Real-time continuous image-guided surgery: Preclinical investigation in glossectomy

Area of Science:

• Surgical Technology
• Medical Simulation
• Image-Guided Surgery

Background:

• Glossectomy procedures require high precision to minimize collateral damage.
• Developing advanced surgical tools is crucial for improving patient outcomes and training surgeons.
• Intraoperative navigation systems can enhance surgical accuracy and reduce learning curves.

Purpose of the Study:

• To develop and validate a real-time continuous image-guided surgery (RTC-IGS) system for glossectomy.
• To assess the efficacy of the RTC-IGS system in improving surgical accuracy, reducing procedure time, and minimizing workload.
• To evaluate the system's utility as a training tool for surgeons of varying experience levels.

Main Methods:

• A prospective study was conducted using a newly developed RTC-IGS system and a surgical simulator for glossectomy.
• Otolaryngology trainees (junior and senior groups) performed guided and unguided tumor resections on realistic tongue phantoms.
• Surgical accuracy, time, collateral damage, and workload (NASA-TLX) were compared between navigated and non-navigated procedures.

Main Results:

• The RTC-IGS system showed a trend towards construct validity, with senior surgeons performing more accurately and requiring less time with navigation.
• Participant feedback indicated the system is a valuable practice tool, increasing confidence.
• Navigation assistance significantly improved surgical accuracy for junior trainees (64.4% to 75.2%, P = .01) and showed improvement in senior trainees (76.1% to 80.9%, P = .16).

Conclusions:

• An RTC-IGS system and surgical simulator were successfully developed, demonstrating a trend of construct validity.
• The navigated simulator provides a valuable platform for junior trainees to practice glossectomies.
• Intraoperative navigation assistance using the RTC-IGS system enhances surgical accuracy for all levels of surgical expertise.