Adding Flexible Instrumentation to a Curved Videolaryngoscope: A Novel Tool for Laryngeal Surgery

Abstract

Objectives Transoral surgery of the larynx with rigid instruments is not always possible. This may result in insufficient therapy or in an increased need for open surgery. For these patients, alternative surgical systems are needed. Here, we demonstrate a curved prototype for laryngeal surgery equipped with flexible instruments. Study Design Pre‐clinical user study in an ex vivo porcine laryngeal model. Methods The prototype was built from established medical devices, namely a hyperangulated videolaryngoscope and modified flexible instruments as well as three‐dimensional printed parts. Feasibility of laryngeal manipulation was evaluated in a user study (n = 19) with a porcine ex vivo laryngeal model. Using three different visualization technologies, the participants performed various fine motor skills tasks and rated the usability of the system on a 5‐point Likert scale. Results Exposure, accessibility, and manipulation of important laryngeal structures were always possible using the new prototype. The participants needed considerably less time (mean, 96.4 seconds ± 6.4 seconds vs. 111.5 seconds ± 4.5 seconds, P = .18), reported significantly better general impression (mean score 3.0 vs. 3.8, P = .041) and significantly lower user head and neck strain (2.6 vs. 1.7, P = .022) using a 40‐inch television screen as compared to a standard videolaryngoscope monitor. Conclusion The results indicate that our curved prototype and large monitor visualization may provide a cost‐effective minimally invasive alternative for difficult laryngeal exposure. Its special advantages include avoiding the need for a straight line of sight and a simple and cost‐effective construction. The system could be further improved through advances in camera chip technology and smaller instruments. Laryngoscope, 131:E561–E568, 2021

Current Advances in Robotics for Head and Neck Surgery—A Systematic Review

“…They reported a good general impression and no head and neck strain using the system with a 40-inch external monitor. The results of this user study suggest that the prototype is an interesting and low-priced alternative to the previously available systems in robotic larynx surgery, especially concerning visualization and accessibility of the operation site [ 37 , 38 ].…”

Evaluation of a curved surgical prototype in a human larynx

“…A detailed setup of the surgical prototype has been published before [ 10 ]. We modified a video laryngoscope for surgical purposes by equipping it with flexible dual-arm instrumentation (Fig.…”

“…We have developed a new surgical prototype, the surgical MAC system (sMAC), which could enable laryngeal diagnostics and surgical treatment even in cases of difficult laryngeal exposure [ 10 ]. The sMAC system is composed of a hyper-angulated video laryngoscope modified with flexible instruments.…”

Laryngeal Examination with Laryngeal Mirror and Laryngoscopy

“…The study conducted by Schild et al showed that use of an hyperangulated video laryngoscope with usage of modified flexible instruments can be cost effective and minimally invasive alternative in cases of difficult laryngeal exposure [13].…”