Intraoperative Optical Coherence Tomography

Intraoperative Optical Coherence Tomography (iOCT) is a transformative imaging technology that has significantly advanced the field of surgery. This technique provides real-time, high-resolution imaging of tissue microstructure during surgical procedures, enabling surgeons to achieve greater precision and improve patient outcomes. Originally developed for ophthalmology, iOCT has expanded into other surgical specialities, including neurosurgery, oncology, and otolaryngology.

At its core, iOCT uses low-coherence interferometry to generate cross-sectional images of tissue. This imaging is analogous to ultrasound, but it employs light waves rather than sound waves, which enables it to achieve micrometre-scale resolution. The ability to visualise subsurface tissue structures in real-time is particularly advantageous during surgery, where precise interventions are critical to success.

In ophthalmology, iOCT has revolutionised procedures such as retinal surgery, corneal transplantation, and glaucoma interventions. By providing a detailed view of the retina and underlying structures, surgeons can assess the integrity of tissues, guide the placement of instruments, and evaluate surgical outcomes immediately. For instance, during macular hole surgery, iOCT allows real-time monitoring of the hole closure and retinal layer alignment, reducing the likelihood of postoperative complications.

Beyond ophthalmology, iOCT is being increasingly utilised in neurosurgery, particularly for tumour resection. Brain tumours often have indistinct margins, and achieving complete resection without damaging healthy tissue is challenging. iOCT enables surgeons to differentiate tumour tissue from normal brain structures with high accuracy, supporting safer and more effective resections. Similarly, in oncology, iOCT is used to assess surgical margins during the excision of cancers such as breast and skin malignancies. This reduces the risk of incomplete tumour removal and the need for subsequent surgeries.

In otolaryngology, iOCT assists in delicate procedures involving the middle ear and vocal cords. Its ability to visualise fine anatomical details, such as the tympanic membrane and cochlea, enhances the precision of surgeries aimed at restoring hearing or treating chronic infections.

Despite its numerous advantages, iOCT does present challenges. Integrating the technology into surgical workflows can be complex, and the equipment is often costly. Additionally, interpreting iOCT images requires specialised training, which may limit its adoption in certain settings. Nevertheless, ongoing advancements in hardware miniaturisation and software development are addressing these limitations, making iOCT more accessible and user-friendly.

Intraoperative Optical Coherence Tomography represents a paradigm shift in surgical practice. Enabling real-time visualisation of tissue microstructure enhances precision, reduces complications, and improves outcomes across various medical disciplines. As the technology continues to evolve, its role in surgery is likely to expand, further cementing its position as an indispensable tool in modern medicine.