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Touching the tumor boundary: a pilot study on ultrasound-based virtual fixtures for breast-conserving surgery
Laura Connolly1, Tamas Ungi2, Adnan Munawar3
1Queen's University, Kingston, Ontario, Canada. laura.connolly@queensu.ca.
Purpose:
Delineating tumor boundaries during breast-conserving surgery is challenging as tumors are often highly mobile, non-palpable, and have irregularly shaped borders. To address these challenges, we introduce a cooperative robotic guidance system that applies haptic feedback for tumor localization. In this pilot study, we aim to assess if and how this system can be successfully integrated into breast cancer care.
Methods:
A small haptic robot is retrofitted with an electrocautery blade to operate as a cooperatively controlled surgical tool. Ultrasound and electromagnetic navigation are used to identify the tumor boundaries and position. A forbidden region virtual fixture is imposed when the surgical tool collides with the tumor boundary. We conducted a study where users were asked to resect tumors from breast simulants both with and without the haptic guidance. We then assess the results of these simulated resections both qualitatively and quantitatively.
Results:
Virtual fixture guidance is shown to improve resection margins. On average, users find the task to be less mentally demanding, frustrating, and effort intensive when haptic feedback is available. We also discovered some unanticipated impacts on surgical workflow that will guide design adjustments and training protocol moving forward.
Conclusion:
Our results suggest that virtual fixtures can help localize tumor boundaries in simulated breast-conserving surgery. Future work will include an extensive user study to further validate these results and fine-tune our guidance system.
Insights
This pilot study shows that a cooperative robotic guidance system with haptic feedback improves tumor localization during simulated breast-conserving surgery. The system enhances resection margins and reduces surgeon mental demand.
Area of Science:
- Surgical Robotics
- Medical Device Technology
- Oncology
Background:
- Accurate tumor boundary delineation in breast-conserving surgery is challenging due to tumor mobility and irregular shapes.
- Non-palpable and irregularly bordered tumors complicate precise surgical resection.
Purpose of the Study:
- To evaluate a novel cooperative robotic guidance system with haptic feedback for tumor localization in breast cancer surgery.
- To assess the integration of this haptic guidance system into clinical breast cancer care.
Main Methods:
- A haptic robot with an electrocautery blade was developed as a cooperative surgical tool.
- Ultrasound and electromagnetic navigation identified tumor boundaries, with virtual fixtures preventing breaches.
- Simulated tumor resections were performed by users with and without haptic guidance.
Main Results:
- Haptic virtual fixture guidance significantly improved surgical resection margins.
- Surgeons reported reduced mental demand, frustration, and effort when using the haptic system.
- Unanticipated impacts on surgical workflow were identified for future system refinement.
Conclusions:
- Virtual fixtures show promise in localizing tumor boundaries during simulated breast-conserving surgery.
- Further validation through extensive user studies is planned to refine the guidance system.
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