Image guided surgery: clinical validation of lesion identification technologies and exploration of nerve sparing approaches

Surgery is considered the golden standard to treat the primary tumour and regional spread of many different cancer types. In addition to the pathological evaluation of surgical margins, the evaluation of lymph nodes is needed to stage the metastatic dissemination of the disease [1,2]. Both these aspects are critical in accomplishing radical excision and are, as such, providing true prognosis. However, the quest for complete cure should be in balance with the desire for minimally invasive surgery [3–5]. Hereby it can be assumed that surgical side effects may negatively influence the patient’s quality of life. Advanced image guided surgery technologies can be used to improve the surgical resection and to minimize the invasive nature of the procedure [6]. In this thesis both these technologies are discussed. Hereby we focussed on the locoregional assessment of the lymphatic tumour spread via sentinel lymph node procedures [7–11]. In addition technologies that support nerve-sparing surgery have been pursued. To realize these ambitious goals, a combination of imaging modalities has been used, ranging from fluorescence to nuclear imaging and hybrid combinations of the same.