Toward Intraoperative Image-Guided Transoral Robotic Surgery

Area of Science:

• Robotic Surgery
• Surgical Navigation
• Medical Imaging

Background:

• Transoral robotic surgery (TORS) is increasingly used for base of tongue tumor resection.
• Accurate identification and navigation of critical structures are crucial for TORS success.
• Current TORS lacks advanced intraoperative guidance, potentially limiting precision.

Purpose of the Study:

• To develop and evaluate a video augmentation system with intraoperative image guidance for TORS.
• To enhance navigation, spatial orientation, and confidence during base of tongue tumor resection.
• To improve the accuracy of surgical target localization in TORS.

Main Methods:

• Development of a video augmentation workflow for the da Vinci S robotic system.
• Segmentation of tumors and critical structures from preoperative CT/MR imaging.
• Deformable registration of preoperative data to intraoperative endoscopic views using C-arm cone-beam CT (CBCT).

Main Results:

• The proposed image guidance system demonstrated a statistically significant improvement in target localization error.
• Comparison was made against simulated current practice in transoral robotic surgery.
• Experiments were conducted using animal specimens to validate the system's efficacy.

Conclusions:

• Video augmentation with intraoperative image guidance shows promise for enhancing TORS procedures.
• The developed system has the potential to improve surgical outcomes in base of tongue tumor resection.
• Further clinical evaluation is warranted to confirm benefits in human patients.