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van Leeuwen FWB, Buckle T, van Oosterom MN, Rietbergen DDD. The Rise of Molecular Image-Guided Robotic Surgery. J Nucl Med 2024:jnumed.124.267783. [PMID: 38991755 DOI: 10.2967/jnumed.124.267783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/05/2024] [Indexed: 07/13/2024] Open
Abstract
Following early acceptance by urologists, the use of surgical robotic platforms is rapidly spreading to other surgical fields. This empowerment of surgical perception via robotic advances occurs in parallel to developments in intraoperative molecular imaging. Convergence of these efforts creates a logical incentive to advance the decades-old image-guided robotics paradigm. This yields new radioguided surgery strategies set to optimally exploit the symbiosis between the growing clinical translation of robotics and molecular imaging. These strategies intend to advance surgical precision by increasing dexterity and optimizing surgical decision-making. In this state-of-the-art review, topic-related developments in chemistry (tracer development) and engineering (medical device development) are discussed, and future scientific robotic growth markets for molecular imaging are presented.
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Affiliation(s)
- Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands; and
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands; and
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands; and
| | - Daphne D D Rietbergen
- Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands; and
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Moore R, Yeung R, Chen W, Zeng Q, Prisman E, Salcudean S. Enabling extracorporeal ultrasound imaging with the da Vinci robot for transoral robotic surgery: a feasibility study. Int J Comput Assist Radiol Surg 2024; 19:1251-1258. [PMID: 38789882 DOI: 10.1007/s11548-024-03160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
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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Affiliation(s)
- Randy Moore
- Department of Electrical and Computer Engineering, The University of British Columbia, 5500-2332 Main Mall, Vancouver, BC, V6T 1Z4, Canada.
| | - Ryan Yeung
- School of Biomedical Engineering, The University of British Columbia, 2222 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Wanwen Chen
- Department of Electrical and Computer Engineering, The University of British Columbia, 5500-2332 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Qi Zeng
- Department of Electrical and Computer Engineering, The University of British Columbia, 5500-2332 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Eitan Prisman
- Department of Otolaryngology, Vancouver General Hospital, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Septimiu Salcudean
- Department of Electrical and Computer Engineering, The University of British Columbia, 5500-2332 Main Mall, Vancouver, BC, V6T 1Z4, Canada
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Kapoor KM, Kapoor A, Bertossi D. Role of Robotics in Neuromodulator and Filler Injections of Face. Indian J Plast Surg 2023; 56:470-473. [PMID: 38026767 PMCID: PMC10663073 DOI: 10.1055/s-0043-1775867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
In recent years, robots have been increasingly used in various fields of medicine, including surgery, dentistry, and ophthalmology. One of the newest and most promising applications of robotic technology in medicine is in the field of facial aesthetics, particularly in the injection of facial fillers and neuromodulators. While facial injections have traditionally been performed manually by trained physicians and nurses, the introduction of robots has the potential to revolutionize the field, offering a range of potential benefits, including increased precision, accuracy, and consistency of results. However, the significant disadvantages of robots are high cost, lack of flexibility and personal touch, limited experience, and risk of injury due to malfunction.
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Affiliation(s)
- Krishan Mohan Kapoor
- Anticlock Clinic, Chandigarh, India
- Department of Plastic Surgery, Fortis Hospital, Mohali, Punjab, India
| | - Aanandita Kapoor
- The Medical School, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Dario Bertossi
- Department of Maxillo-Facial Surgery, University of Verona, Verona, Italy
- Department of Maxillofacial Plastic Surgery Unit, Policlinico G.B. Rossi, Verona, Italy
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Ghedia R, Hariri A, Lee YK, Dragan A, Paleri V, Ap Dafydd D. Saline-aided ultrasound-guided transoral biopsy of retropharyngeal nodes in head and neck cancer: A feasibility study of five patients. Head Neck 2023; 45:2355-2362. [PMID: 37462067 DOI: 10.1002/hed.27453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/21/2023] [Accepted: 06/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the feasibility of the novel technique of intra-cavitary saline-aided ultrasound (US) guided transoral biopsy or excision of retropharyngeal nodes. METHODS We followed the IDEAL 2a framework to develop this technique. Procedures were performed between July 2020 and July 2022 at a tertiary head and neck center. RESULTS Five patients in total underwent an ultrasound-guided biopsy of a retropharyngeal node. They underwent seven procedures between them: three transoral robotic surgery (TORS) procedures, three fine needle aspirations (FNA) and/or core biopsy procedures, and one US assessment under general anesthetic. The six patients with histology taken (three TORS and three FNA/core biopsies) all had diagnostically adequate samples enabling appropriate treatment planning. There were no significant complications from the procedure. CONCLUSION Saline-aided US-guided biopsy of a retropharyngeal node is a safe and useful tool enabling accurate tissue sampling and tumor excision and ongoing appropriate treatment planning.
