Volume 72, Issue 1, Pages (July 2017)

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Volume 72, Issue 1, Pages 110-117 (July 2017) Multispectral Fluorescence Imaging During Robot-assisted Laparoscopic Sentinel Node Biopsy: A First Step Towards a Fluorescence-based Anatomic Roadmap Nynke S. van den Berg, Tessa Buckle, Gijs H. KleinJan, Henk G. van der Poel, Fijs W.B. van Leeuwen European Urology Volume 72, Issue 1, Pages 110-117 (July 2017) DOI: 10.1016/j.eururo.2016.06.012 Copyright © 2016 European Association of Urology Terms and Conditions

Fig. 1 Preoperative sentinel node mapping. Following ICG-99mTc-nanocolloid administration, lymphoscintigrams were acquired at (A) 15min and (B) 2h after injection, followed bt single-photon emission computed tomography (SPECT) and computed tomography (CT) image acquisition. (C) Following reconstruction, SPECT and CT images were fused and a three-dimensional volume rendering was generated. (D) Axial SPECT/CT slice (D) show sentinel nodes located in the external iliac (left and right) and the internal iliac (right) regions. European Urology 2017 72, 110-117DOI: (10.1016/j.eururo.2016.06.012) Copyright © 2016 European Association of Urology Terms and Conditions

Fig. 2 Intraoperative multispectral fluorescence imaging. Laparoscopic fluorescence imaging was performed of the areas of interest (left column). (A) Visualization of a lymphatic duct via both near-infrared fluorescence imaging of the hybrid tracer (middle column; arrow) and visible fluorescence imaging of fluorescein (right column; arrow). (B) The lymphatic duct seen in A ended in a sentinel node visualized via fluorescence imaging of the hybrid tracer (middle column; asterisk). No fluorescein was found in the sentinel node here (right column). (C) Example of a sentinel node that could be visualized via fluorescence imaging of the hybrid tracer (right column; asterisk) whereas via fluorescein imaging clear lymphatic ducts were visualized running to this sentinel node (right column; arrows). (D) Clear sentinel node visualization via both near-infrared fluorescence imaging of the hybrid tracer (middle column; asterisk) and fluorescence imaging of fluorescein (right column; asterisk). With fluorescein, two clear lymphatic ducts running to the sentinel node were also visualized (right column; arrows). European Urology 2017 72, 110-117DOI: (10.1016/j.eururo.2016.06.012) Copyright © 2016 European Association of Urology Terms and Conditions

Fig. 3 Ex vivo multispectral fluorescence imaging of the prostate and a sentinel node. Top row: White-light image showing the prostate (left). Multispectral fluorescence imaging of the near-infrared hybrid tracer (shown in blue) to determine the tracer injection site (middle). Visible fluorescence imaging in the autofluorescence mode to visualize the fluorescein injection site (shown in yellow). Bottom row: White-light imaging of a sentinel node (left). This sentinel node contained both the hybrid tracer (middle; shown in blue) and fluorescein (right; shown in yellow). European Urology 2017 72, 110-117DOI: (10.1016/j.eururo.2016.06.012) Copyright © 2016 European Association of Urology Terms and Conditions