Optical Guidance Research Articles

In situ optical feedback in brain tumor biopsy - a multipara-metric analysis

Abstract Introduction Brain tumor needle biopsy interventions are inflicted with non-diagnostic or biased sampling in up to 25% and hemorrhage, including asymptomatic cases, in up to 60%. To identify diagnostic tissue and sites with increased microcirculation, intraoperative optical techniques have been suggested. The aim of this study was to investigate the clinical implications of in situ optical guidance in frameless navigated tumor biopsies. Methods Real-time feedback on protoporphyrin IX (PpIX) fluorescence, microcirculation, and gray-whiteness was given before tissue sampling (272 positions) in 20 patients along 21 trajectories in total. The primary variables of investigation were fluorescence in relation to neuropathological findings and gadolinium (Gd) enhancement, increased cerebral microcirculation in relation to bleeding incidence, number of trajectories, and impact on operation time. Results PpIX fluorescence was detected in Glioblastoma IDH-wildtype CNS WHO grade 4 (n=12), Primary diffuse large B-cell lymphoma (n=3), astrocytoma IDH-mutated CNS WHO grade 4 (n=1) (Ki67 indices ≥15%). For two patients, no PpIX fluorescence or Gd was found, although samples contained tumorous tissue (Ki67 index 6%). Increased microcirculation was found along nine trajectories (34 sites), located in cortical, tumorous, or tentorium regions. Postoperative bleedings (n=10, nine asymptomatic) were related to skull opening or tissue sampling. The present study strengthens the proposed independence from intraoperative neuropathology as PpIX fluorescence is detected. Objective real-time feedback resulted in fewer trajectories compared to previous studies indicating reduced operation time. Conclusions The integrated optical guidance system provides real-time feedback in situ, increasing certainty and precision of diagnostic tissue before sampling during frameless brain tumor biopsies.

TempDiff: Enhancing Temporal‐awareness in Latent Diffusion for Real‐World Video Super‐Resolution

AbstractLatent diffusion models (LDMs) have demonstrated remarkable success in generative modeling. It is promising to leverage the potential of diffusion priors to enhance performance in image and video tasks. However, applying LDMs to video super‐resolution (VSR) presents significant challenges due to the high demands for realistic details and temporal consistency in generated videos, exacerbated by the inherent stochasticity in the diffusion process. In this work, we propose a novel diffusion‐based framework, Temporal‐awareness Latent Diffusion Model (TempDiff), specifically designed for real‐world video super‐resolution, where degradations are diverse and complex. TempDiff harnesses the powerful generative prior of a pre‐trained diffusion model and enhances temporal awareness through the following mechanisms: 1) Incorporating temporal layers into the denoising U‐Net and VAE‐Decoder, and fine‐tuning these added modules to maintain temporal coherency; 2) Estimating optical flow guidance using a pre‐trained flow net for latent optimization and propagation across video sequences, ensuring overall stability in the generated high‐quality video. Extensive experiments demonstrate that TempDiff achieves compelling results, outperforming state‐of‐the‐art methods on both synthetic and real‐world VSR benchmark datasets. Code will be available at https://github.com/jiangqin567/TempDiff

TCT-367 Impact of Optical Coherence Tomography Guidance During Bioresorbable Scaffold Implantation: Decision Making and Post-Procedure Outcomes

TCT-367 Impact of Optical Coherence Tomography Guidance During Bioresorbable Scaffold Implantation: Decision Making and Post-Procedure Outcomes

The novel magnesium Freesolve bioresorbable scaffold, combined with intravascular optical coherence tomography guidance in the management of MINOCA case.

The novel magnesium Freesolve bioresorbable scaffold, combined with intravascular optical coherence tomography guidance in the management of MINOCA case.

