title: Real-time navigation in transoral robotic nasopharyngectomy utilizing on table fluoroscopy and image overlay software: a cadaveric feasibility study.
abstract: Inability to integrate surgical navigation systems into current surgical robot is one of the reasons for the lack of development of robotic endoscopic skull base surgery. We describe an experiment to adapt current technologies for real-time navigation during transoral robotic nasopharyngectomy. A cone-beam CT was performed with a robotic C-arm after the injecting contrast into common carotid artery. 3D reconstruction of the skull images with the internal carotid artery (ICA) highlighted red was projected on the console. Robotic nasopharyngectomy was then performed. Fluoroscopy was performed with the C-arm. Fluoroscopic image was then overlaid on the reconstructed skull image. The relationship of the robotic instruments with the bony landmarks and ICA could then been viewed in real-time, acting as a surgical navigation system. Navigation during robotic skull base surgery is feasible with available technologies and can increase the safety of robotic skull base surgery.
authors.affiliation: Division of Otorhinolarynology-Head and Neck Surgery, Department of Surgery, University of Hong Kong, Pokfulam, Hong Kong. rkytsang@hku.hk.
authors.forename: Raymond K
authors.initials: RK
authors.lastname: Tsang
authors.affiliation: Intuitive Surgical Inc., Sunnyvale, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Sorger
authors.affiliation: Intuitive Surgical Inc., Sunnyvale, USA.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Azizian
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, USA.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Holsinger
mesh_terms: D017536:Carotid Artery, Common / Q000033:anatomy & histology*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003287:Contrast Media; D005240:Feasibility Studies; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D009305:Nasopharynx / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*; D012984:Software
chemical_list: D003287:Contrast Media
keywords: Computer-aided surgery; Endoscopic skull base surgery; Nasopharyngectomy; Surgical navigation; Transoral robotic surgery