Dr. Michael Topf, an associate professor specializing in Otolaryngology-Head and Neck Surgery at Vanderbilt, spearheaded the initial surgery employing this novel imaging approach. He and his team have since performed multiple surgeries as part of an extensive clinical study involving up to 50 patients. The study’s principal objective is to evaluate the long-term feasibility and clinical benefits of incorporating intraoperative PET-CT to assess tumor resections during surgery, aiming to set a new standard in cancer care.

Intraoperative PET-CT represents a significant technological leap by enabling surgeons to conduct detailed margin analysis in real-time. Traditionally, resected tumor specimens are sent to pathology labs, where comprehensive microscopic evaluations can take days to finalize before confirming whether the surgical margins are clean of cancer cells. By contrast, this new method transports the resected tissue immediately to the nearby scanner within the operating suite, supplying surgeons with rapid and critical feedback on the completeness of the cancer removal.

The innovative imaging modality capitalizes on the strengths of PET and CT technologies in unison. PET provides vital functional insights by detecting metabolic activity, using radiotracers that highlight malignant tissues due to their elevated glucose uptake. Meanwhile, the CT scan offers detailed anatomical views, outlining the tumor and its surroundings with high spatial resolution. This fusion delivers a comprehensive image, enabling surgeons to identify residual malignant cells that could remain undetectable by visual inspection alone.

During the surgical procedure, patients receive an injection of fluorodeoxyglucose (FDG), a radiopharmaceutical that mimics glucose. Cancerous cells, being metabolically hyperactive, absorb and retain FDG more than normal tissues, causing the tumor to “light up” on the PET scan. Once the tumor is excised, the specimen is scanned immediately with the Aura 10 device, and the imaging data are analyzed to determine if the edges of the removed tissue—termed margins—are free from cancerous cells. This immediate feedback empowers surgeons to decide whether additional tissue needs excision to ensure a negative margin and reduce the risk of recurrence.

Dr. Topf emphasized that the ongoing research not only tests the feasibility of using intraoperative PET-CT in the operating room but also rigorously compares its accuracy against the pathology lab’s gold standard of microscopic tissue analysis. Validation of this technology could revolutionize head and neck oncology surgeries by providing surgeons greater confidence during resections, potentially improving cure rates and sparing patients from the morbidity of incomplete removals or excessive surgery.

Nicole Jones, the research coordinator IV in the otolaryngology laboratory, highlighted the transformative clinical implications of incorporating this technology. She noted that current practices involve a time lag between surgery and pathology results, often leading to delayed decisions about follow-up treatments or surgeries. The immediate intraoperative imaging poster presented by the Aura 10 scanner could profoundly impact patient care by drastically shortening this feedback loop, allowing surgical teams to tidy up any residual cancer in a single operative session.

Such innovation redefines surgical workflows by keeping everything within the operative environment. Surgeons no longer need to leave the sterile operating theater to consult pathology results; instead, the entire cycle of tumor removal and assessment occurs seamlessly and in real-time. This integrated model is poised to enhance surgical precision, reduce reoperation rates, and improve overall patient outcomes. It also embodies a bold leap towards more personalized, data-driven surgical oncology.

From the patient perspective, Dr. Topf noted that participation in this clinical research offers a unique and compelling opportunity to benefit from cutting-edge technology without additional hospital visits or invasive testing. Using intraoperative PET-CT represents a convergence of advanced imaging and surgical techniques designed to elevate the standard of care and instill confidence in both surgeons and patients that cancer removal is as thorough and minimally invasive as possible.

The implications of this technology extend beyond head and neck cancer surgeries, potentially applying to numerous other oncologic and surgical disciplines where accurate margin assessment is critical. The real-time, intraoperative visualization of cancer metabolism and localization offers a window into personalized surgery, where every decision is informed by precise biological and anatomical data.

In summary, the integration of the Aura 10 intraoperative PET-CT scanner into head and neck cancer surgeries represents a paradigm shift in oncologic surgery. This novel approach promises to reduce positive surgical margins, lower recurrence rates, and accelerate clinical decision-making. The ongoing study at Vanderbilt University Medical Center, led by Dr. Michael Topf and his team, continues to evaluate the technology’s long-term viability and hopes to pave the way for widespread clinical adoption of intraoperative molecular imaging.