Double Kissing Mini-Culotte Stenting in Unprotected Distal Left Main Bifurcation Under Optical Coherence Tomography Guidance: Immediate and Short-Term Outcomes

IntroductionCulotte stenting is an effective strategy for left main coronary bifurcation lesions. Increased side branch ostial restenosis is the main drawback of Culotte stenting. This is due to a napkin ring or potential gap produced at the ostium of the side branch. A bench study by Toth et al. has shown that additional sequential kissing balloon dilation before main vessel stenting can prevent this deformity. AimWe report immediate and short-term results of Double Kissing (DK) mini-Culotte stenting with a one-year angiographic follow-up. MethodsForty-five patients of distal left main (LM) disease underwent DK mini-Culotte stenting at our center between March 2020 and December 2022 under Optical Coherence Tomography (OCT) guidance. ResultsOut of 45 patients [male:35(77.77%); mean age:63.67±4.94years], chronic coronary syndrome was present in 26(57.8%) and unstable angina in rest. All lesions were Medina (1,1,1), (0,1,1), or (1,0,1) with a median Syntax score of 28 (IQR=23-29). All procedures were technically successful with no adverse clinical events (death, myocardial infarction, or stent thrombosis). Under OCT guidance, adequate minimal stent area (MSA) of 13.28 ± 0.77mm2, 8.25 ± 0.29 mm2, and 7.54 ± 0.45mm2 was achieved in LM, left anterior descending (LAD) and left circumflex (LCx) respectively. Adequate stent expansion of >80% was achieved in all cases. At the end of 1 year, the incidence of major adverse cardiovascular events (MACE) was 2.2%. Further, one (2.2%) patient developed restenosis of the side branch which was managed conservatively. ConclusionDK mini-Culotte stenting in the distal left main bifurcation has shown promising results and is effective in preventing side branch stent deformation and its sequelae of in-stent restenosis.

A Multimodal Protocol Combining 99mTc-Tilmanocept with Indocyanine Green Fluorescence Lympho-Angiography for Sentinel Lymph Node Biopsy in Early-Stage Oral Cancer: A Case Series.

Sentinel lymph node biopsy (SLNB) is currently considered as a viable alternative to elective neck dissection (END) for the management of cN0 oral cavity squamous cell carcinoma (OCSCC). However, some difficulties were detected in sentinel lymph node (SLN) identification in floor of mouth (FOM) and ventral tongue tumors because of the so-called "shine-through radioactivity" of the injection site, which may mask nodal hotspots in proximity. We assessed the feasibility and the potential strengths of combining 99mTc-Tilmanocept with indocyanine green (ICG) fluorescence lympho-angiography in a dedicated multimodal protocol for SLNB in T1/T2N0 oral cancer to evaluate the synergistic role of each of these two tracers in providing the appropriate sensitivity and ease of learning, even in such a critical anatomical subsite. A detailed, stepwise description of our multimodal protocol is provided, together with the presentation of its application in two cases of early-stage ventral tongue tumors. Radioactive guidance with 99mTc-Tilmanocept was used preoperatively to perform planar lymphoscintigraphy and single-photon emission computed tomography/computed tomography and to define the nodal hotspot(s) and the surgical "roadmap". In addition, it was used intraoperatively to pinpoint the SLN location within each nodal hotspot with high specificity but limited spatial resolution. Optical guidance with ICG injection at the tumor bed and near-infrared fluorescence imaging was then added, providing intuitive intraoperative guidance within each nodal hotspot with high spatial resolution. Our small experience with this protocol is illustrated and future perspectives are highlighted.

Anti-disturbance control strategy in capture stage for AUV dynamic base docking with optical guided constraints

This article investigates the challenge of potential optical guidance failure at the end of the underwater docking process due to relative attitude deviation between the Autonomous Underwater Vehicle (AUV) and the recovery platform, especially in the context of a moving base. A novel anti-disturbance control strategy is presented, accounting for environmental dynamics and optical guidance limitations. Firstly, we establish constraint models such as the effective field of view and the guidance beam associated with the optical guidance method. We then divide the recovery control strategy area based on the constraint model and propose the Line-of-sight Considering Visual Constraints (LOSCVC) docking control strategy. This strategy utilizes the line-of-sight method and the virtual leader method to make motion decisions based on the relative attitude offset and completes the docking operation by tracking the motion of the virtual leader. Furthermore, we consider the effect of ocean currents on the docking process of the moving base and design a disturbance compensation control law based on the Lyapunov redesign method. This strategy ensures the AUV maintains effective and continuous optical guidance during the capture phase, thereby achieving precise, safe, and rapid docking control. Simulation results validate the effectiveness and robustness of the proposed docking control strategy.

Exploiting Optical Flow Guidance for Transformer-Based Video Inpainting.

