An experimental image guided surgery simulator for hemicricolaryngectomy and reconstruction by tracheal autotransplantation

Abstract

In this paper we describe the current state of our surgical planning environment for a conservation method for unilateral glottic cancer with significant subglottic extension. The latter consists of a hemicricolaryngectomy and subsequent reconstruction of the laryngeal defect with a transferable patch of revascularized cervical trachea. In order to restore the three crucial functions of the larynx: airway patency, speech and swallowing, such a tracheal patch has to meet a typical surgical constraint (so-called paramedian position at glottic level). As such constraints are difficult to realise intraoperatively, we designed an image-based surgery simulator for the application. The planning environment visualizes medical image volumes (3D surfaces of the anatomy of interest together with multiplanar reslices) and takes specific surgical constraints into account. The guidance of the surgeon through the planning is menu-driven. To partly test our hypothesis that postoperative morphological results can be optimized by 3D planning, a cadaver study was set up. We report on both the planning environment and on the results of this study.