Augmented reality for image guidance in transoral robotic surgery

  • Jason Y. K. ChanEmail author
  • F. Christopher Holsinger
  • Stanley Liu
  • Jonathan M. Sorger
  • Mahdi Azizian
  • Raymond K. Y. TsangEmail author
Original Article


With the advent of precision surgery, there have been attempts to integrate imaging with robotic systems to guide sound oncologic surgical resections while preserving critical structures. In the confined space of transoral robotic surgery (TORS), this offers great potential given the proximity of structures. In this cadaveric experiment, we describe the use of a 3D virtual model displayed in the surgeon’s console with the surgical field in view, to facilitate image-guided surgery at the oropharynx where there is significant soft tissue deformation. We also utilized the 3D model that was registered to the maxillary dentition, allowing for real-time image overlay of the internal carotid artery system. This allowed for real-time visualization of the internal carotid artery system that was qualitatively accurate on cadaveric dissection. Overall, this shows that virtual models and image overlays can be useful in image-guided surgery while approaching different sites in head and neck surgery with TORS.


Augmented reality Transoral robotic surgery Oropharynx HPV Image guidance 



JYKC received funding support by the Dr. Stanley Ho Medical Foundation and the General Research Fund (#14109716; #14108818 General Research Fund, Research Grant Council, Hong Kong government, Hong Kong SAR).

Compliance with ethical standards

Conflict of interest

Jason Y. K. Chan received travel support from Intuitive Surgical Inc. Raymond K. Y. Tsang received travel support from Intuitive Surgical Inc. Jonathan M. Sorger is an employee of Intuitive Surgical Inc. Mahdi Azizian is an employee of Intuitive Surgical Inc. F. Christopher Holsinger and Stanley Liu have no conflict of interest.

Supplementary material

Supplementary material 1 (MP4 54084 kb)


  1. 1.
    Chauvet D, Missistrano A, Hivelin M, Carpentier A, Cornu P, Hans S (2014) Transoral robotic-assisted skull base surgery to approach the sella turcica: cadaveric study. Neurosurg Rev 37(4):609–617. PubMedCrossRefGoogle Scholar
  2. 2.
    Tsang RK, Holsinger FC (2016) Transoral endoscopic nasopharyngectomy with a flexible next-generation robotic surgical system. Laryngoscope 126(10):2257–2262PubMedCrossRefGoogle Scholar
  3. 3.
    Park YM, Kim WS, De Virgilio A, Lee SY, Seol JH, Kim SH (2012) Transoral robotic surgery for hypopharyngeal squamous cell carcinoma: 3-year oncologic and functional analysis. Oral Oncol 48(6):560–566PubMedCrossRefGoogle Scholar
  4. 4.
    Tateya I, Koh YW, Tsang RK et al (2018) Flexible next-generation robotic surgical system for transoral endoscopic hypopharyngectomy: a comparative preclinical study. Head Neck 40(1):16–23. PubMedCrossRefGoogle Scholar
  5. 5.
    Eguchi K, Chan JYK, Tateya I, Shimizu A, Holsinger FC, Sugimoto T (2019) Curved laryngopharyngoscope with flexible next-generation robotic surgical system for transoral hypopharyngeal surgery: a preclinical evaluation. Ann Otol Rhinol Laryngol. PubMedCrossRefGoogle Scholar
  6. 6.
    Weinstein GS, O’Malley BW Jr, Magnuson JS et al (2012) Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins. Laryngoscope 122(8):1701–1707PubMedCrossRefGoogle Scholar
  7. 7.
    Liu WP, Richmon JD, Sorger JM, Azizian M, Taylor RH (2015) Augmented reality and cone beam CT guidance for transoral robotic surgery. J Robot Surg 9(3):223–233. PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Tsang RK, Sorger JM, Azizian M, Holsinger CF (2015) Real-time navigation in transoral robotic nasopharyngectomy utilizing on table fluoroscopy and image overlay software: a cadaveric feasibility study. J Robot Surg 9(4):311–314. PubMedCrossRefGoogle Scholar
  9. 9.
    Holsinger FC (2016) A flexible, single-arm robotic surgical system for transoral resection of the tonsil and lateral pharyngeal wall: next-generation robotic head and neck surgery. Laryngoscope 126(4):864–869PubMedCrossRefGoogle Scholar
  10. 10.
    Hong J, Matsumoto N, Ouchida R, Komune S, Hashizume M (2009) Medical navigation system for otologic surgery based on hybrid registration and virtual intraoperative computed tomography. IEEE Trans Biomed Eng 56(2):426–432. PubMedCrossRefGoogle Scholar
  11. 11.
    Lee CY, Chan H, Ujiie H et al (2018) Novel thoracoscopic navigation system with augmented real-time image guidance for chest wall tumors. Ann Thorac Surg 106(5):1468–1475PubMedCrossRefGoogle Scholar
  12. 12.
    Davis KS, Vosler PS, Yu J, Wang EW (2016) Intraoperative image guidance improves outcomes in complex orbital reconstruction by novice surgeons. J Oral Maxillofac Surg 74(7):1410–1415. PubMedCrossRefGoogle Scholar
  13. 13.
    Huber T, Hadzijusufovic E, Hansen C, Paschold M, Lang H, Kneist W (2019) Head-mounted mixed-reality technology during robotic-assisted transanal total mesorectal excision. Dis Colon Rectum 62(2):258–261. PubMedCrossRefGoogle Scholar
  14. 14.
    Hughes-Hallett A, Mayer EK, Marcus HJ et al (2015) Inattention blindness in surgery. Surg Endosc 29(11):3184–3189. PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryThe Chinese University of Hong KongShatin, N.T.Hong Kong SAR
  2. 2.Department of Otolaryngology, Head and Neck SurgeryStanford UniversityPalo AltoUSA
  3. 3.Intuitive Surgical Inc.SunnyvaleUSA
  4. 4.Division of Otorhinolaryngology-Head and Neck Surgery, Department of SurgeryThe University of Hong KongPok Fu LamHong Kong SAR

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