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J Robot Surg. 2015 Sep;9(3):223-33. doi: 10.1007/s11701-015-0520-5. Epub 2015 Jul 21.

Augmented reality and cone beam CT guidance for transoral robotic surgery.

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Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Intuitive Surgical Inc., Sunnyvale, CA, USA.
Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA.


In transoral robotic surgery preoperative image data do not reflect large deformations of the operative workspace from perioperative setup. To address this challenge, in this study we explore image guidance with cone beam computed tomographic angiography to guide the dissection of critical vascular landmarks and resection of base-of-tongue neoplasms with adequate margins for transoral robotic surgery. We identify critical vascular landmarks from perioperative c-arm imaging to augment the stereoscopic view of a da Vinci si robot in addition to incorporating visual feedback from relative tool positions. Experiments resecting base-of-tongue mock tumors were conducted on a series of ex vivo and in vivo animal models comparing the proposed workflow for video augmentation to standard non-augmented practice and alternative, fluoroscopy-based image guidance. Accurate identification of registered augmented critical anatomy during controlled arterial dissection and en bloc mock tumor resection was possible with the augmented reality system. The proposed image-guided robotic system also achieved improved resection ratios of mock tumor margins (1.00) when compared to control scenarios (0.0) and alternative methods of image guidance (0.58). The experimental results show the feasibility of the proposed workflow and advantages of cone beam computed tomography image guidance through video augmentation of the primary stereo endoscopy as compared to control and alternative navigation methods.


Cone beam computed tomography; Image-guided robotic surgery; Transoral robotic surgery; Video augmentation; da Vinci

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