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Affiliation(s)
- Reshma Ghedia
- Head and Neck Department, Royal Marsden Hospital, London, UK
| | - Ahmad Hariri
- Head and Neck Department, Royal Marsden Hospital, London, UK
| | - Ying Ki Lee
- Head and Neck Department, Royal Marsden Hospital, London, UK
| | - Alina Dragan
- Head and Neck Department, Royal Marsden Hospital, London, UK
| | - Vinidh Paleri
- Head and Neck Department, Royal Marsden Hospital, London, UK
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Chen W, Kalia M, Zeng Q, Pang EHT, Bagherinasab R, Milner TD, Sabiq F, Prisman E, Salcudean SE. Towards transcervical ultrasound image guidance for transoral robotic surgery. Int J Comput Assist Radiol Surg 2023:10.1007/s11548-023-02898-y. [PMID: 37103728 DOI: 10.1007/s11548-023-02898-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Trans-oral robotic surgery (TORS) using the da Vinci surgical robot is a new minimally-invasive surgery method to treat oropharyngeal tumors, but it is a challenging operation. Augmented reality (AR) based on intra-operative ultrasound (US) has the potential to enhance the visualization of the anatomy and cancerous tumors to provide additional tools for decision-making in surgery. METHODS We propose a US-guided AR system for TORS, with the transducer placed on the neck for a transcervical view. Firstly, we perform a novel MRI-to-transcervical 3D US registration study, comprising (i) preoperative MRI to preoperative US registration, and (ii) preoperative to intraoperative US registration to account for tissue deformation due to retraction. Secondly, we develop a US-robot calibration method with an optical tracker and demonstrate its use in an AR system that displays anatomy models in the surgeon's console in real-time. RESULTS Our AR system achieves a projection error from the US to the stereo cameras of 27.14 and 26.03 pixels (image is 540[Formula: see text]960) in a water bath experiment. The average target registration error (TRE) for MRI to 3D US is 8.90 mm for the 3D US transducer and 5.85 mm for freehand 3D US, and the TRE for pre-intra operative US registration is 7.90 mm. CONCLUSION We demonstrate the feasibility of each component of the first complete pipeline for MRI-US-robot-patient registration for a proof-of-concept transcervical US-guided AR system for TORS. Our results show that trans-cervical 3D US is a promising technique for TORS image guidance.
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Affiliation(s)
- Wanwen Chen
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, BC, Canada.
| | - Megha Kalia
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, BC, Canada
| | - Qi Zeng
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, BC, Canada
| | - Emily H T Pang
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Razeyeh Bagherinasab
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, BC, Canada
| | - Thomas D Milner
- Division of Otolaryngology, Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Farahna Sabiq
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Eitan Prisman
- Division of Otolaryngology, Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Septimiu E Salcudean
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, BC, Canada
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Izzetti R, Nisi M, Aringhieri G, Vitali S, Oranges T, Romanelli M, Caramella D, Graziani F, Gabriele M. Ultra-high frequency ultrasound in the differential diagnosis of oral pemphigus and pemphigoid: An explorative study. Skin Res Technol 2021; 27:682-691. [PMID: 33405267 DOI: 10.1111/srt.13000] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/05/2020] [Accepted: 12/05/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Intraoral ultra-high frequency ultrasound (UHFUS) is an emerging technique in oral medicine, due to its possibility to provide submillimeter resolution imaging of superficial mucosal structures. In this study, the potential role of UHFUS in the diagnosis of oral pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) is assessed. MATERIALS AND METHODS Consecutive patients with suspected oral PV or MMP were enrolled. All patients underwent clinical examination, laboratory tests, intraoral UHFUS scan, and biopsy. Histology and direct immunofluorescence were set as benchmark for diagnosis confirmation. The sensitivity and specificity of UHFUS compared to histology were assessed. Mann-Whitney test was performed to evaluate the presence of differences in the echogenicity of PV and MMP. P-value was set at P < 0.05. RESULTS Twenty-five patients were included. Thirteen patients were diagnosed with PV, and twelve with MMP. The UHFUS features of PV and MMP lesions were described. Image analysis showed statistically significant differences between the echogenicity of PV and MMP lesions (P < 0.05). Good concordance between UHFUS and histology was found. UHFUS showed 75% sensitivity in the diagnosis of PV and 66.7% in the diagnosis of MMP. CONCLUSIONS UHFUS appears a valuable tool in the diagnosis of PV and MMP. Although histology and immunofluorescence remain the gold standard, UHFUS role in the diagnostic algorithm of PV and MMP seems promising as a chair-side tool consistently enhancing clinical evaluation of oral bullous lesions.
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Affiliation(s)
- Rossana Izzetti
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Marco Nisi
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Giacomo Aringhieri
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Saverio Vitali
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Teresa Oranges
- Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Romanelli
- Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Davide Caramella
- Diagnostic and Interventional Radiology, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Filippo Graziani
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Mario Gabriele
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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