Transformers have been widely used for video processing owing to the multi-head self attention (MHSA) mechanism. However, the MHSA mechanism encounters an intrinsic difficulty for video inpainting, since the features associated with the corrupted regions are degraded and incur inaccurate self attention. This problem, termed query degradation, may be mitigated by first completing optical flows and then using the flows to guide the self attention, which was verified in our previous work - flow-guided transformer (FGT). We further exploit the flow guidance and propose FGT++ to pursue more effective and efficient video inpainting. First, we design a lightweight flow completion network by using local aggregation and edge loss. Second, to address the query degradation, we propose a flow guidance feature integration module, which uses the motion discrepancy to enhance the features, together with a flow-guided feature propagation module that warps the features according to the flows. Third, we decouple the transformer along the temporal and spatial dimensions, where flows are used to select the tokens through a temporally deformable MHSA mechanism, and global tokens are combined with the inner-window local tokens through a dual-perspective MHSA mechanism. FGT++ is experimentally evaluated to be outperforming the existing video inpainting networks qualitatively and quantitatively.

Successful percutaneous coronary intervention using intravascular lithotripsy with intravascular ultrasound and optical coherence tomography guidance for a calcified saphenous vein graft.

Successful percutaneous coronary intervention using intravascular lithotripsy with intravascular ultrasound and optical coherence tomography guidance for a calcified saphenous vein graft.

Fully automated quantitative coronary angiography versus optical coherence tomography guidance for coronary stent implantation (FLASH): Study protocol for a randomized controlled noninferiority trial

BackgroundArtificial intelligence-based quantitative coronary angiography (AI-QCA) has been developed to provide a more objective and reproducible data about the severity of coronary artery stenosis and the dimensions of the vessel for intervention in real-time, overcoming the limitations of significant inter- and intraobserver variability, and time-consuming nature of on-site QCA, without requiring extra time and effort. Compared with the subjective nature of visually estimated conventional CAG guidance, AI-QCA guidance provides a more practical and standardized angiography-based approach. Although the advantage of intravascular imaging-guided PCI is increasingly recognized, their broader adoption is limited by clinical and economic barriers in many catheterization laboratories. MethodsThe FLASH (fully automated quantitative coronary angiography versus optical coherence tomography guidance for coronary stent implantation) trial is a randomized, investigator-initiated, multicenter, open-label, noninferiority trial comparing the AI-QCA-assisted PCI strategy with optical coherence tomography-guided PCI strategy in patients with significant coronary artery disease. All operators will utilize a novel, standardized AI-QCA software and PCI protocol in the AI-QCA-assisted group. A total of 400 patients will be randomized to either group at a 1:1 ratio. The primary endpoint is the minimal stent area (mm2), determined by the final OCT run after completion of PCI. Clinical follow-up and cost-effectiveness evaluations are planned at 1 month and 6 months for all patients enrolled in the study. ResultsEnrollment of a total of 400 patients from the 13 participating centers in South Korea will be completed in February 2024. Follow-up of the last enrolled patients will be completed in August 2024, and primary results will be available by late 2024. ConclusionThe FLASH is the first clinical trial to evaluate the feasibility of AI-QCA-assisted PCI, and will provide the clinical evidence on AI-QCA assistance in the field of coronary intervention. Clinical trial registrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT05388357.

Simultaneous alcohol septal ablation and intravascular imaging-guided percutaneous transluminal coronary angioplasty – An effective approach in patients with hypertrophic obstructive cardiomyopathy and critical coronary artery disease

Abstract We report a case of symptomatic hypertrophic obstructive cardiomyopathy refractory to medical management with a left ventricular outflow tract pressure gradient (LVOTPG) of 160 mmHg associated with a significant calcific coronary artery disease treated using simultaneous percutaneous transluminal septal myocardial ablation (PTSMA) and an intravascular imaging-guided percutaneous transluminal coronary angioplasty. The left anterior descending artery stenosis distal to the third septal perforator was stented using a drug-eluting stent under optical coherence tomography guidance. Subsequently, the LVOTPG was addressed using PTMSA. Following the procedure, the patient had an uncomplicated recovery. A follow-up echo revealed an LVOTPG of 15 mmHg 4 weeks later.

