LaryngoTORS: A Novel Cable-Driven Parallel Robotic System for Transoral Laser Phonosurgery

Zhao, Ming; Vrielink, T.J.C. Oude; Kogkas, Alexandros; Runciman, Mark; Elson, Daniel S.; Mylonas, George P.

doi:10.1109/lra.2020.2969186

Cited by 31 publications

(14 citation statements)

References 28 publications

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“…Finally, a millimeter-scale tip/tilt laser scanning system based on a micro-mechatronic structure actuated by piezoelectric beams has been proposed for transoral robotic surgery, demonstrating a field of view of 10 mm x 20 mm and scanning speed up to 7 m/s from an 11 mm diameter device (Bothner et al, 2019). This device was subsequently further miniaturized to a diameter of 6 mm and (Zhao et al, 2020). (D) A millimeter-scale tip/tilt laser-steering system (Bothner et al, 2019).…”

Section: Micro-robotic Laser Micromanipulators Beyond µRalpmentioning

confidence: 99%

“…Other prototypes proposed beyond µRALP to steer laser fibers for microsurgery include biocompatible conducting polymer continuum robots ( Chikhaoui et al, 2018 ), tiny flexible steerable instruments to be used through the tool channel of clinical endoscopes ( O’Brien et al, 2019 ), and a cable-driven parallel robotic system for phonosurgery ( Zhao et al, 2020 ). Finally, a millimeter-scale tip/tilt laser scanning system based on a micro-mechatronic structure actuated by piezoelectric beams has been proposed for transoral robotic surgery, demonstrating a field of view of 10 mm x 20 mm and scanning speed up to 7 m/s from an 11 mm diameter device ( Bothner et al, 2019 ).…”

Section: Micro-technologies and Systems For Robot-assisted Endoscopic Laser Microsurgerymentioning

confidence: 99%

“…(A) A biocompatible conducting polymer continuum robot ( Chikhaoui et al, 2018 ) (B) A flexible steerable instrument ( O’Brien et al, 2019 ). (C) A cable-driven parallel robotic system ( Zhao et al, 2020 ). (D) A millimeter-scale tip/tilt laser-steering system ( Bothner et al, 2019 ).…”

Section: Micro-technologies and Systems For Robot-assisted Endoscopic Laser Microsurgerymentioning

confidence: 99%

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μRALP and Beyond: Micro-Technologies and Systems for Robot-Assisted Endoscopic Laser Microsurgery

et al. 2021

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Laser microsurgery is the current gold standard surgical technique for the treatment of selected diseases in delicate organs such as the larynx. However, the operations require large surgical expertise and dexterity, and face significant limitations imposed by available technology, such as the requirement for direct line of sight to the surgical field, restricted access, and direct manual control of the surgical instruments. To change this status quo, the European project μRALP pioneered research towards a complete redesign of current laser microsurgery systems, focusing on the development of robotic micro-technologies to enable endoscopic operations. This has fostered awareness and interest in this field, which presents a unique set of needs, requirements and constraints, leading to research and technological developments beyond μRALP and its research consortium. This paper reviews the achievements and key contributions of such research, providing an overview of the current state of the art in robot-assisted endoscopic laser microsurgery. The primary target application considered is phonomicrosurgery, which is a representative use case involving highly challenging microsurgical techniques for the treatment of glottic diseases. The paper starts by presenting the motivations and rationale for endoscopic laser microsurgery, which leads to the introduction of robotics as an enabling technology for improved surgical field accessibility, visualization and management. Then, research goals, achievements, and current state of different technologies that can build-up to an effective robotic system for endoscopic laser microsurgery are presented. This includes research in micro-robotic laser steering, flexible robotic endoscopes, augmented imaging, assistive surgeon-robot interfaces, and cognitive surgical systems. Innovations in each of these areas are shown to provide sizable progress towards more precise, safer and higher quality endoscopic laser microsurgeries. Yet, major impact is really expected from the full integration of such individual contributions into a complete clinical surgical robotic system, as illustrated in the end of this paper with a description of preliminary cadaver trials conducted with the integrated μRALP system. Overall, the contribution of this paper lays in outlining the current state of the art and open challenges in the area of robot-assisted endoscopic laser microsurgery, which has important clinical applications even beyond laryngology.

