Related Experiment Video
Updated: Feb 25, 2026
Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
Published on: October 24, 2025
Intraoperative image guidance in transoral robotic surgery: A pilot study
Andrew K Ma1, Michael Daly2, Jimmy Qiu2
1Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University of Toronto, Toronto, Ontario, Canada.
Background:
Intraoperative image guidance during transoral robotic surgery (TORS) is hampered by imaging-friendly instrumentation and intraoperative positioning. The purpose of this study was to develop and validate an accurate image-guidance system for TORS.
Methods:
A custom radiolucent mouth retractor was fabricated from biocompatible material (Med-610; Stratasys, Minneapolis, MN). Teflon beads were placed in the oropharynx and carotid arteries of 3 cadavers. CT scans were obtained in the preoperative and intraoperative positions. Displacement of targets between preoperative and intraoperative scans was measured. Surgical navigation was based on the open-source Image-Guided Surgery Toolkit. Target registration error (TRE) was determined by measuring the distance between the tracker and bead registered to preoperative versus intraoperative scans.
Results:
The inferior oropharyngeal targets demonstrated the greatest displacement between positions. A significant reduction in TRE was observed when registering the tracker to the intraoperative compared to the preoperative scan.
Conclusion:
This study describes an accurate intraoperative image-guidance system for TORS.
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