Optical Surface-guided Radiation Therapy for Upper and Lower Limb Sarcomas: An Analysis of Setup Errors and Clinical Target Volume-To-Planning Target Volume Margins

PurposeTo assess the clinical benefits of surface-guided radiotherapy (SGRT) in terms of setup error, positioning time, and clinical target volume-to-planning target volume (CTV-PTV) margin in extremity soft tissue sarcoma (STS). Methods and MaterialsFifty consecutive patients treated with radiotherapy were retrospectively selected. Treatment setup was performed with either laser-based imaging only (control group), or with laser-based and daily optical surface-based imaging (SGRT group). Pre-treatment cone beam computed tomography images were acquired daily for the first 3 – 5 fractions and weekly thereafter, with the frequency adjusted as necessary. Translational and rotational errors were collected. CTV-PTV margin was calculated using the formula, 2.5Σ + 0.7σ. ResultsEach group consisted of 10 and 15 upper and lower limb STSs, respectively. For patients with upper limb sarcomas, the translation errors were (1.64 ± 1.34) mm, (1.10 ± 1.50) mm, and (1.24 ± 1.45) mm in SGRT group, and (1.48 ± 3.16) mm, (2.84 ± 2.85) mm, and (3.14 ± 3.29) mm in control group in the left-right (LR), supero-inferior (SI), and antero-posterior (AP) directions, respectively. Correspondingly, for patients with lower limb sarcomas, the translation errors were (1.21 ± 1.65) mm, (1.39 ± 1.71) mm, and (1.48 ± 2.10) mm in SGRT group, and (1.81 ± 2.60) mm, (2.93 ± 3.28) mm, and (3.53 ± 3.75) mm in control group, respectively. The calculated CTV-PTV margins of SGRT group and control group were 5.0 mm, 3.8 mm, 4.1 mm vs. 5.9 mm, 9.1 mm, 10.1 mm for upper limb sarcomas; and 4.2 mm, 4.7 mm, 5.2 mm vs. 6.3 mm, 9.6 mm, 11.4 mm for lower limb sarcomas in the LR, SI, and AP directions, respectively. ConclusionDaily optical surface guidance can effectively improve the setup accuracy of extremity STS patients, and safely reduce the required CTV-PTV margins.

Целесообразность применения цифровых трамваев на шинах в городах России

Objective: show the prospects of using an innovative type of public urban transport - a digital tram on tires with optical guidance along a strip marked on the road or using magnetic markers along the route, as attractive to passengers, cheaper in the arrangement of lines, as well as requiring less time to build than rail tram for urban transportation, allowing to relieve city roads from traffic jams and improve their ecology. Methods: an analysis and generalization of the operating experience of new digital trams built by the Chinese company CRRC, operated in the cities of China: Zhuzhou, Yibin, Yongxiu, Yancheng and Shanghai, as well as the most advanced designs of the operating rolling stock. Results: the operation of the tire tram revealed a number of problems: after a year of operation, severe rutting appeared on a dedicated lane of the road, speeds and capacity were lower than declared. The construction of new tire tram lines required costs for strengthening the roadway, which was not originally intended by the manufacturer. The possibility of their use in winter climate conditions on roads covered with ice and snow has not been proven. Further testing is required to identify and eliminate emerging deficiencies. Practical significance: despite a number of identified shortcomings, it is advisable to use a digital tire tram for cities with a warm climate, with complex terrain and narrow streets as a medium-capacity vehicle that can improve the mobility and quality of life of citizens, as well as reduce the negative impact on the environment. It is advisable to lay it in new residential areas and industrial zones under construction, as well as to use it for mass transportation of passengers in the event of any major one-time events: major exhibitions, forums, Olympic Games, world football championships, etc.

Stereo Vision Conversion from Planar Videos Based on Temporal Multiplane Images

With the rapid development of 3D movie and light-field displays, there is a growing demand for stereo videos. However, generating high-quality stereo videos from planar videos remains a challenging task. Traditional depth-image-based rendering techniques struggle to effectively handle the problem of occlusion exposure, which occurs when the occluded contents become visible in other views. Recently, the single-view multiplane images (MPI) representation has shown promising performance for planar video stereoscopy. However, the MPI still lacks real details that are occluded in the current frame, resulting in blurry artifacts in occlusion exposure regions. In fact, planar videos can leverage complementary information from adjacent frames to predict a more complete scene representation for the current frame. Therefore, this paper extends the MPI from still frames to the temporal domain, introducing the temporal MPI (TMPI). By extracting complementary information from adjacent frames based on optical flow guidance, obscured regions in the current frame can be effectively repaired. Additionally, a new module called masked optical flow warping (MOFW) is introduced to improve the propagation of pixels along optical flow trajectories. Experimental results demonstrate that the proposed method can generate high-quality stereoscopic or light-field videos from a single view and reproduce better occluded details than other state-of-the-art (SOTA) methods. https://github.com/Dio3ding/TMPI

Long-term clinical outcomes of intravascular imaging-guided percutaneous coronary intervention versus angiography-guided percutaneous coronary intervention in complex coronary lesions: a systematic review and meta-analysis.