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Section: Micro-robotic Laser Micromanipulators Beyond µRalpmentioning

confidence: 99%

Section: Micro-technologies and Systems For Robot-assisted Endoscopic Laser Microsurgerymentioning

confidence: 99%

Section: Micro-technologies and Systems For Robot-assisted Endoscopic Laser Microsurgerymentioning

confidence: 99%

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μRALP and Beyond: Micro-Technologies and Systems for Robot-Assisted Endoscopic Laser Microsurgery

et al. 2021

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“…This results in relatively heavy and large external actuation systems that may require mounting to the MRI table, affecting surgical workflow and patient access. Snake-like robots ( 34 , 35 ) face similar challenges with actuator compactness and are typically not MRI compatible. Microrobotic steering systems have been used for endoscopic laser surgery ( 36 , 37 ); however, these systems are also generally not MRI compatible.…”

Section: Introductionmentioning

confidence: 99%

Soft robotic manipulator for intraoperative MRI-guided transoral laser microsurgery

Fang

Chow

et al. 2021

Sci. Robot.

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Magnetic resonance (MR) imaging (MRI) provides compelling features for the guidance of interventional procedures, including high-contrast soft tissue imaging, detailed visualization of physiological changes, and thermometry. Laser-based tumor ablation stands to benefit greatly from MRI guidance because 3D resection margins alongside thermal distributions can be evaluated in real time to protect critical structures while ensuring adequate resection margins. However, few studies have investigated the use of projection-based lasers like those for transoral laser microsurgery, potentially because dexterous laser steering is required at the ablation site, raising substantial challenges in the confined MRI bore and its strong magnetic field. Here, we propose an MR-safe soft robotic system for MRI-guided transoral laser microsurgery. Owing to its miniature size (Ø12 × 100 mm), inherent compliance, and five degrees of freedom, the soft robot ensures zero electromagnetic interference with MRI and enables safe and dexterous operation within the confined oral and pharyngeal cavities. The laser manipulator is rapidly fabricated with hybrid soft and hard structures and is powered by microvolume (<0.004 milliter) fluid flow to enable laser steering with enhanced stiffness and lowered hysteresis. A learning-based controller accommodates the inherent nonlinear robot actuation, which was validated with laser path–following tests. Submillimeter laser steering accuracy was demonstrated with a mean error < 0.20 mm. MRI compatibility testing demonstrated zero observable image artifacts during robot operation. Ex vivo tissue ablation and a cadaveric head-and-neck trial were carried out under MRI, where we employed MR thermometry to monitor the tissue ablation margin and thermal diffusion intraoperatively.

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“…6 In recent years, there has been growing interest in shifting more autonomy to the robotic system during RAS. 4,[7][8][9] Autonomy refers to the ability to perform intended tasks without human intervention, based solely on the current robot and tissue states. 10 Yang et al…”

mentioning

confidence: 99%

A systematic review of robotic surgery: From supervised paradigms to fully autonomous robotic approaches

Han

Davids

Ashrafian

et al. 2021

Robotics Computer Surgery

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Background:From traditional open surgery to laparoscopic surgery and robotassisted surgery, advances in robotics, machine learning, and imaging are pushing the surgical approach to-wards better clinical outcomes. Pre-clinical and clinical evidence suggests that automation may standardise techniques, increase efficiency, and reduce clinical complications.Methods: A PRISMA-guided search was conducted across PubMed and OVID.Results: Of the 89 screened articles, 51 met the inclusion criteria, with 10 included in the final review. Automatic data segmentation, trajectory planning, intraoperative registration, trajectory drilling, and soft tissue robotic surgery were discussed. Conclusion:Although automated surgical systems remain conceptual, several research groups have developed supervised autonomous robotic surgical systems with increasing consideration for ethico-legal issues for automation. Automation paves the way for precision surgery and improved safety and opens new possibilities for deploying more robust artificial intelligence models, better imaging modalities and robotics to improve clinical outcomes.

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LaryngoTORS: A Novel Cable-Driven Parallel Robotic System for Transoral Laser Phonosurgery

Cited by 31 publications

References 28 publications

μRALP and Beyond: Micro-Technologies and Systems for Robot-Assisted Endoscopic Laser Microsurgery

μRALP and Beyond: Micro-Technologies and Systems for Robot-Assisted Endoscopic Laser Microsurgery

Soft robotic manipulator for intraoperative MRI-guided transoral laser microsurgery

A systematic review of robotic surgery: From supervised paradigms to fully autonomous robotic approaches

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