First Robotic SPECT for Minimally Invasive

Sentinel Lymph Node Mapping

Abstract

In this paper we present the usage of a drop-in gamma probe for intra-operative Single-
Photon Emission Computed Tomography (SPECT) imaging in the scope of minimally invasive
robot-assisted interventions. The probe is designed to be inserted and reside inside the abdominal
cavity during the intervention. It is grasped during the procedure using a robotic laparoscopic
gripper enabling full six degrees of freedom handling by the surgeon. We demonstrate the first
deployment of the tracked probe for intra-operative in-patient robotic SPECT enabling
augmented-reality image guidance. The hybrid mechanical- and image-based in-patient probe
tracking is shown to have an accuracy of 0.2 mm. The overall system performance is evaluated
and tested with a phantom for gynecological sentinel lymph node interventions and compared to
ground-truth data yielding a mean reconstruction accuracy of 0.67 mm.

Index TermsEndoscopy/laparoscopy, image-guided treatment, SPECT, surgical

guidance/navigation.

Existing System
It is of relevance to mention that imaging the metastases themselves using functional
imaging like Positron Emission Tomography (PET) in combination with CT, Magnetic
Resonance Imaging (MRI), or multiparametric MRI is not a real option. This is mainly due to the
fact that clinically relevant lymph node metastases may be smaller than 7 mm in patients with
early cervical cancer [17], [18]. In the case of PET, the metastases do not necessarily present
with an uptake of the tracer which is high enough relative to the background such that the partial
volume effect cannot be ignored. In contrast to diagnostic imaging, current interventional SLNM
is not limited by the size of the lymph node nor the affinity of the tracer to the tumor as the
contrast to the background is theoretically infinite. Also, tissue deformation due to patient
positioning does not need to be taken into account when performing interventional SLNM.
Disadvantage
1. Failure in detection
2. Low accuracy
3. Only for imaging
4. Manual process

Proposed System

The proposed interventional SPECT imaging system requires a minimally invasive

surgical system, which provides natural dexterity during laparoscopic interventions, a
miniaturized probe inserted through the trocar and grabbed using the laparoscopic tool, and a
tracking technique to precisely compute the position and pose of the probe within the patient.
After the acquisition, the reconstruction of the SPECT image is performed (Section II-F).
Finally, the SPECT image is visualized in the surgeon's console to enable image guided
interventions. To present this novel imaging concept, we utilize a da Vinci S minimally invasive
robotic surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA; Section II-C), a drop-in
probe (Eurorad, Eckbolsheim, France; Section II-B), a computer oscilloscope that captures the
electrical signal from the probe, and a computer with significant computational power due to a
graphics processor unit. The latter two components are part of the commercially available
declipse SPECT imaging system (SurgicEye GmbH, Munich, Germany). Additionally, an
infrared tracking system (Polaris Vicra, Northern Digital Inc, Canada) is used to track patient and
endoscope movements. The concept of robotic SPECT for minimally invasive SLNM is not
restricted to the use of the components mentioned. However, several sections of the presented
methodology focus on the combination and use of these components.
Advantages
1. Accuracy high
2. No manual
3. Direct access

Application

1. Probe Tracking
 2. Robotic Surgical System

Software Requirements

1. Matlab R2009a

H/W System Configuration:-

Processor - Pentium III

Speed - 1.1 GHz

RAM - 256 MB (min)

Hard Disk - 20 GB

Floppy Drive - 1.44 MB

Key Board - Standard Windows Keyboard