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Session:: ePosters-Mon1015-M6: Colon & Colorectal Cancer

EP834 - Intraoperative Navigation With O-ARM Visualization In Colorectal Cancer

Monday, May 11, 2026
10:42 AM - 10:47 AM ET

    Author(s)

  • HK

    Hiroko Kunitake, MD MPH

    Associate Professor
    Harvard Medical School, Massachusetts General Hospital
    Harvard Medical School, Massachusetts General Hospital
    Boston, MA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • SL

    Santiago Lozano-Calderon, M.D.,PhD

    Attending Surgeon Orthopaedic Oncology, Assoicate Professor Orthopaedic Surgery
    Massachusetts General Hospital, Harvard Medical School
    Dedham, Massachusetts, United States

    Disclosure information not submitted.

  • KR

    Kevin Raskin, MD

    Chief, Orthopaedic Oncology
    MassGeneral Brigham
    Boston, Massachusetts, United States

    Disclosure information not submitted.

    • ePoster Presenter(s)

  • Rocco R. Ricciardi, MD

    Chief, Division of Colon & Rectal Surgery
    Massachusetts General Hospital
    Harvard University
    Boston, MA, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Hiroko Kunitake, MD MPH: This individual has no financial relationships with ineligible companies.
Purpose/Background: There is a need for enhanced real time imaging during radical colorectal cancer resections. The goal of our proposed study is to identify the value of the O-ARM in intraoperative tumor visualization for colorectal cancer patients.

Methods/Interventions: We evaluated the role of the Medtronic O-ARM in select patients with locally advanced tumors of the colon and rectum. In particular, we investigated the value of real time imaging and intraoperative navigation on surgical results of locally advanced colorectal cancer resections. We recorded tumor size, operative time, surgical blood loss, extent of resection, critical pelvic structure injury, intraoperative radiation therapy time, and rate of circumferential and distal positive margins with the O-ARM system.

Results/Outcomes: In preliminary testing, our group has demonstrated significant value in field testing of the O-ARM in large bulky pelvic tumors and in resection of recurrent cancers. At this time, the O-ARM was used without difficulty in all patients in which the system was engaged including 7 of 8 patients with large bulky invasive tumors. Six of eight patients presented with recurrent cancer and 63% had multivisceral resections. Longest tumor dimension ranged from 2.1 to 7.6 cm (average 4+/-2cm). Operative time for these complex procedures was 411+/-290 minutes, blood loss was 1234+/-1744mL, and intraoperative radiation therapy time was 49 minutes. There were no adverse events. Final pathology revealed negative radial and distal margins for all cases except one patient with evidence of carcinomatosis at time of surgery.

Conclusion/Discussion: The O-arm was particularly useful in multivisceral resections and in those cases in which intraop radiation was used. The navigation system allows for continuous imaging and intraoperative navigation to track the exact position of instruments and the pelvic tumor relative to the surrounding anatomy. Intraoperative navigation facilitates accurate tumor resection and enables accurate identification of anatomic variations to make real-time adjustments to our surgical approach, improving both the safety and efficacy of colorectal cancer procedures.

Intraop Images
Image of the navigator during intraoperative field testing