title: Intraoperative image-guided transoral robotic surgery: pre-clinical studies.
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.
  
  
  CONCLUSIONS
  Intraoperative image guidance with augmentation of critical surgical structures has the potential to improve target localization for TORS.
authors: Department of Computer Science, Johns Hopkins University, Baltimore, USA.
authors: Wen P
authors: WP
authors: Liu
authors: Department of Computer Science, Johns Hopkins University, Baltimore, USA.
authors: Sureerat
authors: S
authors: Reaugamornrat
authors: Intuitive Surgical Inc., Sunnyvale, USA.
authors: Jonathan M
authors: JM
authors: Sorger
authors: Department of Computer Science, Johns Hopkins University, Baltimore, USA.|Department of Biomedical Engineering, Johns Hopkins University, Baltimore, USA.
authors: Jeffrey H
authors: JH
authors: Siewerdsen
authors: Department of Computer Science, Johns Hopkins University, Baltimore, USA.
authors: Russell H
authors: RH
authors: Taylor
authors: Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, USA.
authors: Jeremy D
authors: JD
authors: Richmon
mesh_terms: D000818:Animals; D002102:Cadaver; D054893:Cone-Beam Computed Tomography; D006801:Humans; D008953:Models, Anatomic; D009959:Oropharyngeal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D019047:Phantoms, Imaging; D065287:Robotic Surgical Procedures / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013552:Swine; D014059:Tongue / Q000000981:diagnostic imaging / Q000601:surgery; D020535:Video-Assisted Surgery / Q000379:methods
keywords: base of tongue resection; cone-beam CT; intraoperative image-guidance; stereo video augmentation; transoral robotic surgery