IN VIVO EVALUATION OF A CT-COMPATIBLE RETRACTOR FOR IMAGE GUIDED TRANS-ORAL SURGERY - PROJECT SUMMARY CANCE…

Assistance award details

Assistance award identifier

ASST_NON_R03EB034053_075

FAIN

R03EB034053

Recipient

TRUSTEES OF DARTMOUTH COLLEGE

Awarding agency

Department of Health and Human Services

Funding agency

Department of Health and Human Services

Assistance listing (CFDA)

93.286

Total obligated

$174,022

Period

Sep 15, 2022 – Jun 30, 2024

Fiscal year

2022

Place of performance state

NH

Source file

FY2022_All_Assistance_Full_20261006.zip

Description

IN VIVO EVALUATION OF A CT-COMPATIBLE RETRACTOR FOR IMAGE GUIDED TRANS-ORAL SURGERY - 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 (TOS) FOR IMPROVED ASSESSMENT OF TUMOR DEPTH AND AVOIDANCE OF VASCULAR STRUCTURES. IMAGE GUIDANCE IS CURRENTLY NOT FEASIBLE FOR TRANS-ORAL 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 METALLIC INSTRUMENTATION REQUIRED FOR EXPOSURE AND AIRWAY MANAGEMENT DURING TRANS-ORAL SURGERY CREATES SIGNIFICANT ARTIFACT ON CT IMAGING. AS PART OF AN ON-GOING NIH-FUNDED R21 PROGRAM (1R21CA246158-01A1), WE HAVE DEVELOPED A NOVEL 3D PRINTED POLYMER RETRACTOR THAT ENABLES US TO ACQUIRE ARTIFACT FREE IMAGES OF CADAVER HEAD DURING TRANS-ORAL SURGERY PROCEDURES AND A SURGICAL NAVIGATION FRAMEWORK TO ENABLE IMAGE-GUIDED TRANS-ORAL ROBOTIC SURGERY. THE WORK IN THIS R21 IS BEING PERFORMED ON BENCHTOP MODELS AND CADAVER HEADS. HERE IN THIS