Background: In this study, we aim to discuss the long-term clinical outcomes of intravascular ultrasound imaging-guided percutaneous intervention (IVUS-PCI) versus angiography-guided percutaneous coronary intervention (PCI) in complex coronary lesions over a mean period of 2years. Methods: A systematic search and meta-analysis were conducted to assess the efficacy of using intravascular ultrasound or optical coherence tomography guidance in coronary artery stenting compared to angiography. Results: A total of 11randomized controlled trialswith 6740 patients were included. For the primary outcome, a pooled analysis (3.2vs 5.6%). For secondary outcomes, the risk was significantly low in image-guided percutaneous intervention compared withangiography. Conclusion: Intravascular imaging-guided PCI is significantly more effective than angiography-guided PCI in reducing the risk of target lesion revascularization, target vessel revascularization, cardiac death, major adverse cardiovascular eventsandstent thrombosis.

Canine preclinical safety evaluation of a multimodal nanoparticle agent (Nanotrast-CF800) for image-guided cancer surgery.

Surgical oncology often requires the use of contrast-enhanced cross-sectional imaging preoperatively to characterize solitary tumours and identify sentinel lymph nodes. Intraoperative optical guidance can effectively aid tissue-sparing tumour excision and locate sentinel lymph nodes. Nanotrast-CF800 (CF800) is a novel dual-modality contrast agent, which co-encapsulates iohexol and indocyanine green (ICG) within a liposomal nanoparticle. It was developed for preoperative and intraoperative imaging of solitary tumours and sentinel lymph node mapping and its efficacy has been demonstrated in preclinical animal models (Zheng et al. 2015). The objective of this study is to evaluate the safety profile of CF800 following intravenous administration in healthy dogs. Six research dogs were randomized into two groups. Group 1 received a low dose (1 mL/kg) and group 2 received a high dose (5 mL/kg). Dogs were placed under general anesthesia and a continuous rate infusion of CF800 was administered based on group allocation. Physiologic parameters including heart rate, respiratory rate, direct arterial blood pressure, cardiac output, and temperature were measured at set time points. Plasma concentrations of iohexol, ICG, and histamine were measured at set time points. Dogs underwent whole body computed tomography scans pre-injection, 2-, and 7-days post-injection (p.i.). Contrast enhancement was measured in select organ systems and great vessels at each time point. There were no significant changes in physiologic parameters following IV infusion of CF800 in all dogs. Plasma iohexol and ICG concentrations peaked at 1 day p.i., while histamine concentrations peaked at 30 minutes p.i. Significant contrast enhancement was noted within the liver, heart, aorta, and caudal vena cava on day 2 p.i., which was significantly different compared to baseline. Prolonged contrast retention within the liver was identified. Intravenous administration of CF800 was safe to use in healthy dogs with no significant systemic adverse effects.

Multi-Scale Volumetric Dynamic Optoacoustic and Laser Ultrasound (OPLUS) Imaging Enabled by Semi-Transparent Optical Guidance.

Major biological discoveries are made by interrogating living organisms with light. However, the limited penetration of un-scattered photons within biological tissues limits the depth range covered by optical methods. Deep-tissue imaging is achieved by combining light and ultrasound. Optoacoustic imaging exploits the optical generation of ultrasound to render high-resolution images at depths unattainable with optical microscopy. Recently, laser ultrasound has been suggested as a means of generating broadband acoustic waves for high-resolution pulse-echo ultrasound imaging. Herein, an approach is proposed to simultaneously interrogate biological tissues with light and ultrasound based on layer-by-layer coating of silica optical fibers with a controlled degree of transparency. The time separation between optoacoustic and ultrasound signals collected with a custom-made spherical array transducer is exploited for simultaneous 3D optoacoustic and laser ultrasound (OPLUS) imaging with a single laser pulse. OPLUS is shown to enable large-scale anatomical characterization of tissues along with functional multi-spectral imaging of chromophores and assessment of cardiac dynamics at ultrafast rates only limited by the pulse repetition frequency of the laser. The suggested approach provides a flexible and scalable means for developing a new generation of systems synergistically combining the powerful capabilities of optoacoustics and ultrasound imaging in biology and medicine.

