John C. Malone Associate Professor of Electrical and Computer Engineering Muyinatu A. Lediju Bell has received a four-year, $1.5 million R01 grant from the National Institutes of Health to develop new technology for photoacoustic-guided hysterectomies in an effort to make the procedures safer via informative, real-time feedback.

Over 600,000 hysterectomies—surgical procedures to remove the uterus from the body—are performed each year in the United States. Damage to the ureter, a duct that carries urine away from the kidney, is one of the most serious complications of such gynecological procedures. If these ureteral injuries go unrecognized, they can result in an increased risk of complete kidney failure, sepsis, or even death.

Current clinical practices—including visual inspection and the use of laparoscopic cameras—struggle with accurately identifying the relative positions of the ureter, surrounding arteries, and surgical tool tips at sufficient depth and with enough image contrast to reliably identify ureteral injuries when they occur. In an earlier study published in IEEE Transactions on Medical Imaging, Bell and her team at the Photoacoustic and Ultrasonic Systems Engineering Lab demonstrated photoacoustic imaging’s potential in this area; the laser-based live imaging method allows for complete avoidance of the ureter and improved targeting of the uterine arteries, which must be cut and cauterized when performing a hysterectomy.

Now, to advance this technology into surgical practice, Bell and her primary co-investigator Karen C. Wang—an assistant professor of gynecology and obstetrics at the School of Medicine and the director of the Division of Minimally Invasive Gynecologic Surgery at the Johns Hopkins Hospital—are working to optimize photoacoustic imaging system designs to provide informative, real-time feedback during hysterectomy procedures.

“Our long-term goal is to develop guidance technology to differentiate critical structures in real time during surgery,” says Bell, who previously received a $1.4 million R01 grant from the NIH to support the improvement of ultrasound techniques for breast cancer screening and diagnosis.

Building on Bell’s 2018 Johns Hopkins Discovery Award, this new project aims to establish the optical, acoustic, and navigational parameters necessary for a photoacoustic imaging system to achieve optimal detection of surgical tools and key structures during hysterectomies. Bell and Wang plan to conduct a series of simulations and live studies to determine these parameters.

“The state of photoacoustic imaging use in hysterectomies is currently non-existent,” Bell says. “We are hoping to change that with our technology designs and ideas.”

Other co-investigators on this project include collaborators at the School of Medicine—Kathleen Gabrielson, an associate professor of molecular and comparative microbiology, and Zaver M. Bhujwalla, a professor of radiology and radiological science—and Kathryn Carson, a senior research associate in the Department of Epidemiology at the Bloomberg School of Public Health.