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However, the relatively low levels of PSMA-receptor expression and background signal can hinder in vivo lesion detection and margin evaluation. Back-table imaging (ex vivo) potentially provides a means to confirm surgical accuracy. For <jats:sup>99m<\/jats:sup>Tc-PSMA-radioguided surgery, an innovative gantry-free hybrid imaging technique has recently been proposed, namely handheld single-photon emission computed tomography (<jats:italic>h<\/jats:italic>SPECT) combined with light detection and ranging (LiDAR). This study aimed to assess the feasibility and performance of <jats:italic>h<\/jats:italic>SPECT\/LiDAR in analyzing tissue specimens excised after robotic <jats:sup>99m<\/jats:sup>Tc-PSMA-radioguided surgery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We included samples from 5 prostate cancer patients undergoing primary or salvage robot-assisted resection of <jats:sup>99m<\/jats:sup>Tc-PSMA-I&amp;S avid lesions that were identified using a drop-in gamma probe. 12 samples (1 prostatic tissue, 1 local recurrence tissue, 10 lymph nodes) were analyzed ex vivo using a custom-built specimen tray, including an optical reference tracker for scan registration. LiDAR was used to acquire a surface scan of the specimens, and the 3D OBJ image output was fused with the 3D DICOM of a <jats:italic>h<\/jats:italic>SPECT obtained using a handheld gamma camera and DeclipseSPECT tracking system.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>\n              <jats:italic>h<\/jats:italic>SPECT\/LiDAR imaging provided accurate representation of the <jats:sup>99m<\/jats:sup>Tc-PSMA-I&amp;S uptake within the specimens. In 8 samples, it helped to confirm a true positive lesion. In the remaining 4 samples, non-visualization aligned with negative histopathology (true negative). A strong correlation was found between PSMA-<jats:italic>h<\/jats:italic>SPECT\/LiDAR and PSMA-PET\/CT (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), but no correlation could be established with PSMA-SPECT\/CT (<jats:italic>p<\/jats:italic>\u2009=\u20090.515). The count rates fount in the scan correlated to tumor size (<jats:italic>p<\/jats:italic>\u2009=\u20090.016) and were not influenced by the overall specimen\u2019s size (<jats:italic>p<\/jats:italic>\u2009=\u20090.558).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>We present the technical feasibility of a new 3D hybrid modality (<jats:italic>h<\/jats:italic>SPECT\/LiDAR) that allows back-table assessment of surgical specimens from the already well validated robotic <jats:sup>99m<\/jats:sup>Tc-PSMA-radioguided surgery workflow.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00464-025-12081-w","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T19:45:08Z","timestamp":1756151108000},"page":"6943-6954","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Back-table specimen scanning using gantry-free hybrid hSPECT\/LiDAR imaging: a feasibility study during PSMA-radioguided surgery"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9627-5065","authenticated-orcid":false,"given":"Giusi","family":"Pisano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias N.","family":"van Oosterom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera A.","family":"Ottens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Claire","family":"Berrens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon J.","family":"Slof","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berkay A.","family":"\u00c7akal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daphne D. 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