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Enabling technologies for effective image-guided surgical navigation in trans-oral cancer surgery

Throat cancers have been increasing in incidence worldwide. Despite advances in surgical and non-surgical management of these cancers, treatment continues to be associated with significant functional and cosmetic morbidity. More minimally invasive trans-oral surgical (TOS) approaches have reduced treatment morbidity and complications. However, one drawback of TOS is the difficulty in intraoperatively assessing tumor extent and locating major vascular structures. Surgical navigation with image guidance has shown improved safety and efficacy with other surgical procedures; however it is currently not feasible in TOS due to the soft tissue and airway deformation that occurs with placement of instruments needed to access the throat, thus rendering preoperative scans unusable in the intraoperative setting.

The overarching objective of our research is to develop enabling technologies that allow for surgical navigation with image guidance for TOS. Our research strategy is to acquire intraoperative imaging during TOS in order to develop models of upper aerodigestive tract deformation that reflect the intraoperative state. This, in turn, would allow for registration of preoperative images to the intraoperative state. We are well equipped to solve this problem due to the unique intraoperative CT and MR imaging resources available at the Dartmouth Center for Surgical Innovation. We have successfully developed a 3D printable polymer laryngoscopy system which, unlike standard metal laryngoscopes, is CT and MRI compatible. We have also acquired preliminary intraoperative imaging data during laryngoscopy procedures. The next steps in this research will be to further quantify and characterize tissue deformation that occurs during TOS and ultimately develop a surgical navigation platform for trans-oral procedures.

Faculty contact: Ryan Halter, Joe Paydarfar