Optical solitons in hollow-core fibres

I review the historical observation and subsequent research on optical soliton dynamics in gas-filled hollow-core optical fibres. I include both large-core hollow capillary fibres, and hollow-core photonic-crystal or microstructured fibres with smaller cores, in particular photonic bandgap and antiresonant guiding fibres. I discuss how the optical guidance properties of these different fibre structures influence the soliton dynamics that can be obtained. The dynamics I consider include: soliton propagation at peak power levels ranging from the megawatt to terawatt level, and pulse energies from sub-microjoule to millijoule range; pulse self-compression, leading to sub-cycle and sub-femtosecond pulse duration; soliton self-frequency shifting due to both the Raman effect, and the influence of photoionisation and plasma formation; and resonant dispersive wave emission, leading to the generation of tuneable few-femtosecond pulses across the vacuum and deep ultraviolet, visible, and near-infrared spectral regions.

Impact of Medina classification on clinical outcomes of imaging-guided coronary bifurcation stenting

BackgroundIntracoronary imaging improves clinical outcomes after stenting of complex coronary bifurcation lesions (CBLs), but the impact of Medina classification-based CBL distribution on outcomes of imaging-guided bifurcation stenting is unclear. MethodsIn this integrated analysis of four previous studies, in which all CBLs were treated with drug-eluting stents under intravascular ultrasound or optical coherence tomography guidance, the distribution of 763 CBLs was assessed using angiographic Medina classification. Major adverse cardiac events (MACE), including target lesion revascularization (TLR), myocardial infarction, stent thrombosis, and cardiac death, were investigated at 1-year follow-up. ResultsThe most and least prevalent Medina subtypes were 0-1-0 (27.9 %) and 0-0-1 lesions (2.8 %). The most and least frequent MACE/TLR rates were 18.2 %/18.2 % for 0-0-1 lesions and 4.1 %/2.8 % for 0-1-0 lesions. Risks were higher for 0-0-1 lesions than for 0-1-0 lesions for both MACE (hazard ratio [HR]: 4.04, 95 % confidence interval [CI]: 1.21–13.45, p = 0.02) and TLR (HR: 6.19, 95 % CI: 1.69–22.74, p = 0.006). MACE rates were similar for true and non-true CBLs excluding 0-0-1 lesions (8.2 % and 5.9 %, HR 1.54, 95 % CI: 0.86–2.77, p = 0.15), while MACE (HR: 3.25, 95 % CI: 1.10–9.63, p = 0.03) and TLR (HR: 4.24, 95 % CI: 1.38–12.96, p = 0.01) risks were higher for 0-0-1 lesions. ConclusionsThis integrated analysis of imaging-guided bifurcation stenting demonstrated similar clinical outcomes in true and non-true CBLs, except for 0-0-1 lesions, which had a significantly higher risk of MACE/TLR.

How to objectively evaluate the impact of image-guided surgery technologies.

This manuscript aims to provide a better understanding of methods and techniques with which one can better quantify the impact of image-guided surgical technologies. A literature review was conducted with regard to economic and technical methods of medical device evaluation in various countries. Attention was focused on applications related to image-guided interventions that have enabled procedures to be performed in a minimally invasive manner, produced superior clinical outcomes, or have become standard of care. The review provides examples of successful implementations and adoption of image-guided surgical techniques, mostly in the field of neurosurgery. Failures as well as newly developed technologies still undergoing cost-efficacy analysis are discussed. The field of image-guided surgery has evolved from solely using preoperative images to utilizing highly specific tools and software to provide more information to the interventionalist in real time. While deformations in soft tissue often preclude the use of such instruments outside of neurosurgery, recent developments in optical and radioactive guidance have enabled surgeons to better account for organ motion and provide feedback to the surgeon as tissue is cut. These technologies are currently undergoing value assessments in many countries and hold promise to improve outcomes for patients, surgeons, care teams, payors, and society in general.