Robotic microlaryngeal phonosurgery: Testing of a “steady‐hand” microsurgery platform

Abstract

Objectives/Hypothesis: To evaluate gains in microlaryngeal precision achieved by using a novel robotic "steady hand" microsurgery platform in performing simulated phonosurgical tasks.Study Design: Crossover comparative study of surgical performance and descriptive analysis of surgeon feedback. Methods: A novel robotic ear, nose, and throat microsurgery system (REMS) was tested in simulated phonosurgery. Participants navigated a 0.4-mm-wide microlaryngeal needle through spirals of varying widths, both with and without robotic assistance. Fail time (time the needle contacted spiral edges) was measured, and statistical comparison was performed. Participants were surveyed to provide subjective feedback on the REMS.Results: Nine participants performed the task at three spiral widths, yielding 27 paired testing conditions. In 24 of 27 conditions, robot-assisted performance was better than unassisted; five trials were errorless, all achieved with the robot. Paired analysis of all conditions revealed fail time of 0.769 6 0.568 seconds manually, improving to 0.284 6 0.584 seconds with the robot (P 5 .003). Analysis of individual spiral sizes showed statistically better performance with the REMS at spiral widths of 2 mm (0.156 6 0.226 seconds vs. 0.549 6 0.545 seconds, P 5 .019) and 1.5 mm (0.075 6 0.099 seconds vs. 0.890 6 0.518 seconds, P 5 .002). At 1.2 mm, all nine participants together showed similar performance with and without robotic assistance (0.621 6 0.923 seconds vs. 0.868 6 0.634 seconds, P 5 .52), though subgroup analysis of five surgeons most familiar with microlaryngoscopy showed statistically better performance with the robot (0.204 6 0.164 seconds vs. 0.664 6 0.354 seconds, P 5 .036).Conclusions: The REMS is a novel platform with potential applications in microlaryngeal phonosurgery. Further feasibility studies and preclinical testing should be pursued as a bridge to eventual clinical use.

Phonosurgery: A review of current methodologies

“…16e18 Muscle tremor can be mitigated with conscientious body, arm, and instrument positioning but cannot be entirely eliminated without the use of surgical robot instrument stabilization. 19 Conversely, one of the distinct advantages of cold steel laryngeal instrumentation is due to the long lever arm and its direct connection with the working instrument tip which facilitates haptic feedback. The ability to palpate the vocal cords allows the surgeon to surmise the likely etiology of a lesion or estimate the invasion depth of a glottic mass.…”

Applied Force during Piston Prosthesis Placement in a 3D‐Printed Model: Freehand vs Robot‐Assisted Techniques

“…The technical description of the platform and its subsequent capabilities were previously described within the otolaryngology-head and neck surgery and robotics literature. [20][21][22][23][24] In brief, the system consists of a base-the delta stage-that allows for manipulation of a gantry arm in the x, y, and z planes. Rotational movements about the x and y axes are provided by the roll and tilt stages, respectively.…”

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

“…Details of the REMS platform, its design, and its function have been previously described within both the robotic and OHNS literature. [15][16][17][18][19] In brief, the technology was developed at the Johns Hopkins Laboratory for Computational Sensing and Robotics (Baltimore, MD) and is now under a licensing agreement with Galen Robotics, Inc. It consists of a robotic gantry arm that stabilizes the user's primary instrument along six degrees of freedom.…”

“…The Robotic ENT (Ear, Nose, and Throat) Microsurgery System (REMS) (Galen Robotics, Inc., Sunnyvale, CA) is a novel robotic platform designed specifically for otolaryngology–head and neck surgery (OHNS). Previously, we have demonstrated its feasibility and utility in performing simulated microsurgical and microlaryngeal tasks with heightened precision and dampened tremor . The REMS operates via a cooperative‐control mechanism with which the user and robot manipulate the surgical instrument together.…”

“…Previously, we have demonstrated its feasibility and utility in performing simulated microsurgical and microlaryngeal tasks with heightened precision and dampened tremor. 15,16 The REMS operates via a cooperative-control mechanism with which the user and robot manipulate the surgical instrument together. Conventional surgical instruments ranging from microvascular needle drivers to microlaryngeal forceps are fitted with custom adapters to articulate with the gantry arm of the REMS.…”