Selecting Image-Guided Surgical Technologies in Oncology: A Surgeon’s Perspective

Research article published on Science direct. August 3, 2020

AUTHORS: Melanie Lindenberg MSc, Valesca Retèl PhD, Janine van Til PhD, Koert Kuhlmann MD, PhD TheoRuers MD, PhD, Wim van Harten MD, PhD.


To improve surgical performance, image-guided (IG) technologies are increasingly introduced. Yet, it is unknown which oncological procedures yield most value from these technologies. This study aimed to select the most promising IG technology per oncologic indication.

An Analytic Hierarchical Process was used to evaluate three IG technologies: navigation, optical imaging, and augmented reality, in five oncologic indications compared with usual care. Sixteen decision criteria were selected. The relative importance of the criteria and the expected performance of the technologies were evaluated among surgeons. The combination of these scores gives the expected value per technology.

On criteria level, sparing critical tissue (9%-18%) and reducing the risk of local recurrence (11%-27%) were most important. Navigation was preferred in three indications—removal of lymph nodes (42%), liver (47%), and rectal tumors (33%). In removing rectal tumors, optical imaging was equally preferred (34%). In removing breast and tongue tumors, no technology was clearly preferred.

In selecting IG technologies, especially optical and navigation technologies are expected to add value in addition to usual care. Further development of those technologies for the preferred indications seems valuable. Multi-attribute analysis showed to be useful in prioritization of conducting clinical studies and steer research and development initiatives.

Surgical oncology (Mesh)Technology assessment (Mesh)Image-guided surgeryMulticriteria decision analysisMedical devices

Keywords: mixed methods, health services research, review literature, case study, vrijhoef