A Surgical Navigation Framework for Image-Guided Transoral Robotic Surgery

Transoral robotic surgery (TORS) is an effective minimally invasive alternative to traditional open surgery with improved surgical outcomes and reduced morbidity. However, TORS utilizes the natural orifice approach and does not provide haptic feedback, resulting in difficulty in assessing the extent of tumor or identifying critical structures. Intra-operative surgical navigation with image guidance has the potential to compensate for the sensory deficit in TORS. The authors previously enabled intra-operative image guidance for TORS and demonstrated the feasibility of electromagnetic tracking of da Vinci robotic instruments. In this paper, the authors described the development of a TORS navigation framework with real-time tracking and integration with the da Vinci surgeon's console, assessed the system efficacy in a multi-user phantom localization study, and discussed study limitations. Five participants with various experience levels performed target localization tasks without and with navigation and all achieved significantly reduced target localization error (TLE) (p <= 0.05; alpha=0.05), with the lowest TLE being 2.1mm. The authors successfully demonstrated the potential of the navigation system in facilitating precise target localization and enabling accurate image-guided TORS (igTORS).