Abstract
Due to loss of tactile feedback the assessment of tumor margins during robotic surgery is based only on visual inspection, which is neither significantly sensitive nor specific. Here we demonstrate time-resolved fluorescence spectroscopy (TRFS) as a novel technique to complement the visual inspection of oral cancers during transoral robotic surgery (TORS) in real-time and without the need for exogenous contrast agents. TRFS enables identification of cancerous tissue by its distinct autofluorescence signature that is associated with the alteration of tissue structure and biochemical profile. A prototype TRFS instrument was integrated synergistically with the da Vinci Surgical robot and the combined system was validated in swine and human patients. Label-free and real-time assessment and visualization of tissue biochemical features during robotic surgery procedure, as demonstrated here, not only has the potential to improve the intraoperative decision making during TORS but also other robotic procedures without modification of conventional clinical protocols.
Highlights
Robotic surgery is becoming a preferred means of treatment for numerous cancers and diseases in areas such as head and neck, urologic, gynecologic, and thoracic surgery
We present the first integration of a multispectral label-free fluorescence lifetime technique into the da Vinci Surgical System and demonstrate the ability of this technique to (1) record robust time-resolved fluorescence data during transoral robotic surgery (TORS) procedures in human patients, (2) augment autofluorescence lifetime data onto conventional white-light images seen on the da Vinci surgeon console in real-time, and (3) provide contrast between distinct tissue types, including alteration by surgical procedures in human patients
TORS presents numerous benefits for the patient, it removes tactile guidance leaving only visual inspection for the assessment of tumor margins
Summary
Robotic surgery is becoming a preferred means of treatment for numerous cancers and diseases in areas such as head and neck, urologic, gynecologic, and thoracic surgery. In robotic surgery[3,8] the lack of tactile feedback limits the surgeon to visual assessment through the robot camera, increasing the possibility of positive margins and residual diseased tissue. To minimize such risk, the da Vinci Surgical System employs advanced technologies including highly-magnified 3D vision and precisely controlled instruments[3]. Recent studies have employed this technology for numerous fluorescence-guided robot-assisted interventions including, but not limited to, robotic oncologic surgery, lymph nodes identification, vascularization and organ and tissue perfusion imaging[9,10].
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