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An Imaging-Compatible Oral Retractor System for Transoral Robotic Surgery
Yuan Shi1, Xiaotian Wu2, Joseph A Paydarfar2,3,4
1Thayer School of Engineering, Dartmouth College, Hanover, NH, USA. yuan.shi.th@dartmouth.edu.
Annals of Biomedical Engineering
|May 25, 2024
Summary
A novel 3D-printed polymer oral retractor system enables artifact-free intraoperative CT/MR imaging for transoral robotic surgery (TORS). This innovation offers improved surgical navigation and patient outcomes.
Area of Science:
- Biomedical Engineering
- Surgical Technology
- Medical Imaging
Background:
- Transoral robotic surgery (TORS) currently lacks reliable intraoperative imaging guidance.
- Metallic retractors used in TORS can cause artifacts in CT/MR imaging, hindering real-time visualization.
- Development of non-artifact-generating, compatible retractors is crucial for advancing TORS navigation.
Purpose of the Study:
- To develop and validate a Computed Tomography (CT)/Magnetic Resonance Imaging (MRI)-compatible polymer oral retractor system for TORS.
- To assess the system's performance in enabling intraoperative imaging, surgical exposure, and robotic system compatibility.
- To evaluate the material's suitability for clinical use, including sterilization and long-term robustness.
Main Methods:
- A polymer retractor system was 3D-printed using carbon fiber composite and nylon, mimicking standard metallic designs.
- Comprehensive evaluations included bench-top and cadaveric experiments assessing imaging compatibility, surgical exposure, and robotic integration.
- Material strength, sterilization feasibility (STERRAD), and device stability during simulated procedures were rigorously tested.
Main Results:
- The polymer retractor system successfully enabled high-resolution, artifact-free intraoperative CT/MR imaging during TORS.
- It provided surgical exposure comparable to metallic retractors, with an inter-incisive distance of 42.55 mm and a working volume of 200.09 cm³.
- The system demonstrated compatibility with da Vinci surgical platforms, effective sterilization, and minimal displacement (<1.5 mm) during prolonged use.
Conclusions:
- This 3D-printed polymer retractor system is the first to enable artifact-free intraoperative CT/MR imaging in TORS.
- The system is feasible for clinical application, offering comparable surgical exposure and robotic compatibility.
- This advancement paves the way for image-guided surgical navigation in TORS, potentially enhancing surgical precision and patient outcomes.
