Toward intraoperative image-guided transoral robotic surgery

Liu, Wen P.; Reaugamornrat, Sureerat; Deguet, Anton; Sorger, Jonathan M.; Siewerdsen, Jeffrey H.; Richmon, Jeremy D.; Taylor, Russell H.

doi:10.1007/s11701-013-0420-5

Cited by 22 publications

(21 citation statements)

References 18 publications

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“…After placement of surface registration fiducials, contrast material is injected to enable visualization of critical vascular oropharyngeal structures while a CBCTA image is obtained. The acquired volumetric data not only captures the deformation of the oral workspace (tongue, neck, mandible) in the operative position, but can serve as the anchor to register multimodal preoperative images and plans as proposed in [23]. The lingual artery, and tumor if visible, are then segmented from the CBCTA using ITK-Snap [25] (www.itk-snap.org) by manual initialization and refined with intensity-based, region growing techniques.…”

Section: Methodsmentioning

confidence: 99%

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Augmented reality and cone beam CT guidance for transoral robotic surgery

et al. 2015

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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.

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Section: Methodsmentioning

confidence: 99%

“…In previous simple target localization experiments [23], an intensity-based algorithm developed by Reaungamornrat et al [24] is used to deformably register preoperative CT to the perioperative cone beam CT (CBCT), and the deformation field is then used to update the graphical models of the anatomic structures.…”

Section: Introductionmentioning

confidence: 99%

Augmented reality and cone beam CT guidance for transoral robotic surgery

et al. 2015

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“…Using CBCT as the primary intra-operative imaging modality, Liu et al [7,8] and Reaungamornrat et al [9] have described the development of an image guidance system through a sequence of experimental studies, beginning with 3D-printed anatomy combined with ex vivo tissue samples, progressing through in vivo animal (porcine) trials, and most recently culminating in human cadaveric investigation. While TORS applied to the resection of oropharyngeal cancers can significantly reduce morbidity and improve postoperative function in comparison to open surgery, the approach can present substantial challenges on account of the typically deep submucosal extent of the target lesion, and the surgeon's inability to palpate anatomical structures directly.…”

Section: Deformable Registration With Cbct Imagingmentioning

confidence: 99%

Transoral Robotic Surgery: Image Guidance and Augmented Reality

Pratt

Arora

2018

ORL

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Transoral robotic surgery (TORS) is being used increasingly as an alternative to conventional open procedures, as its minimally invasive approach results in significant benefits for the patient. This includes faster recovery times and better functional outcomes, less postoperative pain and morbidity associated with open access, shorter operative times, and a reduction in the risk of infection. However, the confined working spaces and sensory deficit, due to a lack of haptic sensation, and proximity to critical vasculature and other vitally important anatomical structures bestow significant challenges on the surgeon. Recent advances in the field of surgical image guidance show promise in helping address these issues. This overview considers a number of important recent developments, all of which exploit imaging technologies that, to a lesser or greater extent, are integrated with the surgical robot platform. In its most advanced form, this combination of technologies results in a fusion of visual information such that the operative field is combined with navigational cues and representations of key anatomical structures through augmented reality registration and overlay. In terms of registration accuracy, image guidance as applied to TORS procedures is an exciting proposition, since the regions of interest (e.g., the tongue base, oropharynx) are typically adjacent to and enclosed by rigid anatomy. Clinical indications and overall effectiveness are discussed together with the limitations of the current technologies. Where appropriate, directions for future work are identified.

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“…The proposed method for 3D deformable image registration (V) is detailed in this paper. Endoscopic video calibration (VI) and CBCT-to-robot registration (VII) are the subject of ongoing and future work (Liu et al, 2012). …”

Section: Figurementioning

confidence: 99%

“…The combined registration is intensity-invariant and thereby allows registration of preoperative CT and/or MR to intraoperative CBCT. Other aspects of the system, such as image quality and dose in C-arm CBCT (Daly et al, 2006, Fahrig et al, 2006, Bachar et al, 2007, Daly et al, 2011, Schafer et al, 2011, Schafer et al, 2012) and overlay of registered planning data in stereoscopic video (Liu et al, 2012), are the subject of other work. Section 2 details the registration method, and Sections 3 and 4 analyze the resulting registration performance in cadaver studies, with a detailed sensitivity analysis of algorithm parameters provided in the Appendix.…”

Section: Introductionmentioning

confidence: 99%

Deformable image registration for cone-beam CT guided transoral robotic base-of-tongue surgery

Reaungamornrat¹,

Liu²,

Wang³

et al. 2013

Phys. Med. Biol.

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Transoral robotic surgery (TORS) offers a minimally invasive approach to resection of base of tongue tumors. However, precise localization of the surgical target and adjacent critical structures can be challenged by the highly deformed intraoperative setup. We propose a deformable registration method using intraoperative cone-beam CT (CBCT) to accurately align preoperative CT or MR images with the intraoperative scene. The registration method combines a Gaussian mixture (GM) model followed by a variation of the Demons algorithm. First, following segmentation of the volume of interest (i.e., volume of the tongue extending to the hyoid), a GM model is applied to surface point clouds for rigid initialization (GM rigid) followed by nonrigid deformation (GM nonrigid). Second, the registration is refined using the Demons algorithm applied to distance map transforms of the (GM-registered) preoperative image and intraoperative CBCT. Performance was evaluated in repeat cadaver studies (25 image pairs) in terms of target registration error (TRE), entropy correlation coefficient (ECC), and normalized pointwise mutual information (NPMI). Retraction of the tongue in the TORS operative setup induced gross deformation >30 mm. The mean TRE following the GM rigid, GM nonrigid, and Demons steps was 4.6, 2.1, and 1.7 mm, respectively. The respective ECC was 0.57, 0.70, and 0.73 and NPMI was 0.46, 0.57, and 0.60. Registration accuracy was best across the superior aspect of the tongue and in proximity to the hyoid (by virtue of GM registration of surface points on these structures). The Demons step refined registration primarily in deeper portions of the tongue further from the surface and hyoid bone. Since the method does not use image intensities directly, it is suitable to multi-modality registration of preoperative CT or MR with intraoperative CBCT. Extending the 3D image registration to the fusion of image and planning data in stereo-endoscopic video is anticipated to support safer, high-precision base of tongue robotic surgery.

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Toward intraoperative image-guided transoral robotic surgery

Cited by 22 publications

References 18 publications

Augmented reality and cone beam CT guidance for transoral robotic surgery

Augmented reality and cone beam CT guidance for transoral robotic surgery

Transoral Robotic Surgery: Image Guidance and Augmented Reality

Deformable image registration for cone-beam CT guided transoral robotic base-of-tongue surgery

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