Interventinal molecular imaging: the role of technology in precision surgery

Abstract

This thesis explores the development and clinical application of image-guided techniques aimed at improving the accuracy of oncological surgery while reducing morbidity. Lymph node status is a key prognostic factor in penile cancer and relevant in prostate cancer, yet conventional lymph node dissections are associated with significant complications. Sentinel node (SN) biopsy improves outcomes with reduced morbidity in penile cancer, while its role in prostate cancer remains investigational. Preoperative SPECT/CT imaging is shown to be essential for reliable SN detection, as fluorescence guidance alone is often insufficient.

The multispectral imaging capabilities of the da Vinci robotic systems enable differentiation between lymphatic drainage pathways using multiple fluorescent tracers, allowing distinction between prostate and lower-limb drainage. This approach may facilitate more tailored pelvic lymph node dissections with fewer complications. The thesis also demonstrates that fluorescein, in addition to ICG, can be detected by these systems, expanding the possibilities of multi-dye image-guided surgery.

Furthermore, the first-in-human study of the DROP-IN gamma probe shows its feasibility for intraoperative radioguidance during robotic surgery, improving surgeon autonomy and maneuverability. Its combination with PSMA-targeted tracers is also presented. Finally, feasibility studies in oral cavity surgery and image-guided ablation demonstrate that three-dimensional fluorescence guidance and volume navigation improve precision compared with conventional techniques.