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Integrated surgery and radiology: trans-oral robotic surgery guided by real-time radiologist-operated intraoral ultrasound

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Abstract

Purpose

We aimed to evaluate the feasibility and utility of intraoral ultrasound as a real-time guidance technique in trans-oral robotic surgery (TORS).

Methods

We report our early experiences of radiologist-operated intraoral ultrasound during TORS, providing information on tumour margin and important adjacent structures. Resection specimens were sonographically imaged for margin assessment.

Results

Four patients underwent ultrasound-guided TORS, with a close correlation between intraoperative and preoperative imaging in each case. The tumour was fully excised in three cases (one did not proceed due to difficult access). No ultrasound-related adverse events occurred, surgical margins were negative, and the treated patients are currently in a state of remission, with functional swallows.

Conclusion

Intraoperative ultrasound can allow previously inaccessible disease to be robotically resected with confidence. Sonographic interrogation of the resected specimen correlated closely with histological margin analysis, and a novel technique of using saline to improve ultrasound conductance and therefore image quality is described.

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Authors and Affiliations

  1. Department of Radiology, Royal Free London NHS Foundation Trust, London, UK

    Edward D. Green

  2. Head and Neck Unit, The Royal Marsden Hospitals NHS Foundation Trust, London, UK

    Vinidh Paleri, John C. Hardman, Cyrus Kerawala & Francesco M. G. Riva

  3. Department of Radiology, North Middlesex University Hospital, London, UK

    Alaa A. Jaly

  4. Department of Radiology, The Royal Marsden Hospitals NHS Foundation Trust, London, UK

    Derfel ap Dafydd

Authors
  1. Edward D. Green
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  2. Vinidh Paleri
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  3. John C. Hardman
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  4. Cyrus Kerawala
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  5. Francesco M. G. Riva
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  6. Alaa A. Jaly
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  7. Derfel ap Dafydd
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Correspondence to Edward D. Green.

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Institutional ethical approval was obtained from the Royal Marsden Hospital Institutional Review Board.

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The authors declare that they have no conflict of interest.

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Green, E.D., Paleri, V., Hardman, J.C. et al. Integrated surgery and radiology: trans-oral robotic surgery guided by real-time radiologist-operated intraoral ultrasound. Oral Maxillofac Surg 24, 477–483 (2020). https://doi.org/10.1007/s10006-020-00880-5

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  • DOI: https://doi.org/10.1007/s10006-020-00880-5

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