As the landscape of cancer surgery evolves, innovations like this that blend real-time molecular imaging with surgical practice could herald a new era in precision oncology, improving patient survival and quality of life through enhanced surgical accuracy and tailored treatment approaches. The success of this research may ultimately redefine how surgeons approach cancer resections and set new benchmarks for operative excellence worldwide.

Subject of Research: Advanced intraoperative imaging technology in head and neck cancer surgery

Article Title: Breakthrough Use of Intraoperative PET-CT in Head and Neck Cancer Surgery at Vanderbilt University

News Publication Date: (Information not provided)

Web References: (Information not provided)

References: (Information not provided)

Image Credits: Photo by Erin O. Smith, Vanderbilt University Medical Center

Keywords: Head and neck cancer, Otolaryngology, Intraoperative PET-CT, Surgical oncology, Cancer margin assessment, Real-time molecular imaging

Access to potentially life-saving neurosurgical care remains very uneven worldwide, with potentially life-threatening consequences. This is especially true for a process called ventriculostomy, the most common neurosurgical procedure. Ventriculostomy involves the insertion of a catheter into the brain cavities called ventricles to drain cerebrospinal fluid and relieve intracranial pressure.

It’s a delicate, difficult process that requires extreme precision: misplacing the catheter, which happens in up to 30 per cent of freehand procedures, can result in hemorrhage, infection, prolonged hospital stays, morbidity and even death.

That’s why a group of Gina Cody School of Engineering and Computer Science researchers sought to improve access to low-cost technologies that can aid in improving ventriculostomy accuracy. Marta Kersten-Oertel, an associate professor in the Department of Computer Science and Software Engineering, and her team have developed an augmented-reality (AR)-based platform. They say it may make the procedure far safer and more accurate, especially in low- and middle-income countries and resource-limited settings.

The iSurgARy system uses LIDAR, a light detection and ranging technology, to help surgeons identify specific landmarks on the skull and accurately map them to the patient’s preoperative images (CT/MRI). Augmented reality is then used to project the ventricles onto the patient. The creators describe the technology in the Healthcare Technology Letters journal.

“The technology offers better spatial awareness of patient anatomy, which provides surgeons better aim at their target points,” says co-author Joshua Pardillo Castillo, MSc 24. “The augmented reality overlays the patient’s medical images to better see how they can best position the catheter.”

Precision brain mapping

LIDAR, available on Apple’s iOS devices, helps determine distances from the sensor to seven anatomical landmarks on the patient’s head: the tragus (the pointed eminence jutting out from the scalp at the front of the ear) on both sides of the head, the outer eyes, the inner eyes and the bridge of the nose. These landmarks are used to align the virtual models of the patient’s anatomy to the actual patient, providing the medical personnel with an augmented reality view that shows them where the ventricles are.

This visualization guides the clinician to the optimal location for catheter placement, while the catheter’s tracking tool can provide spatial understanding of the distance between the tip of the catheter and the ventricles.

“The AR view shows where the ventricles are so clinicians can decide on the best approach,” Kersten-Oertel explains. “The freehand technique relies on bony landmarks of the skull, and clinicians make their decision based on them. But if there is a brain tumour that is causing pressure or a traumatic brain injury, the brain may have shifted so the ventricles are not where they are expected to be. This system allows users to see the ventricles projected on the patient and accurately target them.”

The researchers point out that the platform emerged out of a practical need identified by an experienced clinician — David Sinclair, a clinical professor in cerebrovascular and skull base neurosurgery in the Division of Neurosurgery of McGill University’s Department of Neurology and Neurosurgery and a co-author on the paper. Sinclair asked Kersten-Oertel if it was possible to develop a tool that improves visualization to target ventricles in emergent scenarios where time, cost and accuracy are of utmost importance.

“This kind of collaboration with a neurosurgeon in the design and discovery phase makes this whole project unique,” says Zahra Asadi, a PhD student and co-first author on the paper.

“Working with him and getting to know the needs of the people who will be using this application is critical.”

Read the cited paper: “iSurgARy: A mobile augmented reality solution for ventriculostomy in resource-limited settings.”

Journal

Healthcare Technology Letters

DOI

10.1049/htl2.12118

The retina operates as the body’s visual processor, converting light into neural signals relayed to the brain. Surgeons routinely undertake intricate tasks when addressing retinal issues, including repairing retinal detachment or delivering therapeutic agents for inherited retinal diseases. However, the delicacy of these procedures demands unparalleled precision, as surgeons face the daunting task of navigating an environment rife with potential disturbances, including involuntary hand movements and the inevitable motion caused by the patient’s breathing and blinking.

