Real‐time robotic airway measurement: An additional benefit of a novel steady‐hand robotic platform

Abstract

Objective Describe the secondary capability of a robotic system to provide real‐time measurements of airway dimensions with high fidelity. Methods Seven unique phantoms of laryngotracheal stenosis (LTS) were modeled using a computer‐aided design tool and were three dimensionally printed. These stenoses were of different dimensions and orientations, and some were purposefully oblique. The dimensions of the stenoses were then measured with the novel Robotic ENT (Ear, Nose, and Throat) Microsurgery System (REMS; Galen Robotics, Inc., Sunnyvale, CA) because it is capable of tool position memory in three dimensional (3D) space. Five participants (two laryngologists, two otolaryngology–head and neck surgery residents, one neurotology fellow) measured each axis of stenosis (anteroposterior, lateral, and craniocaudal) three times for each of the seven stenosis phantoms. These measurements were then compared to the known design dimensions. Mean magnitude of error (MOE) and interrater reliability (IRR) using an intraclass correlation coefficient (ICC) were then calculated. Results Mean MOE and standard deviation for all measurements was 0.306 ± 0.247 mm. Mean MOE was 0.374 ± 0.292 mm, 0.300 ± 0.237 mm, and 0.244 ± 0.185 mm for the anteroposterior, lateral, and craniocaudal dimensions of stenosis, respectively. Eighty‐two percent of all measurements had MOE < 0.5 mm. ICC was 0.945 (95% confidence interval [CI]: 0.847–0.989), 0.995 (95% CI: 0.984–0.999), and 0.993 (95% CI: 0.987–0.999) for anteroposterior, lateral, and craniocaudal dimensions, respectively, indicating excellent agreement among participants. Conclusion The REMS can be used to reliably and accurately measure airway dimensions in 3D regardless of the orientation of stenosis. This ability may be easily extrapolated to the measurement of any airway lesion during laryngotracheal surgery. Level of Evidence 4 Laryngoscope, 129:324–329, 2019

Microsurgery Robots: Applications, Design, and Development

“…The Robotic ENT Microsurgery System (REMS) is a co-manipulated MSR system designed for otolaryngology-head and neck surgery. The system was developed by the Laboratory for Computational Sensing and Robotics at Johns Hopkins University and is currently under a commercial license agreement with Galen Robotics Inc. (Baltimore, MD, USA) [244].…”

Volumetric Accuracy Analysis of Virtual Safety Barriers for Cooperative-Control Robotic Mastoidectomy

“…Our group has investigated an experimental cooperative-control robot for microsurgery in otolaryngology and demonstrated its use in simulated microlaryngeal, microvascular, and otologic surgical tasks (9,10,(17)(18)(19). Previously, we validated its ability to allow a novice surgeon to successfully complete a mastoidectomy without visibly damaging known anatomical structures (10).…”

Image‐Guided Mastoidectomy with a Cooperatively Controlled ENT Microsurgery Robot

“…We have developed an experimental cooperatively controlled robot for ear, nose, and throat (ENT) microsurgery and have demonstrated its use in simulated microlaryngeal, microvascular, and otologic surgical tasks due to its ability to eliminate tremor, enhance precision, and have accurate knowledge of tool position in 3-dimensional space. [12][13][14][15] Here we describe its capability to incorporate image-based virtual fixtures facilitating cortical mastoidectomy by a novice surgeon.…”