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The Click-On gamma probe, a second-generation tethered robotic gamma probe that improves dexterity and surgical decision-making

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 studie...

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Detalles Bibliográficos
Autores principales: Azargoshasb, Samaneh, van Alphen, Simon, Slof, Leon J., Rosiello, Giuseppe, Puliatti, Stefano, van Leeuwen, Sven I., Houwing, Krijn M., Boonekamp, Michael, Verhart, Jeroen, Dell’Oglio, Paolo, van der Hage, Jos, van Oosterom, Matthias N., van Leeuwen, Fijs W. B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8566398/
https://www.ncbi.nlm.nih.gov/pubmed/34031721
http://dx.doi.org/10.1007/s00259-021-05387-z
Descripción
Sumario: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 (57)Co-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.