Feasibility of photoacoustic-guided teleoperated hysterectomies

Hysterectomies (i.e., surgical removal of the uterus) are the prevailing solution to treat medical conditions such as uterine cancer, endometriosis, and uterine prolapse. One complication of hysterectomies is accidental injury to the ureters located within millimeters of the uterine arteries that are severed and cauterized to hinder blood flow and enable full uterus removal. This work explores the feasibility of using photoacoustic imaging to visualize the uterine arteries (and potentially the ureter) when this imaging method is uniquely combined with a da Vinci^® surgical robot that enables teleoperated hysterectomies. We developed a specialized light delivery system to surround a da Vinci^® curved scissor tool, and an ultrasound probe was placed externally, representing a transvaginal approach, to receive the acoustic signals. Photoacoustic images were acquired while sweeping the tool across our custom 3-D uterine vessel model covered in ex vivo bovine tissue that was placed between the 3-D model and the fiber, as well as between the ultrasound probe and the 3-D model. Four tool orientations were explored, and the robot kinematics were used to provide tool position and orientation information simultaneously with each photoacoustic image acquisition. The optimal tool orientation produced images with contrast [Formula: see text] and background signal-to-noise ratios (SNRs) [Formula: see text], indicating minimal acoustic clutter from the tool tip. We achieved similar contrast and SNR measurements with four unique wrist orientations explored with the scissor tool in open and closed configurations. Results indicate that photoacoustic imaging is a promising approach to enable visualization of the uterine arteries to guide hysterectomies (and other gynecological surgeries). These results are additionally applicable to other da Vinci^® surgeries and other surgical instruments with similar tip geometry.