Paper Submission & Registration
8th Dutch Bio-Medical Engineering Conference
15:20   Oncology - II
Chair: Theo van Walsum
15 mins
Added value of surgical navigation for challenging intra-abdominal or pelvic soft tissue sarcomas
Harald Groen, Sophie Reijers, Wouter Heerink, Ruben van Veen, Jasper Nijkamp, Nikie Hoetjes, Yvonne Schrage, Alexander van Akkooi, Geerard Beets, Frits van Coevorden, Theo Ruers, Winan van Houdt
Abstract: Objective: Resection of (recurrent) intra-abdominal or pelvic soft tissue sarcomas can be challenging due to difficult locations, various critical anatomical structures, a narrow pelvic space and/or fibrotic tissue after pretreatment. The aim of this study was to assess whether electromagnetic surgical navigation can be of added value during these resections. Methods: Soft tissue sarcoma patients who were included in a prospective surgical navigation study with lower intra-abdominal or pelvic tumor locations scheduled for laparotomy were selected. A pre-operatively patient specific 3D roadmap was made, which was registered to the patient in the OR using an intraoperative CBCT scan and tracked using electromagnetic reference-markers. During the operation, an electromagnetic pointer was used for localization of the tumor and critical structures. Our primary endpoint was feasibility of the system, secondary outcomes were safety and usability. Usability of the navigation system was evaluated based on a survey including the System Usability Scale (SUS), filled out by the surgeons after the operations. Results: Nine sarcoma patients with a total of 12 tumors were included. Median age at surgery was 63 years (56-72), median tumor size was 5.2 cm (2.4-10.4). In 7 out of 9 patients the surgical indication was locally recurrent sarcoma. Median shortest distance of the tumor(s) to arteries was 0.02 cm (0.00-1.86), to veins 0.23 cm (0.00-5.97), bone 0.88 cm (0.00-2.32) and ureters 0.71 cm (0.00-6.60). Despite these short distances, 89% of the resections resulted in complete (R0) resections. Application of the navigation was successful in all the operations without technical or safety issues. Based on the survey, surgeons stated that navigation resulted in shorter surgery time and made the resections easier and potentially safer. SUS scores showed a high user-friendliness of the navigation system. Conclusion: Electromagnetic navigation facilitates resections of challenging lower intra-abdominal or pelvic soft tissue sarcomas, and might be of added value.
15 mins
Design of 3D printed needle insertion device and control using mobile phone application
Mart Bluiminck, Vincent Groenhuis, Françoise Siepel, Stefano Stramigioli
Abstract: Breast cancer is a disease with significant worldwide impact. Many hand-operated biopsies have been performed by radiologists to diagnose patients with a cancerous lesion. Robotic systems have been developed and demonstrated an increased accuracy of biopsies. However, with the introduction of robotics, the radiologist's biopsy device is often replaced by a lessintuitive interface like a joystick. Furthermore, robotic biopsy systems are costly. This research proposes a design of a needle insertion device, which combines a rapid prototypeable endeffector with control using a hand-held smartphone. Low-cost servo motors are used to generate rotational motions in two dimensions of freedom, plus a stepper motor used in a screw-thread mechanism for a translational injection of the needle. All components are assembled in a 3D printed enclosure. The system uses the built-in accelerometer and gyroscope sensor of the mobile phone to retrieve the phone's orientation, which is reproduced by the end-effector. A mobile application is designed to retrieve the phone's sensor data and communicate wireless to a microcontroller. In the system modes are implemented to increase the workability: in biopsy mode, the angular movements are attenuated to enhance precision. Results show that the designed robot had an angular accuracy of 1.03 degrees based on targeting predefined points in space using an automated program. The phone's orientation was captured with less than 0.30 degrees deviation from the real orientation in all directions. The full system was tested by targeting lesions inside a transparent phantom with 85% success rate (17 hits out of 20 attempts). Using the robotic system developed in this research, it is possible to control an injection needle using a handheld mobile phone, and target lesions sized 1 cm and up to 9 cm deep with 85% success rate under visual guidance.
15 mins
Smart electrosurgical knife for real-time tumor border detection during breast conserving surgery
Sara Azizian Amiri, Jenny Dankelman, Benno H. W. Hendriks
Abstract: The number of women diagnosed with early-stage breast cancer increases every year. Therefore, the challenge of complete tumor resection and avoiding positive margin during breast-conserving surgery (BCS) becomes more and more attentive. If some parts of the tumor tissue remain in the breast of the patient after BCS surgery, her treatment may have to be followed by a re-excision surgery or boost radiation therapy, which would result in negative cosmetic outcomes associated with less patient satisfaction or additional morbidity. Considering the high occurrence rate of positive margin, using a margin assessment technique appears to be quite effective in detecting the border of the tumor during BCS. Diffuse reflectance spectroscopy (DRS) is an optical approach to measure the concentration of the constituents of the tissue. It has been shown that using DRS, it’s possible to distinguish diseased tissue from healthy tissue in the breast [1]. In this research, a Smart electrosurgical knife is developed by integrating a normal electrosurgical knife with a DRS system with intention of providing the surgeon with real-time oncological guidance during BCS. Using the Smart electrosurgical knife, the surgeon would be able to recognize the type of the tissue and find the edge of the tumor while cutting the tissue with the knife during BCS. To investigate the effectiveness of the Smart electrosurgical knife, we studied the effect of tissue alteration and debris formation during electrosurgery on the tissue detection power of the DRS in animal tissue. The performance of the device was also assessed in a phantom study. We showed that neither tissue alteration nor debris formation during electrosurgery had a significant effect on tissue read-out [2]. Moreover, the results of the phantom study showed that the new design can discriminate the different layers of the breast phantom during electrosurgery. In conclusion, we showed that the Smart electrosurgical knife was useful for complete tumor resection in the phantom. Hence, using of the Smart knife can become a promising approach in detecting the borders of the tumor, and facilitates the complete resection, during breast conserving surgery, which may reduce the occurrence rate of positive margins as well as re-excision surgeries. References [1] L. De Boer, B. Molenkamp, T. Bydlon, B.H.W. Hendriks, J. Wesseling, H. Sterenborg, T.J.J.B.c.r. Ruers, treatment, Fat/water ratios measured with diffuse reflectance spectroscopy to detect breast tumor boundaries, 152(3) (2015) 509-518. [2] S.A. Amiri, C.M. Van Gent, J. Dankelman, B.H.W. Hendriks, Intraoperative tumor margin assessment using diffuse reflectance spectroscopy: the effect of electrosurgery on tissue discrimination using ex vivo animal tissue models, Biomed. Opt. Express 11(5) (2020) 2402-2415.

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