Intraoperative molecular imaging - it's all about advancing surgical decision making and improving dexterity.

Clinical implementation of intraoperative molecular imaging has accelerated by incorporating molecular image-guided decision making into minimal invasive robotic surgery. The resulting digital surgery concepts combine precise molecular image-guided decision making with increased dexterity, with the aim to achieve value-based medicine. In this review several surgically encountered challenges and the technological innovations the field of intraoperative molecular imaging and molecular image-guided robotics, that include navigation in preoperative imaging roadmaps, dosing, imaging and sensing and performance assessment are discussed. Herein specific focus is placed on physical trade-offs between key issues such as penetration depth, spatial resolution and background signal, as well as integration of hybrid tracers and multimodal strategies.