# Image guidance for trans-oral robotic surgery

> **NIH NIH R21** · DARTMOUTH COLLEGE · 2020 · $407,096

## Abstract

PROJECT SUMMARY
Cancers of the head and neck (oral cavity, pharynx, and larynx) are the 5th most common cancers worldwide.
Trans-oral surgical approaches such as trans-oral robotic surgery (TORS) and trans-oral laser microsurgery
(TLM) are effective, reducing complications and long-term treatment morbidity. One of the drawbacks of the
trans-oral approach is the difficulty in intraoperatively assessing tumor extent and locating critical vascular
structures, resulting in positive margins and risks of vascular complications. Image guidance and surgical
navigation play a significant role in sinus, skull base, and neurosurgery, demonstrating improvement in the
safety and efficacy of these procedures. There may be advantages to applying this technology to trans-oral
surgery for improved assessment of tumor depth and avoidance of vascular structures. Image guidance is
currently not feasible for trans-oral robotic surgery. The main reason is the significant intraoperative tissue
deformation that occurs with the introduction of retractors needed to provide surgical access. This
intraoperative deformation limits the ability to accurately register preoperative imaging to the intra-operative
state. With the availability of intra-operative CT and MRI imaging at Dartmouth’s unique Center for Surgical
Innovation, intra-operative imaging is feasible. However, current instrumentation required for exposure and
airway management during trans-oral robotic surgery creates significant artifact on CT imaging. We have
developed a novel 3D printed polymer laryngoscope that enables us to safely acquire artifact free images of
patients during laryngoscopy-based trans-oral surgery procedures and are now proposing to develop a similar
CT-compatible retractor system for use in robotic procedures and to explore the development of a surgical
navigation framework for TORS. The overarching goal of our efforts is to improve the safety and efficacy of
trans-oral robotic surgery and enable surgeons to perform surgery on more complex cases through the use of
surgical navigation. To achieve this goal, we propose to explore image guidance for trans-oral robotic surgery
in two distinct phases: 1) development and validation of a CT-compatible retractor and instrument tracking to
facilitate intraoperative imaging and surgical navigation and 2) comparison of conventional TORS and image-
guided TORS (igTORS) in the resection of faux tumor models embedded in the base of tongue, larynx, and
tonsils of cadaver heads. Importantly, this igTORS framework will be implemented through use of clinically
standard navigation systems typically used for neurosurgical navigation (i.e. Medtronic’s StealthStation); this
will help us to translate this framework more quickly to the bedside than had we developed a custom
navigation system. By the end of this program we expect to have developed the framework for a fully
integrated surgical guidance system for use in trans-oral robotic surgery. Follow on studies...

## Key facts

- **NIH application ID:** 10057445
- **Project number:** 1R21CA246158-01A1
- **Recipient organization:** DARTMOUTH COLLEGE
- **Principal Investigator:** Ryan Joseph Halter
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $407,096
- **Award type:** 1
- **Project period:** 2020-08-01 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10057445

## Citation

> US National Institutes of Health, RePORTER application 10057445, Image guidance for trans-oral robotic surgery (1R21CA246158-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10057445. Licensed CC0.

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