Wen P Liu1, Sureerat Reaugamornrat1, Jonathan M Sorger2, Jeffrey H Siewerdsen1,3, Russell H Taylor1, Jeremy D Richmon4. 1. Department of Computer Science, Johns Hopkins University, Baltimore, USA. 2. Intuitive Surgical Inc., Sunnyvale, USA. 3. Department of Biomedical Engineering, Johns Hopkins University, Baltimore, USA. 4. Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, USA.
Abstract
BACKGROUND: Adequate resection of oropharyngeal neoplasms with transoral robotic surgery (TORS) poses multiple challenges, including difficulty with access, inability to palpate the tumor, loss of landmarks, and intraoperative patient positioning with mouth retractor and tongue extended creating significant tissue distortion from preoperative imaging. METHODS: This study evaluates a workflow integrating intraoperative cone beam computed tomography (CBCT) for image-guided TORS through robotic experimentation locating 8-10 embedded targets in five porcine tongues and a cadaveric head phantom, conducted under various modes of visualization and integration of preoperative/intraoperative imaging. RESULTS: A statistically significant improvement in mean target localization error was achieved for both the porcine tongue ((9.8 ± 4.0) mm vs. (5.3 ± 1.3) mm, P-value = 0.0151) and cadaver ((11.2 ± 5.0) mm vs. (5.8 ± 2.5) mm P-value = 0.0189) in experiments comparing scenarios simulating current standard-of-care practice and the proposed image guidance system. CONCLUSION: Intraoperative image guidance with augmentation of critical surgical structures has the potential to improve target localization for TORS.
BACKGROUND: Adequate resection of oropharyngeal neoplasms with transoral robotic surgery (TORS) poses multiple challenges, including difficulty with access, inability to palpate the tumor, loss of landmarks, and intraoperative patient positioning with mouth retractor and tongue extended creating significant tissue distortion from preoperative imaging. METHODS: This study evaluates a workflow integrating intraoperative cone beam computed tomography (CBCT) for image-guided TORS through robotic experimentation locating 8-10 embedded targets in five porcine tongues and a cadaveric head phantom, conducted under various modes of visualization and integration of preoperative/intraoperative imaging. RESULTS: A statistically significant improvement in mean target localization error was achieved for both the porcine tongue ((9.8 ± 4.0) mm vs. (5.3 ± 1.3) mm, P-value = 0.0151) and cadaver ((11.2 ± 5.0) mm vs. (5.8 ± 2.5) mm P-value = 0.0189) in experiments comparing scenarios simulating current standard-of-care practice and the proposed image guidance system. CONCLUSION: Intraoperative image guidance with augmentation of critical surgical structures has the potential to improve target localization for TORS.
Authors: Peter W Kahng; Xiaotian Wu; Nithya P Ramesh; David A Pastel; Ryan J Halter; Joseph A Paydarfar Journal: Int J Comput Assist Radiol Surg Date: 2019-02-07 Impact factor: 2.924
Authors: James M Ferguson; Bryn Pitt; Alan Kuntz; Josephine Granna; Nicholas L Kavoussi; Naren Nimmagadda; Eric J Barth; Stanley Duke Herrell; Robert J Webster Journal: Int J Med Robot Date: 2020-09-01 Impact factor: 2.483