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Intraoperative image‐guided transoral robotic surgery: pre‐clinical studies
Author(s) -
Liu Wen P.,
Reaugamornrat Sureerat,
Sorger Jonathan M.,
Siewerdsen Jeffrey H.,
Taylor Russell H.,
Richmon Jeremy D.
Publication year - 2015
Publication title -
the international journal of medical robotics and computer assisted surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.556
H-Index - 53
eISSN - 1478-596X
pISSN - 1478-5951
DOI - 10.1002/rcs.1602
Subject(s) - transoral robotic surgery , retractor , medicine , cadaveric spasm , cone beam computed tomography , imaging phantom , image guided surgery , tongue , cadaver , radiology , medical physics , surgery , computed tomography , pathology
Abstract Background Adequate resection of oropharyngeal neoplasms with transoral robotic surgery (TORS) poses multiple challenges, including difficulty with access, inability to palpate the tumor, loss of landmarks, and intraoperative patient positioning with mouth retractor and tongue extended creating significant tissue distortion from preoperative imaging. Methods This study evaluates a workflow integrating intraoperative cone beam computed tomography (CBCT) for image‐guided TORS through robotic experimentation locating 8–10 embedded targets in five porcine tongues and a cadaveric head phantom, conducted under various modes of visualization and integration of preoperative/intraoperative imaging. Results A statistically significant improvement in mean target localization error was achieved for both the porcine tongue ((9.8 ± 4.0) mm vs. (5.3 ± 1.3) mm, P ‐value = 0.0151) and cadaver ((11.2 ± 5.0) mm vs. (5.8 ± 2.5) mm P ‐value = 0.0189) in experiments comparing scenarios simulating current standard‐of‐care practice and the proposed image guidance system. Conclusion Intraoperative image guidance with augmentation of critical surgical structures has the potential to improve target localization for TORS. Copyright © 2014 John Wiley & Sons, Ltd.