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Int J Comput Assist Radiol Surg. 2019 Feb 7. doi: 10.1007/s11548-018-01907-9. [Epub ahead of print]

Improving target localization during trans-oral surgery with use of intraoperative imaging.

Author information

1
Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
2
Thayer School of Engineering at Dartmouth, Hanover, NH, USA.
3
The Dartmouth Institute of Health Policy and Clinical Practice, Hanover, NH, USA.
4
Division of Neuroradiology, Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
5
Geisel School of Medicine at Dartmouth, Hanover, NH, USA. joseph.a.paydarfar@hitchcock.org.
6
Thayer School of Engineering at Dartmouth, Hanover, NH, USA. joseph.a.paydarfar@hitchcock.org.
7
Section of Otolaryngology, Audiology & Maxillofacial Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA. joseph.a.paydarfar@hitchcock.org.

Abstract

PURPOSE:

Trans-oral surgery provides a less invasive means for the surgical management of upper aerodigestive tract malignancies but is limited in its ability to readily assess submucosal tumor extent and location of critical structures intraoperatively. We sought to determine surgeons' baseline target localization accuracy during operative laryngoscopy with preoperative imaging alone and then assess for improvement in localization accuracy when presented with intraoperative CT imaging capturing soft tissue deformation.

METHODS:

Fiducial beads were placed submucosally in four cadaver heads. "Preoperative" (PO) and "intraoperative" (IO) neck CTs were acquired before and during suspension laryngoscopy using a CT-compatible laryngoscopy system. Surgeons attempted to localize submucosal fiducials beads using pins based on sequential review of PO and IO images.

RESULTS:

Mean total error (TE) decreased from 12.8 ± 9.9 to 10 ± 7.5 mm from PO to IO (P < 0.001), respectively. TE for base of tongue and vallecula decreased by 1.7 ± 6.7 mm (P = 0.015). Right-sided structures were most exposed by scope positioning and experienced a TE reduction of 4.8 ± 9.3 mm (P < 0.001). Task completion time decreased from PO to IO by 26% (P < 0.001).

CONCLUSIONS:

Intraoperative imaging significantly improves localization accuracy and task efficiency when targeting submucosal beads in cadaver heads during operative laryngoscopy.

KEYWORDS:

Image-guided surgical navigation; Intraoperative imaging; Laryngoscopy; Localization accuracy; Localization error; Trans-oral surgery

PMID:
30730029
DOI:
10.1007/s11548-018-01907-9

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