Transoral Robotic Surgery: Image Guidance and Augmented Reality

Transoral robotic surgery (TORS) is being used increasingly as an alternative to conventional open procedures, as its minimally invasive approach results in significant benefits for the patient. This includes faster recovery times and better functional outcomes, less postoperative pain and morbidity associated with open access, shorter operative times, and a reduction in the risk of infection. However, the confined working spaces and sensory deficit, due to a lack of haptic sensation, and proximity to critical vasculature and other vitally important anatomical structures bestow significant challenges on the surgeon. Recent advances in the field of surgical image guidance show promise in helping address these issues. This overview considers a number of important recent developments, all of which exploit imaging technologies that, to a lesser or greater extent, are integrated with the surgical robot platform. In its most advanced form, this combination of technologies results in a fusion of visual information such that the operative field is combined with navigational cues and representations of key anatomical structures through augmented reality registration and overlay. In terms of registration accuracy, image guidance as applied to TORS procedures is an exciting proposition, since the regions of interest (e.g., the tongue base, oropharynx) are typically adjacent to and enclosed by rigid anatomy. Clinical indications and overall effectiveness are discussed together with the limitations of the current technologies. Where appropriate, directions for future work are identified.