Pilot Study of Trans-oral Robotic-Assisted Needle Direct Tracheostomy Puncture in Patients Requiring Prolonged Mechanical Ventilation

Abstract

COVID-19 can induce severe respiratory problems that need prolonged mechanical ventilation in the intensive care unit. While Open Tracheostomy (OT) is the preferred technique due to the excellent visualization of the surgical field and structures, Percutaneous Tracheostomy (PT) has proven to be a feasible minimally invasive alternative. However, PT's limitation relates to the inability to precisely enter the cervical trachea at the exact spot since the puncture is often performed based on crude estimation from anatomical laryngeal surface landmarks. Besides, there is no absolute control of the trajectory and force required to make the percutaneous puncture into the trachea, resulting in inadvertent injury to the cricoid ring, cervical esophagus, and vessels in the neck. Therefore, we hypothesize that a flexible mini-robotic system, incorporating the robotic needling technology, can overcome these challenges by allowing the trans-oral robotic instrument of the cervical trachea. This approach promises to improve current PT technology by making the initial trachea puncture from an “inside-out” approach, rather than an “outside-in” manner, fraught with several technical uncertainties.

Emerging Robotic Innovations and Artificial Intelligence in Endotracheal Intubation and Airway Management: Current State of the Art

“…Xiao et al (2020) designed a robotic prototype known as the Robotic-Assisted Trans-Oral Tracheostomy System that drills a hole from within the trachea and outwards. Operators can see the drilling position using a camera for percutaneous tracheostomy [ 23 ].…”

Quo Vadis Anesthesiologist? The Value Proposition of Future Anesthesiologists Lies in Preserving or Restoring Presurgical Health after Surgical Insult

“…The pharmacological system provides a close loop medication administration to achieve a certain goal such as arterial pressure or train-of-four with obvious implications for providing hemodynamic stability during surgery. Finally, robots entered the world of physical manipulation by assisting with intubation, regional anesthesia, and intravenous catheter placement [139][140][141].…”

RASEC: Rescaling Acquisition Strategy with Energy Constraints under Fusion Kernel for Active Incision Recommendation in Tracheotomy

“…W ITH the current increasing infections of COVID -19, respiratory failure has become a frequent cause of mortality, in which 25.9% of pneumonia required admission to the Intensive Care Unit (ICU), and 20.1% developed acute respiratory distress syndrome (ARDS) [1]- [6]. The tracheotomy creates an artificial airway with a transverse incision between the trachea cartilages and plays a major role in buying considerable time for mechanical ventilation [7]- [9]. Before mechanical incision and intubation towards the tracheal region of the patient, there is a very critical positioning step: surgeons commonly employ palpation techniques on the tracheal surface to build a tactile understanding of human anatomy [10].…”

“…Taking a single trachea region as an example, our proposed method can generate a hardness distribution map within a sampling resolution of 1 mm. a few peer studies exploring robotic-assisted techniques in the tracheotomy process and optimizing the procedures to gain more possibilities for follow-up treatment success [9], [14]- [16]. Prior to robotic tracheotomy surgery, precisely identifying the trachea rings, thus, the appropriate localization of the incision region is a critical issue.…”