ICHNO-ECHNO 2022 - Abstract Book

S55

ICHNO-ECHNO 2022

PO-0093 Expanding robotic applications in the head and neck

J. Faulkner 1 , P. Surda 2 , A. Arora 3 , C. Daniel 4 , J. Uddin 4 , J. Jeannon 3

1 Kings College London, School of Biomedical Engineering and Image Sciences, London, United Kingdom; 2 Guys' and St Thomas' NHS Foundation Trust, ENT Surgery, London, United Kingdom; 3 Guys' and St Thomas' NHS Foundation Trust, Head and Neck Surgery, London, United Kingdom; 4 Moorfields Eye Hospital, Moorfields Eye Hospital, London, United Kingdom Purpose or Objective Robotic assisted surgery within the head and neck is most commonly utilised for the treatment of early oropharyngeal squamous cell carcinoma. Robotic applications beyond this anatomical sub-site are more limited. Robotic surgical platforms offer three dimensional vision, motion scaling and tremor filtration. These advantageous traits are widely applicable in several head and neck applications. This study explores the role for robotic assisted surgery in the orbit, skull base and nasopharynx. Materials and Methods Principles of the IDEAL framework were adhered to through out this study. IDEAL phase 0 preclinical evaluations in dry lab and cadaveric settings were undertaken before moving to Phase 1 clinical evaluations. The Versius robotic system (CMR Surgical) was utilised for all preclinical cadaveric assessments and the Da Vinci Xi (Intuitive Inc.) was used for clinical evaluations. Orbital, skull base and nasopharyngeal access were assessed independently by expert surgeons in each field respectively. Robotic Assisted Orbital Surgery (RAOS) was evaluated pre-clinically through 3 index procedures. Medial orbital exploration, lacrimal gland excision and orbital exenteration. Access to the skull base and nasopharynx both utilised a novel combined transorbital and transnasal approach. Skull base access was performed with bilateral transorbital ports for the instruments and a unilateral transnasal port for the endoscope. Access to the nasopharynx was via bilateral nasal ports for the instruments and a unilateral transorbital port for the endoscope. Following successful preclinical evaluation and local ethics approval a phase 1 clinical evaluation of robotic assisted orbital surgery was undertaken. A patient with a recurrent medial canthus basal cell carcinoma (BCC) originally recommended for orbital exenteration by the multidisciplinary team underwent robotic assisted excision in an effort to save the globe. Results All pre-clinical evaluations were successful. Robotic access to the skull base and nasopharynx were feasible through a combined approach. Lack of bone cutting instrumentation was found to be a limitation in anterior skull base robotic surgery. The first in man robotic assisted orbital surgery (RAOS) procedure was successfully performed. The lesion was successfully excised and the patients globe and sight preserved. Conclusion Robotic assisted surgery in the skull base, nasopharynx and orbit are feasible and valuable applications of robotic surgery. We have demonstrated the first in man robotic assisted orbital procedure and are undertaking further work to expand this application. Current system instrument limitations limit the applications within the skull base and further exploratory work in this area is required. Robotic surgery within the head and neck has a much larger potential than currently being utilised. Inherent features of robotic systems offer advantages over conventional surgical techniques and should be embraced to enhance surgical outcomes.

PO-0094 Developing a Patient Specific Quality Assurance program for tongue cancers treated through a Co-60

M.H. Gholami 1

1 Mahdieh Radiotherapy and Brachytherapy Charity Centre, Radiotherapy, Hamedan, Iran Islamic Republic of

Purpose or Objective Brachytherapy (BT) is a useful modality in both the definitive and adjuvant setting of oral tongue cancer. In our project, we presented a PSQA procedure, for tongue cancer brachytherapy. Materials and Methods Five patient with stage 2A oral tongue cancer were treated with HDR BT as a sole treatment. Two homemade Head and Neck phantoms were designed for PSQA tasks in brachytherapy. Radiation dose distribution was originally measured at several positions using EBT3 Gafchromic films. Using a three-dimensional (3D) radiation dose distribution data for several regions including Clinical Target Volumes (CTVs) and Organ at Risks (OARs). The results compared with those computed using a Treatment Planning System (TPS) at the corresponding conditions. Both datasets ultimately compared with those calculated correspondingly through a Monte Carlo-based simulation known as the gold standard for dose verification. The results were then assessed using a gamma function algorithm with routine pass criteria (3%/3mm) applied for External Beam Radiotherapy.

Results