Radioguided surgery in urology decreases the surgical time and in the long term, improves survival.
Image Guided Surgery is a standard of quality in certain specialties, however, the use of radiotracers in urologic surgery, except for penile cancer has so far been anecdotal. New diagnostic methods based on molecular mages (PET-CT, SPECT-CT, MRI, PET-MRI) in addition to improving the diagnostic performance can be used in surgical planning of urologic tumors, such as the sentinel node in prostate cancer, with lafinalidad to reduce surgical time and morbidity of classical surgery, and possibly improve long-term survival.
When is sentinel node surgery?
Sentinel node surgery is indicated in patients with high intermediate risk prostate that have a high probability of cancer and lymph node involvement were previously, in most cases, undergoing radiotherapy with hormone therapy. It is also a salvage surgery in patients after radical prostatectomy or radiation therapy have a biochemical recurrence (rising PSA) and PET-CT and other radiological methods show exclusively nodal involvement.
How is it done?
The day before surgery Tecnecio99 injected into the prostate for the realization of SPECT-CT to identify and locate the sentinel node and allow surgical planning. Intraoperative identification for a probe adapted to laparoscopic surgical field and an external browser (Sentinella®) that can locate even the sentinel nodes located outside the territory of usual drainage test cardiopulmonary activity of sentinel lymph nodes removed and used absence of activity in the indicative of complete removal surgical bed.
¿Future radioguided surgery in urology?
Systematization and consolidation of radio-prostate surgery is allowing its expansion to other diseases such as kidney tumor and invasive bladder. The future will determine whether consolidate and generalize these techniques in routine practice.