Recognizing the complexity of such surgical endeavors, the collaborative research team at the University of Utah has devised a robust solution: a head-mounted robotic system that markedly enhances surgical precision. By anchoring the robotic device to the patient’s head, the researchers ensure that any natural head movements are neutralized, thereby stabilizing the surgical field. This innovative approach allows the robot to maintain a consistent and reliable positional reference, significantly mitigating the risks associated with manual surgical operations.

One of the standout features of this robotic surgery device is its extraordinary capability to execute movements with unparalleled precision—down to a mere one micrometer. For comparison, this measurement is smaller than the width of a human hair and equivalent to the size of individual cells within the retina. Such remarkable accuracy is achieved by employing a sophisticated haptic interface that enables surgeons to manipulate the robot with natural hand movements while simultaneously scaling down these motions to match the minuscule scale of the surgery.

The research conducted by the team extends beyond theoretical modeling; they have put their innovation to the test using enucleated pig eyes. Publishing their findings in the prestigious journal Science Robotics, the researchers reported successful outcomes when utilizing the robotic system for subretinal injections. This critical step paves the way for refining treatment techniques meant for patients suffering from inherited retinal diseases—a condition which, if left untreated, can lead to severe vision impairments.

Gene therapy represents a promising frontier in treating retinal disorders, allowing researchers to potentially reverse the effects of inherited conditions such as retinitis pigmentosa. However, the delivery of such therapies remains a complex challenge, especially when targeting subretinal spaces that are both minuscule and precariously positioned between delicate layers of retinal cells. Hence, the introduction of the robotic device may represent an essential advancement in delivering these sophisticated treatments effectively and safely.

Another ground-breaking aspect of this invention lies in its potential to transform the patient experience during procedures. Traditionally, eye surgeries involving retinal injections often necessitate the use of general anesthesia due to the complexity and sensitivity of the involved processes. However, the head-mounted design of this robotic system opens the door for administering intravenous (IV) sedation as a viable alternative. This paradigm shift not only enhances patient comfort but also allows for a much quicker recovery time, ultimately leading to safer and more efficient surgeries.

As the research team prepares to transition their device from laboratory settings to clinical applications, they remain laser-focused on the interdisciplinary approach that has characterized their work. The collaboration between the mechanical engineers and ophthalmic specialists has proven essential in realizing this project’s goals. Each contribution, whether from engineers, chemists, or physicists, has shaped the robotic device into a formidable tool that promises to elevate the standards of care in retinal surgery.

While currently in the experimental phase, the potential implications of this robotic device extend far beyond the lab. Its successful integration into surgical practice could revolutionize ophthalmic interventions, ensuring that surgeons are equipped with the means to address increasingly complex treatment paradigms as they arise. The vision for the future of eye surgery appears bright and promising as innovations like this robotic device redefine what’s possible in the realm of retinal healthcare.

In the advent of promising technologies, what lies ahead for patients facing the harsh reality of vision loss presents a new ray of hope. This journey through experimental research underscores the significance of innovation in medicine as it stands on the brink of substantial breakthroughs that will ultimately enhance patient outcomes and advance the field of ophthalmic surgery as a whole.

The ongoing commitment toward refining and optimizing this robotic device continues to be guided by a shared mission: to improve the efficacy of retinal treatments and facilitate better surgical outcomes. As the team looks to the future, the routine promise of robotics within healthcare not only beckons for ongoing exploration but embodies the aspirations of countless patients yearning for effective therapies that restore vision and curb the progression of hereditary retinal ailments.

Undoubtedly, this venture encapsulates a successful story of collaboration, innovation, and the relentless pursuit of excellence—a narrative that will shape the future of eye surgery. As the surgical robot takes its steps closer to reality in operating rooms, the vision becomes clearer: to offer patients the best possible care through the seamless integration of cutting-edge technology and world-class expertise.

### Subject of Research:
Robotic assistance in eye surgery.

### Article Title:
Head-mounted surgical robots are an enabling technology for subretinal injections.

### News Publication Date:
19-Feb-2025.

### Web References:
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### References:
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### Image Credits:
Moran Eye Center, University of Utah.