The latest in intra-operative navigation tools for robotic surgery
More advanced versions of existing tools and novel applications will make intra-operative navigation even easier in the very near future.
Successive generations of innovations and upgrades are helping robotic surgeons navigate more confidently through often complex anatomies. More advanced versions of existing tools and novel applications will make intra-operative navigation even easier in the very near future.
“Surgeons can already display preoperative and intra-operative imaging on their consoles during robotic surgery,” said Chandru P. Sundaram, MD, FACS, FRCS, professor of urology and director of minimally invasive surgery at Indiana University School of Medicine in Indianapolis. “Intra-operative ultrasound with color flow Doppler is already routine for intra-operative navigation during robotic surgery, especially for partial nephrectomies.”
Dr. Sundaram will moderate a panel discussion on “Intra-Operative Navigation Tools for Robot-Assisted Surgery” during the Monday plenary from 9:50 a.m. to 10:20 a.m. Ahmed E. Ghazi, MD, FEBU, MBBS, associate professor of urology and director of the Simulation Innovation Laboratory at the University of Rochester School of Medicine and Dentistry in Rochester, New York, and Daniele Amparore, MD, PhD, research fellow of urology at the University of Turin in Italy, will describe the latest developments in intra-operative navigation tools for robotic systems plus look into the future of advanced intra-operative imaging devices and agents.
“We already have multiple robotic systems in clinical use worldwide,” Dr. Sundaram said. “Each has its own technologies that focus on navigation, different navigation techniques and tools with different advantages than many urologists might be used to thinking about.”
Imaging agents, both familiar and novel, are already a common feature in robotic surgery. Agents such as indocyanine green are being used to highlight vascularity and in identification of anatomical structures and neoplasms.
“There are several more advanced molecular imaging agents that are being developed to detect cancers inside the abdomen during robotic surgery,” Dr. Sundaram said. “Surgeons will be able to more accurately and completely remove those cancers that light up with these new agents.”
Imaging agents that target prostate-specific membrane antigen are already being used in positron emission tomography imaging to detect suspected prostate cancer metastases. Other prostate-specific membrane antigen-specific tags have been used for intra-operative imaging in small clinical studies, he said.
Look for new fluorescent agents to visualize different cancers in the near future. Dr. Sundaram has worked with OTL-38, a molecular imaging agent that binds to folate receptors on tumor surfaces, in both kidney and lung cancers. Multiple other cancer-specific agents are in development.
“We are also going to see augmented reality on our consoles,” he predicted. “Augmented reality is where you overlay preoperative images with the robotic image you see in real time, superimposing the preoperative image on the anatomy you see during surgery, to help guide you to your surgical target.”
Augmented reality is already used in MRI/ultrasound fusion-guided biopsies for prostate cancer, Dr. Sundaram continued, but is still in development for routine robotic surgery.
It is easy enough to add positron emission tomography, MRI and most other images to the console view. The more difficult part is ensuring the overlay is accurate, and that it adds to the anatomy seen on the console to provide useful navigational guidance.
“Robotic surgery is evolving rapidly and so are our tools for intra-operative navigation,” Dr. Sundaram said. “We will discuss more effective use of techniques we already have, such as ultrasound and imaging agents that can be used during robotic surgery, as well as explore the investigational tools that are to come. The scope of intra-operative navigation is just tremendous.”