Drone-Enabled Transport of Intraoperative Onco-Surgical Specimens for Frozen Section Analysis: A Proof-of-Concept Study from India

Background:
Peripheral hospitals often lack facilities for intraoperative frozen section analysis, requiring onco-surgical specimens to be transported to tertiary pathology centres. Conventional road transport can delay diagnosis, prolong operative time, increase repeat surgeries, and adversely affect patient outcomes. This proof-of-concept study evaluated the feasibility, safety, and clinical utility of drone-enabled transportation of intraoperative onco-surgical specimens for frozen section diagnosis.

Methods:
A prospective implementation study was conducted by the Indian Council of Medical Research (ICMR) in collaboration with Kasturba Medical College, Manipal, Dr. T.M.A. Pai Hospital, Karkala, and industry partners. The project was implemented in two phases. Phase I evaluated transportation of 14 non-oncological tissue specimens to assess specimen orientation, tissue integrity, cellular morphology, and evidence of autolysis following drone transport. Phase II involved transportation of eight intraoperative onco-surgical specimens requiring frozen section analysis for real-time surgical decision-making. In parallel, a TELOSS (Technical, Economic, Legal, Operational, Social, and Schedule) framework was applied to assess implementation feasibility and identify the most appropriate deployment strategy.

Results:
All transported specimens-maintained orientation, tissue integrity, and histo-morphological characteristics without evidence of autolysis or cytoplasmic/nuclear degradation. Frozen section diagnoses were concordant with final histopathological findings in all clinical cases, enabling immediate intraoperative decision-making. Drone-assisted logistics supported breast-conserving procedures, confirmed tumour-free surgical margins in oral cancer surgery, guided management of ovarian malignancy, and prevented unnecessary radical procedures in benign lesions. TELOSS analysis identified a hybrid model employing drone transport for time-critical specimens as the most practical implementation strategy, balancing technical feasibility, operational efficiency, regulatory compliance, and cost-effectiveness.

Conclusions:
Drone-enabled transportation of intraoperative surgical specimens is feasible, safe, and capable of preserving diagnostic quality while facilitating timely frozen section analysis. The approach has the potential to decentralize specialist pathology services, reduce repeat surgeries, optimize operating room efficiency, and improve access to advanced cancer care in geographically underserved regions.