HOLSINGER RESEARCH GROUP

OBJECTIVE

Improve and refine outcomes of cancer patients undergoing surgery by utilizing new approaches to surgical vision using:

Innovative robotic telesurgical systems

Multi- and hyper spectral scanning

Computer-assisted image analysis and augmented reality

Next-generation robotic surgery

Transoral endoscopic head and neck surgery has become an essential part of the paradigm for multidisciplinary treatment for head and neck cancers.  Transoral robotic surgery (TORS) blossomed from seminal work in cadavers and canine models first published in 2005. However, at present, this system designed for cardiac and abdomino-pelvic surgery, is the only commercially available robotic surgical system. 

The dimensions of this first-generation robotic surgical system are larger than what would be ideal for head and neck surgery (HNS), and it utilizes three rigid instruments arms that must approach transoral anatomy from a feasible, but sometime troublesome, trajectory outside of the surgical field. Apart from challenges with docking the multi-arm robotic systems in the head and neck, it can be difficult to maneuver three separate robotic arms within the confined spaces of the pharynx and larynx.

Recently, a next-generation robotic surgical system was approved for use in genitourinary surgery. This system provides three fully articulating instruments, as opposed to two rigid instrument arms available with current multi-arm robotic systems.  The three-instruments, along with an articulating three-dimensional high-definition camera are delivered through a single 25 mm cannula entry-port. The three working instruments allow traction and counter-traction that may lead to more precise surgical dissection of head and neck anatomy in ways that have not been possible up to this point. Another advantage of the single-port design may come from its smaller spatial presence which allows greater access and maneuverability for the bedside surgical assistant. 

Multispectral and Hyperspectral Imaging in Endoscopy and Surgery

In 2014, a prospective study began to evaluate the advantage of multispectral vision (using filtered light at 415 ± 30 nm, 445 ±30 nm, 500± 30 nm ).  Preliminary data suggests that simple filters enhance the contrast of the vasculature surrounding and within tumors of the oropharynx.  Using machine-learning and a Gaussian mixture model, it may be possible to better identify occult tumors of the head and neck, as well as to better appreciate the safety margin around these tumors during surgery.

This simple approach shows the value both of multispectral imaging, but also the potential utilizing live, computer-assisted surgical vision.

A successful cancer operation depends the surgeon’s ability to discern the complexity of human anatomy and its alterations, dramatic or subtle: for instance, blood vessel from nerve;  tumor from surrounding normal, and so one.  While human vision is a critical aspect of performing successful surgery, it is limited by how visual processing through the cortex and retina interprets the complex interactions between light and the diverse tissues of the human body.  The molecular composition of surgical anatomy is more complex that can be rendered by human visual processing, which is hampered from the retina to occipital cortex – and how this system transforms this complex reality into three dominant colors of red, green, and blue.

The use of hyper spectral imaging may now be feasible, including wavelengths from 400-1100nm, and using computer-assisted image analysis.

(Above) A left oropharyngeal tumor seen using multispectral scanning (Olympus NBI Rhinolaryngoscope)

(Below) The same left oropharyngeal tumor seen with white light.

Computer-assisted image surgical vision and augmented, mixed and virtual reality

Chris Holsinger, MD, FACS, has ten years of experience both in the clinical application of computer-aided vision and in robotic surgery.  

However, recently, innovation and progress in augmented and/or mixed reality technology has increased the feasibility of incorporating these into surgery.   

Recent Publications

  • Surgical trials in head and neck oncology: Renaissance and revolution? Head & neckShaw, R. J., Holsinger, F. C., Paleri, V., Evans, M., Tudur-Smith, C., Ferris, R. L.2015; 37 (7): 927-930
  • Robotic Total Thyroidectomy with Modified Radical Neck Dissection via Unilateral Retroauricular Approach ANNALS OF SURGICAL ONCOLOGYByeon, H. K., Holsinger, F. C., Tufano, R. P., Chung, H. J., Kim, W. S., Koh, Y. W., Choi, E. C.2014; 21 (12): 3872-3875
  • Measuring the Extent of Total Thyroidectomy for Differentiated Thyroid Carcinoma Using Radioactive Iodine Imaging Relationship With Serum Thyroglobulin and Clinical OutcomesJAMA OTOLARYNGOLOGY-HEAD & NECK SURGERYHolsinger, F. C., Ramaswamy, U., Cabanillas, M. E., Lang, J., Lin, H. Y., Busaidy, N. L., Grubbs, E., Rahim, S., Sturgis, E. M., Lee, J. E., Weber, R. S., Clayman, G. L., Rohren, E. M.2014; 140 (5): 410-415
     

Christopher Holsinger, MD

About Dr. Chris Holsinger

Dr. Holsinger is Professor and Chief of Head and Neck Surgery at Stanford University Medical Center, where he also leads the multidisciplinary Head and Neck Oncology Program at the Stanford Cancer Center. From 2003-2013, Dr. Holsinger worked at the Department of Head and Neck Surgery at the University of Texas M.D. Anderson Cancer Center where he founded and led the Program in Minimally Invasive and Endoscopic Head and Neck Surgery and co-directed the program in Minimally Invasive Technology in Oncologic Surgery.

Dr. Holsinger’s surgical practice focuses on the surgical management of benign and malignant diseases of the thyroid, as well as head and neck cancers. His areas of research interest include endoscopic head and neck surgery, including robotic thyroidectomy, transoral robotic surgery and transoral laser microsurgery, as well as time-honoured approaches of conservation laryngeal surgery, supracricoid partial laryngectomy. 

Dr. Holsinger's research focuses on surgical innovation, clinical trials, and genomics. He serves as surgical PI for RTOG920 and coordinates surgeon-credentialing prospective clinical trails, through NCI-funded cooperative groups. 

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