Cognitive Supervision for Transoral Laser Microsurgery

Abstract

The thermal laser-tissue interactions described in Chap. 2 constitute the basic building block of laser microsurgery. In particular, ablation by vaporization is the process by means of which laser incisions and resections are performed. As we shall see in this chapter, these interactions need to be carefully monitored to ensure the formation of incisions as planned by the surgeon. Control of the laser effects on tissue is essential for the purpose of ensuring a safe and efficient surgical performance, which encompasses both resection accuracy and limited thermal damage to underlying and surrounding tissues.Despite its importance, the control of the laser effects on tissues during Transoral Laser Microsurgery (TLM) is still performed manually, since available technologies do not include any support to monitor the state of tissues under laser irradiation. When analyzing the workflow of these interventions, it becomes apparent that the quality of laser resections depends entirely on clinicians, who must possess the experience required to anticipate and understand the results of their laser actions.This chapter introduces the problem of the automatic supervision of laser-induced effects during laser surgery. A top-down approach is used to tackle this problem: specific circumstances in which surgeons would value enhanced information regarding the effects of their laser actions on tissues are identified. The problem is grounded in the identification of variables of interest that are selected as target for the supervision. In the scope of this thesis, we explore the application of artificial cognitive approaches to monitor these variables in a surgical scenario.The first two sections of this chapter describe the current workflow of TLM and discuss its limitations from a clinical perspective. Our analysis is based both on evidence reported in medical literature, as well as on the opinions of clinicians who were consulted in the course of this doctoral research. In Sect. 3.3, we formulate the concept of a system capable of assisting clinicians during TLM, enhancing their perception of laser-induced effects on tissues. Two specific effects: thermal (temperature of tissues) and mechanical (laser cutting depth). We will review existing approaches to monitor these effects during laser irradiation, focusing on considerations regarding their