Abstract
Purpose
Transoral robotic surgery (TORS) is a challenging procedure due to its small workspace and complex anatomy. Ultrasound (US) image guidance has the potential to improve surgical outcomes, but an appropriate method for US probe manipulation has not been defined. This study evaluates using an additional robotic (4th) arm on the da Vinci Surgical System to perform extracorporeal US scanning for image guidance in TORS.
Methods
A stereoscopic imaging system and da Vinci-compatible US probe attachment were developed to enable control of the extracorporeal US probe from the surgeon console. The prototype was compared to freehand US by nine operators in three tasks on a healthy volunteer: (1) identification of the common carotid artery, (2) carotid artery scanning, and (3) identification of the submandibular gland. Operator workload and user experience were evaluated using a questionnaire.
Results
The robotic US tasks took longer than freehand US tasks (2.09x longer; \(p = 0.001\)) and had higher operator workload (2.12x higher; \(p = 0.004\)). However, operator-rated performance was closer (avg robotic/avg freehand = 0.66; \(p =0.017\)), and scanning performance measured by MRI-US average Hausdorff distance provided no statistically significant difference.
Conclusion
Extracorporeal US scanning for intraoperative US image guidance is a convenient approach for providing the surgeon direct control over the US image plane during TORS, with little modification to the existing operating room workflow. Although more time-consuming and higher operator workload, several methods have been identified to address these limitations.
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Funding
We gratefully acknowledge scholarship support from the National Science and Engineering Research Council of Canada, NSERC Discovery Grant and Charles Laszlo Chair in Biomedical Engineering held by Dr. Salcudean, as well as an equipment donation and maintenance support from Intuitive Surgical Inc.
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RM was involved in writing—review and editing, writing—original draft, visualization, validation, software, resources, project administration, methodology, investigation, formal analysis, data curation, and conceptualization. RY contributed to writing—review and editing, visualization, validation, software, methodology, and investigation. WC was involved in writing—review and editing, visualization, validation, and methodology. QZ assisted in writing—review and editing, visualization, validation, and software. EP contributed to supervision, resources, and conceptualization. SS contributed to writing—review and editing, supervision, resources, project administration, methodology, investigation, funding acquisition, and conceptualization.
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The authors have no relevant financial or non-financial interests to disclose beyond the funding sources listed above.
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Ethics approval was granted by the University of British Columbia Research Ethics Board (Study Number: H19-04025, Date of Approval: August 31, 2023).
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Informed consent to participate and to publish anonymized data was obtained from all individual da Vinci operators and the healthy volunteer included in this study.
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Moore, R., Yeung, R., Chen, W. et al. Enabling extracorporeal ultrasound imaging with the da Vinci robot for transoral robotic surgery: a feasibility study. Int J CARS 19, 1251–1258 (2024). https://doi.org/10.1007/s11548-024-03160-9
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DOI: https://doi.org/10.1007/s11548-024-03160-9