title: Real-time continuous image-guided surgery: Preclinical investigation in glossectomy.
abstract: To develop, validate, and study the efficacy of an intraoperative real-time continuous image-guided surgery (RTC-IGS) system for glossectomy.
  
  
  
  Prospective study.
  
  
  
  We created a RTC-IGS system and surgical simulator for glossectomy, enabling definition of a surgical target preoperatively, real-time cautery tracking, and display of a surgical plan intraoperatively. System performance was evaluated by a group of otolaryngology residents, fellows, medical students, and staff under a reproducible setting by using realistic tongue phantoms. Evaluators were grouped into a senior and a junior group based on surgical experience, and guided and unguided tumor resections were performed. National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores and a Likert scale were used to measure workloads and impressions of the system, respectively. Efficacy was studied by comparing surgical accuracy, time, collateral damage, and workload between RTC-IGS and non-navigated resections.
  
  
  
  The senior group performed more accurately (80.9% ± 3.7% vs. 75.2% ± 5.5%, P = .28), required less time (5.0 ± 1.3 minutes vs. 7.3 ± 1.2 minutes, P = .17), and experienced lower workload (43 ± 2.0 vs. 64.4 ± 1.3 NASA-TLX score, P = .08), suggesting a trend of construct validity. Impressions were favorable, with participants reporting the system is a valuable practice tool (4.0/5 ± 0.3) and increases confidence (3.9/5 ± 0.4). Use of RTC-IGS improved both groups' accuracy, with the junior group improving from 64.4% ± 5.4% to 75.2% ± 5.5% (P = .01) and the senior group improving from 76.1% ± 4.5% to 80.9% ± 3.7% (P = .16).
  
  
  
  We created an RTC-IGS system and surgical simulator and demonstrated a trend of construct validity. Our navigated simulator allows junior trainees to practice glossectomies outside the operating room. In all evaluators, navigation assistance resulted in increased surgical accuracy.
  
  
  
  NA Laryngoscope, 127:E347-E353, 2017.
authors.affiliation: Guided Therapeutics, Techna Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Reza
authors.identifier: 0000-0002-3452-6081
authors.initials: R
authors.lastname: Tabanfar
authors.affiliation: Guided Therapeutics, Techna Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Qiu
authors.affiliation: Guided Therapeutics, Techna Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Harley
authors.initials: H
authors.lastname: Chan
authors.affiliation: Institute of Biomaterials and Biomedical Engineering University of Toronto, Toronto, Ontario, Canada.
authors.forename: Niousha
authors.initials: N
authors.lastname: Aflatouni
authors.affiliation: Guided Therapeutics, Techna Institute, University Health Network, Toronto, Ontario, Canada.|Department of Radiation Oncology University of Toronto, Toronto, Ontario, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Weersink
authors.affiliation: University Health Network, Toronto, Ontario, Canada.
authors.forename: Wael
authors.initials: W
authors.lastname: Hasan
authors.affiliation: Guided Therapeutics, Techna Institute, University Health Network, Toronto, Ontario, Canada.|University Health Network, Toronto, Ontario, Canada.|Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Irish
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D005927:Glossectomy / Q000193:education* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology / Q000193:education*; D011446:Prospective Studies; D000066908:Simulation Training / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000193:education* / Q000379:methods; D016526:Workload
keywords: Intraoperative surgical navigation; glossectomy; surgical simulation