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Photoacoustic-Guided Laparoscopic and Open Hysterectomy Procedures Demonstrated With Human Cadavers
Insights
Dual-wavelength photoacoustic imaging helps surgeons differentiate uterine arteries from ureters during hysterectomy. This technology provides real-time audiovisual feedback to prevent accidental ureteral injuries.
Area of Science:
- Medical Imaging
- Surgical Technology
- Biomedical Engineering
Background:
- Hysterectomy necessitates careful dissection of uterine arteries while preserving adjacent ureters.
- Accidental ureteral injury is a significant risk during hysterectomy procedures.
- Current visualization methods may not offer sufficient real-time differentiation between critical structures.
Purpose of the Study:
- To investigate dual-wavelength and audiovisual photoacoustic imaging for ureter and uterine artery visualization.
- To develop a system for real-time guidance to prevent ureteral injury during hysterectomy.
- To assess the efficacy of photoacoustic imaging in differentiating these structures and measuring proximity.
Main Methods:
- Dual-wavelength (690/750 nm) photoacoustic imaging was applied during open and laparoscopic hysterectomies on human cadavers.
- A custom display translated photoacoustic data into visual and auditory feedback.
- Surgical tool proximity to the ureter was tracked and quantified using the photoacoustic imaging system.
Main Results:
- Significant contrast differences (up to 10 dB in open, 24 dB in laparoscopic) were observed between ureters and uterine arteries.
- The system successfully visualized both structures and their spatial relationship to the surgical tool.
- Auditory signals effectively mapped distances between the ureter and the surgical tool tip, ranging from 2.47 to 7.31 mm.
Conclusions:
- Dual-wavelength photoacoustic imaging shows potential for differentiating ureters from uterine arteries during hysterectomy.
- The developed audiovisual feedback system can provide real-time guidance to surgeons.
- This technology may significantly reduce the risk of accidental ureteral injuries in hysterectomy procedures.
Abstract:
Hysterectomy (i.e., surgical removal of the uterus) requires severing the main blood supply to the uterus (i.e., the uterine arteries) while preserving the nearby, often overlapping, ureters. In this paper, we investigate dual-wavelength and audiovisual photoacoustic imaging-based approaches to visualize and differentiate the ureter from the uterine artery and to provide the real-time information needed to avoid accidental ureteral injuries during hysterectomies. Dual-wavelength 690/750 nm photoacoustic imaging was implemented during laparoscopic and open hysterectomies performed on human cadavers, with a custom display approach designed to visualize the ureter and uterine artery. The proximity of the surgical tool to the ureter was calculated and conveyed by tracking the surgical tool in photoacoustic images and mapping distance to auditory signals. The dual-wavelength display showed up to 10 dB contrast differences between the ureter and uterine artery at three separation distances (i.e., 4 mm, 5 mm, and 6 mm) during the open hysterectomy. During the laparoscopic hysterectomy, the ureter and uterine artery were visualized in the dual-wavelength image with up to 24 dB contrast differences. Distances between the ureter and the surgical tool ranged from 2.47 to 7.31 mm. These results are promising for the introduction of dual-wavelength photoacoustic imaging to differentiate the ureter from the uterine artery, estimate the position of the ureter relative to a surgical tool tip, map photoacoustic-based distance measurements to auditory signals, and ultimately guide hysterectomy procedures to reduce the risk of accidental ureteral injuries.
