C.LIM1, J.LEUNG2, M.ONG2, J.GOO2, S.H.FOONG3, J.Y.KHAW3, M.NG1, C.CHIA2
MOH Holdings Pte Ltd (MOHH)1, Khoo Teck Puat Hospital2, Singapore University of Technology and Design3
Margins assessment during breast conserving surgery (BCS) is critical to reduce re-excision rates and poor patient satisfaction. During BCS, a cube of tissue containing the tumour is excised and sent for X-ray to determine margins adequacy. However orientation is currently suboptimal and only single view. We aimed to innovate a specimen holder for accurate radiological orientation, ability for two views (anterior-posterior and lateral), to help the surgeon determine margins adequacy.
The team collaborated with Singapore University Technology and Design to design a specimen holder that allows for accurate fixation and orientation. The initial concept comprised of interlocking blocks to customize a flexible specimen holder that allows multidirectional compression during imaging. This was created using 3D printing technology to produce TPU (Thermoplastic polyurethane), a highly elastic form of plastic. Subsequent prototypes incorporated radiolucent substitute material to improve penetrance and reduce interference. The final prototype encompassed a user-friendly flexible box with adjustable lid heights, embedded orientation markers and slits for placement of hook-wire specimens which also acts as anchor point to prevent displacement.
Our final prototype is user friendly and achieved our objective of accurate orientation using radiolucent material that reduces imaging interference, obtained two critical views and satisfactory X-ray orientation. This innovation was tested on live specimens and feedback from surgeons, radiographers and radiologists were positive. A patent has been filed for this invention.
The intra-operative breast specimen holder achieves precise orientation of excised specimen with additional views that can help a breast surgeon determine the adequacy of resection margins radiologically.