Abstract
During microsurgery, en face imaging of the surgical field through the operating microscope limits the surgeon's depth perception and visualization of instruments and sub-surface anatomy. Surgical procedures outside microsurgery, such as breast tumor resections, may also benefit from visualization of the sub-surface tissue structures. The widespread clinical adoption of optical coherence tomography (OCT) in ophthalmology and its growing prominence in other fields, such as cancer imaging, has motivated the development of intraoperative OCT for real-time tomographic visualization of surgical interventions. This article reviews key technological developments in intraoperative OCT and their applications in human surgery. We focus on handheld OCT probes, microscope-integrated OCT systems, and OCT-guided laser treatment platforms designed for intraoperative use. Moreover, we discuss intraoperative OCT adjuncts and processing techniques currently under development to optimize the surgical feedback derivable from OCT data. Lastly, we survey salient clinical studies of intraoperative OCT for human surgery.
Highlights
Investigators determined that intraoperative Optical Coherence Tomography (OCT) could be advantageous compared to alternative imaging modalities due to its superior resolution, and because OCT was based on optical communications technology that was more cost-effective and could be readily integrated into surgical instruments and microscopes
The Joos group at Vanderbilt University incorporated a needle-based OCT probe [105] capable of Bscan imaging into the shaft of 23-gauge surgical forceps [112] (Fig. 3(b)). This design strategy ensured that the distal ends of the forceps were always visible in the B-scans and minimized OCT shadowing from the instrument, a problem that is frequently encountered in other intraoperative OCT applications
The first demonstration of microscope integrated optical coherence tomography (MIOCT) used a dichroic mirror after the microscope objective to couple the OCT beam onto the optical axis of the operating microscope [69]
Summary
Microsurgery may be defined as surgery performed at the sub-millimeter scale and, due to its minimally invasive nature, has been adopted for a wide array of surgical disciplines, including neurosurgery and ophthalmic surgery [1]. Initial investigations into OCT’s potential for surgical diagnostics in other microsurgeries were conducted for the first time in the late 1990’s [65] From these studies, investigators determined that intraoperative OCT (iOCT) could be advantageous compared to alternative imaging modalities due to its superior resolution, and because OCT was based on optical communications technology that was more cost-effective and could be readily integrated into surgical instruments and microscopes. In conjunction with the Fourier-domain revolution of the early 2000’s [29,30,31], facilitated the introduction of OCT into the operating suite: handheld OCT (HHOCT) probes [66,67], microscope-integrated OCT (MIOCT) [68,69,70,71], and OCT-guided laser surgical modules [72,73] The aim of this manuscript is to review key intraoperative OCT technologies and their application to various surgical disciplines.
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