Samaneh Azargoshasb1,2, Imke Boekestijn1,3, Meta Roestenberg4,5, Gijs H KleinJan6, Jos A van der Hage7, Henk G van der Poel2, Daphne D D Rietbergen1,3, Matthias N van Oosterom1,2, Fijs W B van Leeuwen8,9. 1. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. 2. Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, the Netherlands. 3. Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. 4. Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands. 5. Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands. 6. Department of Urology, Leiden University Medical Center, Leiden, The Netherlands. 7. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. 8. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. F.W.B.van_Leeuwen@lumc.nl. 9. Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, the Netherlands. F.W.B.van_Leeuwen@lumc.nl.
Abstract
PURPOSE: Surgical fluorescence guidance has gained popularity in various settings, e.g., minimally invasive robot-assisted laparoscopic surgery. In pursuit of novel receptor-targeted tracers, the field of fluorescence-guided surgery is currently moving toward increasingly lower signal intensities. This highlights the importance of understanding the impact of low fluorescence intensities on clinical decision making. This study uses kinematics to investigate the impact of signal-to-background ratios (SBR) on surgical performance. METHODS: Using a custom grid exercise containing hidden fluorescent targets, a da Vinci Xi robot with Firefly fluorescence endoscope and ProGrasp and Maryland forceps instruments, we studied how the participants' (N = 16) actions were influenced by the fluorescent SBR. To monitor the surgeon's actions, the surgical instrument tip was tracked using a custom video-based tracking framework. The digitized instrument tracks were then subjected to multi-parametric kinematic analysis, allowing for the isolation of various metrics (e.g., velocity, jerkiness, tortuosity). These were incorporated in scores for dexterity (Dx), decision making (DM), overall performance (PS) and proficiency. All were related to the SBR values. RESULTS: Multi-parametric analysis showed that task completion time, time spent in fluorescence-imaging mode and total pathlength are metrics that are directly related to the SBR. Below SBR 1.5, these values substantially increased, and handling errors became more frequent. The difference in Dx and DM between the targets that gave SBR < 1.50 and SBR > 1.50, indicates that the latter group generally yields a 2.5-fold higher Dx value and a threefold higher DM value. As these values provide the basis for the PS score, proficiency could only be achieved at SBR > 1.55. CONCLUSION: By tracking the surgical instruments we were able to, for the first time, quantitatively and objectively assess how the instrument positioning is impacted by fluorescent SBR. Our findings suggest that in ideal situations a minimum SBR of 1.5 is required to discriminate fluorescent lesions, a substantially lower value than the SBR 2 often reported in literature.
PURPOSE: Surgical fluorescence guidance has gained popularity in various settings, e.g., minimally invasive robot-assisted laparoscopic surgery. In pursuit of novel receptor-targeted tracers, the field of fluorescence-guided surgery is currently moving toward increasingly lower signal intensities. This highlights the importance of understanding the impact of low fluorescence intensities on clinical decision making. This study uses kinematics to investigate the impact of signal-to-background ratios (SBR) on surgical performance. METHODS: Using a custom grid exercise containing hidden fluorescent targets, a da Vinci Xi robot with Firefly fluorescence endoscope and ProGrasp and Maryland forceps instruments, we studied how the participants' (N = 16) actions were influenced by the fluorescent SBR. To monitor the surgeon's actions, the surgical instrument tip was tracked using a custom video-based tracking framework. The digitized instrument tracks were then subjected to multi-parametric kinematic analysis, allowing for the isolation of various metrics (e.g., velocity, jerkiness, tortuosity). These were incorporated in scores for dexterity (Dx), decision making (DM), overall performance (PS) and proficiency. All were related to the SBR values. RESULTS: Multi-parametric analysis showed that task completion time, time spent in fluorescence-imaging mode and total pathlength are metrics that are directly related to the SBR. Below SBR 1.5, these values substantially increased, and handling errors became more frequent. The difference in Dx and DM between the targets that gave SBR < 1.50 and SBR > 1.50, indicates that the latter group generally yields a 2.5-fold higher Dx value and a threefold higher DM value. As these values provide the basis for the PS score, proficiency could only be achieved at SBR > 1.55. CONCLUSION: By tracking the surgical instruments we were able to, for the first time, quantitatively and objectively assess how the instrument positioning is impacted by fluorescent SBR. Our findings suggest that in ideal situations a minimum SBR of 1.5 is required to discriminate fluorescent lesions, a substantially lower value than the SBR 2 often reported in literature.
Authors: Giovanni E Cacciamani; A Shakir; A Tafuri; K Gill; J Han; N Ahmadi; P A Hueber; M Gallucci; G Simone; R Campi; G Vignolini; W C Huang; J Taylor; E Becher; F W B Van Leeuwen; H G Van Der Poel; L P Velet; A K Hemal; A Breda; R Autorino; R Sotelo; M Aron; M M Desai; A L De Castro Abreu Journal: World J Urol Date: 2019-07-08 Impact factor: 4.226
Authors: Joost R van der Vorst; Boudewijn E Schaafsma; Floris P R Verbeek; Stijn Keereweer; Jeroen C Jansen; Lilly-Ann van der Velden; Antonius P M Langeveld; Merlijn Hutteman; Clemens W G M Löwik; Cornelis J H van de Velde; John V Frangioni; Alexander L Vahrmeijer Journal: Oral Oncol Date: 2012-08-28 Impact factor: 5.337
Authors: Florian van Beurden; Danny M van Willigen; Borivoj Vojnovic; Matthias N van Oosterom; Oscar R Brouwer; Henk G van der Poel; Hisataka Kobayashi; Fijs W B van Leeuwen; Tessa Buckle Journal: Mol Imaging Date: 2020 Jan-Dec Impact factor: 4.488
Authors: Imke Boekestijn; Samaneh Azargoshasb; Matthias N van Oosterom; Leon J Slof; Petra Dibbets-Schneider; Jenny Dankelman; Arian R van Erkel; Daphne D D Rietbergen; Fijs W B van Leeuwen Journal: Int J Comput Assist Radiol Surg Date: 2022-08-07 Impact factor: 3.421