Abstract Purpose Photoacoustic imaging has the potential to provide real-time surgical guidance to avoid ureteral injury during hysterectomies, including photoacoustic-based distance measurements and auditory alerts to warn surgeons of unsafe proximity. Validation of tool tip tracking performance and assessments of surgeon interaction with multiple feedback options derived from photoacoustic-based tool tip tracking are essential to assess the expected impact. Methods Tracked tool tip positions were compared with ground-truth data acquired to validate our recently proposed velocity-based tracking approach. A user study with gynecological surgeons, OB/GYN residents, and a control group of non-medical professionals was then performed to determine the extent of improvements that can be achieved with multiple photoacoustic-based feedback techniques derived from the proposed velocity-based tracking approach. Results The average mean tracking errors across various programmed tool motions were 0.24 mm and 0.56 mm in the lateral and axial dimensions, respectively. Combinations of photoacoustic-based distance measurements, auditory feedback, and photoacoustic video display improved correct classifications of tool-to-ureter distances by 11.1% to 48.1% and reduced the aggregated response times among users by 1.72–2.15 s (i.e., 37–47% improvement) relative to camera videos. Conclusion Results are promising for the continued development of a photoacoustic surgical guidance system that successfully mitigates ureteral injuries during hysterectomies, simultaneously enabling reduced reliance on subjective camera-based visualization and addressing limitations of depth perception in conventional surgical imaging. This integration of photoacoustic image guidance into intraoperative workflows has the potential to enhance surgical safety.
Venkatayogi et al. (Sat,) studied this question.