Author(s)
Richard Wu, MPH
Kayvon Sharif, BA
Victor Jegede, BS
Derek Mann, BS
Joseph Curry, MD
Michael Topf, MD
Affiliation(s)
Thomas Jefferson University; Vanderbilt University Medical Center;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to understand the potential impact of emerging 3D computer aided design (CAD) technologies for head and neck cancer surgery.
Objectives: Demonstrate the elements of the novel CAD margin protocol and its utility in head and neck cancer surgery and determine the feasibility of implementing into a preexisting virtual reality (VR) surgical planning workflow.
Study Design: Case report.
Methods: A 70 year old male with a cT2N2b squamous cell carcinoma (SCC) of the oral tongue was scheduled for right hemiglossectomy. Preoperatively, CT DICOM files were uploaded to the Medical Holodeck software to generate an autosegmented 3D anatomic model which could then be viewed and manipulated in VR. Intraoperatively, a structured light 3D scanner (Einscan SP, Shining 3D) was used to capture the 3D surface topography of the fresh surgical specimen. CAD software (Autodesk Meshmixer) was used to annotate the sites of frozen sections onto the 3D model. Videoconferencing displayed the 3D model from the laboratory to the operating room (OR) in real time.
Results: The 3D anatomic model in VR allowed for the surgeon to plan the case preoperatively. Intraoperative, image acquisition time for the 3D scan data was 7 minutes and 35 seconds. Frozen section diagnosis was delivered to the OR via videoconference providing visual anatomic cues of the site of margin sampling and live updates on margin status. Final pathology showed a 3.5cm SCC with 6mm depth of invasion. All resection margins were negative.
Conclusions: Surgical planning in virtual reality may enhance surgeon understanding of patient anatomy and tumor morphology. Intraoperative 3D scanning of the surgical specimen may allow for visual guidance and improved communication of frozen section analysis results.