Touching the tumor boundary: A pilot study on ultrasound based virtual fixtures for breast-conserving surgery

Purpose: Delineating tumor boundaries during breast-conserving surgery is challenging as tumors are often highly mobile, non-palpable, and have irregularly shaped borders. To address these challenges, we introduce a cooperative robotic guidance system that applies haptic feedback for tumor localization. In this pilot study, we aim to assess if and how this system can be successfully integrated into breast cancer care. Methods: A small haptic robot is retrofitted with an electrocautery blade to operate as a cooperatively controlled surgical tool. Ultrasound and electromagnetic navigation are used to identify the tumor boundaries and position. A forbidden region virtual fixture is imposed when the surgical tool collides with the tumor boundary. We conducted a study where users were asked to resect tumors from breast simulants both with and without the haptic guidance. We then assess the results of these simulated resections both qualitatively and quantitatively. Results: Virtual fixture guidance is shown to improve resection margins. On average, users find the task to be less mentally demanding, frustrating, and effort intensive when haptic feedback is available. We also discovered some unanticipated impacts on surgical workflow that will guide design adjustments and training protocol moving forward. Conclusion: Our results suggest that virtual fixtures can help localize tumor boundaries in simulated breast-conserving surgery. Future work will include an extensive user study to further validate these results and fine-tune our guidance system.