头颈部多模态磁共振和荧光引导机器人辅助前哨淋巴结活检的临床前可行性。
Preclinical feasibility of robot-assisted sentinel lymph node biopsy using multi-modality magnetic and fluorescence guidance in the head and neck.
机构信息
Department of Otolaryngology, Head and Neck Surgery, The University of Adelaide, Adelaide, South Australia, Australia.
Future Industries Institute, University of South Australia, Mawson Lakes Campus, Adelaide, South Australia, Australia.
出版信息
Head Neck. 2022 Dec;44(12):2696-2707. doi: 10.1002/hed.27177. Epub 2022 Sep 8.
BACKGROUND
Sentinel lymph node biopsy (SLNB) is a staging procedure dependent on accurate mapping of draining lymphatics via tracers. Robot-assisted SLNB enables access to multiple neck levels with a single incision and intraoperative fluorescence guidance to the SLN.
METHODS
Lymphatic mapping in swine was done using a magnetic tracer and fluorescent dye, injected into the tongue. MRI preoperatively mapped lymphatic spread of the magnetic tracer. Dissection was performed using a da Vinci Xi robot guided by fluorescence-imaging of the dye.
RESULTS
Robot-assisted SLNB was successfully performed in all animals (n = 5). A novel MRI protocol differentiated SLNs (n = 6) from lower echelon nodes (n = 11) based on flow progression. Fluorescence imaging provided valuable intraoperative guidance and correlated with magnetic-positive nodes.
CONCLUSIONS
This study demonstrates preclinical feasibility of a robot-assisted approach to SLNB using magnetic and fluorescent tracers in the head and neck, enabling both preoperative mapping and intraoperative guidance.
背景
前哨淋巴结活检 (SLNB) 是一种依赖于示踪剂准确绘制引流淋巴通路的分期手术。机器人辅助 SLNB 可通过单个切口进入多个颈部水平，并在手术中进行荧光引导至 SLN。
方法
在猪中使用磁性示踪剂和荧光染料经舌部注射进行淋巴定位。术前 MRI 对磁性示踪剂的淋巴扩散进行了定位。使用达芬奇 Xi 机器人进行解剖，通过对染料的荧光成像进行引导。
结果
所有动物（n=5）均成功完成了机器人辅助 SLNB。一种新的 MRI 方案根据血流进展将 SLN（n=6）与低阶淋巴结（n=11）区分开来。荧光成像提供了有价值的术中指导，并与磁性阳性淋巴结相关。
结论
本研究证明了使用磁性和荧光示踪剂在头颈部进行机器人辅助 SLNB 的临床前可行性，实现了术前定位和术中引导。
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