Ma Andrew K, Daly Michael, Qiu Jimmy, Chan Harley H L, Goldstein David P, Irish Jonathan C, de Almeida John R
Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University of Toronto, Toronto, Ontario, Canada.
Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.
Head Neck. 2017 Oct;39(10):1976-1983. doi: 10.1002/hed.24805. Epub 2017 Jul 28.
Intraoperative image guidance during transoral robotic surgery (TORS) is hampered by imaging-friendly instrumentation and intraoperative positioning. The purpose of this study was to develop and validate an accurate image-guidance system for TORS.
A custom radiolucent mouth retractor was fabricated from biocompatible material (Med-610; Stratasys, Minneapolis, MN). Teflon beads were placed in the oropharynx and carotid arteries of 3 cadavers. CT scans were obtained in the preoperative and intraoperative positions. Displacement of targets between preoperative and intraoperative scans was measured. Surgical navigation was based on the open-source Image-Guided Surgery Toolkit. Target registration error (TRE) was determined by measuring the distance between the tracker and bead registered to preoperative versus intraoperative scans.
The inferior oropharyngeal targets demonstrated the greatest displacement between positions. A significant reduction in TRE was observed when registering the tracker to the intraoperative compared to the preoperative scan.
This study describes an accurate intraoperative image-guidance system for TORS.
经口机器人手术（TORS）期间的术中图像引导受到成像友好型器械和术中定位的阻碍。本研究的目的是开发并验证一种用于TORS的精确图像引导系统。
用生物相容性材料（Med-610；Stratasys，明尼阿波利斯，明尼苏达州）制作了一种定制的可透射线口腔牵开器。将特氟龙珠放置在3具尸体的口咽和颈动脉中。在术前和术中位置进行CT扫描。测量术前和术中扫描之间目标的位移。手术导航基于开源图像引导手术工具包。通过测量术前与术中扫描注册的跟踪器与珠子之间的距离来确定目标配准误差（TRE）。
口咽下部目标在不同位置间的位移最大。与术前扫描相比，将跟踪器注册到术中扫描时，TRE显著降低。
本研究描述了一种用于TORS的精确术中图像引导系统。
