicine and Molecular Imaging
|
Issue 13/2021
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Abstract
Purpose
Decision-making and dexterity, features that become increasingly relevant in (robot-assisted) minimally invasive surgery, are considered key components in improving the surgical accuracy. Recently, DROP-IN gamma probes were introduced to facilitate radioguided robotic surgery. We now studied if robotic DROP-IN radioguidance can be further improved using tethered Click-On designs that integrate gamma detection onto the robotic instruments themselves.
Methods
Using computer-assisted drawing software, 3D printing and precision machining, we created a Click-On probe containing two press-fit connections and an additional grasping moiety for a ProGrasp instrument combined with fiducials that could be video tracked using the Firefly laparoscope. Using a dexterity phantom, the duration of the specific tasks and the path traveled could be compared between use of the Click-On or DROP-IN probe. To study the impact on surgical decision-making, we performed a blinded study, in porcine models, wherein surgeons had to identify a hidden 57Co-source using either palpation or Click-On radioguidance.
Results
When assembled onto a ProGrasp instrument, while preserving grasping function and rotational freedom, the fully functional prototype could be inserted through a 12-mm trocar. In dexterity assessments, the Click-On provided a 40% reduction in movements compared to the DROP-IN, which converted into a reduction in time, path length, and increase in straightness index. Radioguidance also improved decision-making; task-completion rate increased by 60%, procedural time was reduced, and movements became more focused.
Conclusion
The Click-On gamma probe provides a step toward full integration of radioguidance in minimal invasive surgery. The value of this concept was underlined by its impact on surgical dexterity and decision-making.