Application of Natural Orifice Transluminal Endoscopic Surgery (NOTES) Instrumentation to the Endolarynx

Tan, Melin; Prufer, Neil; Chinosornvatana, Nina; Park, Chan; Woo, Peak

doi:10.1177/000348941212100703

Cited by 6 publications

(6 citation statements)

References 10 publications

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“…While the structure of the sheep larynx varies from human anatomy, it is sufficiently analogous to allow the most common of surgical procedures, including injection laryngoplasty, vocal fold lesion excision, hydrodissection and incision, and micro-suturing. Our experience was similar to that of Tan et al 8 . They suspended a freshly excised lamb's larynx, and operated using a microscope and the relatively large RealHand ™ instruments.…”

Section: Discussionsupporting

confidence: 68%

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Ex vivoovine model for suspension microlaryngoscopy training

2016

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Section: Discussionsupporting

confidence: 68%

“…While of proven value, these holders are expensive to build and are not widely available 7 . They accurately reproduce the experience of laryngeal microdissection, but do not teach the skills required for suspension laryngoscopy 8 …”

Section: Introductionmentioning

confidence: 99%

Ex vivoovine model for suspension microlaryngoscopy training

2016

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“…Another preliminary study focuses on possible gains in endolaryngeal operative dexterity using RealHand high‐dexterity instrumentation (Novare Surgical, Cupertino, CA) designed for natural orifice transluminal endoscopic surgery. In an animal laryngeal model, this study demonstrated that with modification, these tools may be suitable for laryngeal procedures . These dexterous laparoscopic instruments are still operated manually, however, and this technology does not offer any robotic assistance in instrument manipulation.…”

Section: Discussionmentioning

confidence: 96%

“…In an animal laryngeal model, this study demonstrated that with modification, these tools may be suitable for laryngeal procedures. 36 These dexterous laparoscopic instruments are still operated manually, however, and this technology does not offer any robotic assistance in instrument manipulation.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…Several authors have described using excised larynx models for learning laryngoscopy skills. 12 , 13 , 14 , 15 , 16 Unfortunately, fresh human tissues are increasingly difficult to obtain and have the highest risk of disease transmission of any model. 17 More recently, computerized simulators have been utilized for bronchoscopy and intubation as well as developing skills in endolaryngeal and percutaneous laryngeal procedures.…”

Section: Discussionmentioning

confidence: 99%

Ex vivo ovine model for teaching open laryngotracheal surgery

Soliman¹,

Ianacone²,

Isaacson³

2018

World j. otorhinolaryngol.-head neck surg.

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ObjectiveTo develop an animal model for teaching open laryngotracheal surgical procedures.MethodsThe heads and necks from 5 pre-pubescent sheep were harvested after humane anesthesia. After 2–5 days to allow for rigor mortis to resolve, a specimen was supported with sandbags on an operating table. Operative procedures including tracheotomy, medialization laryngoplasty, anterior cartilage grafting, tracheal resection with primary anastomosis, and laryngectomy with closure of the pharynx were attempted.ResultsThe ovine head and neck provided an accurate model for simulation of all attempted procedures. Ovine tissue resembled that of humans in mechanical properties and handling. Postsurgical endoscopy confirmed graft alignment.ConclusionsThe sheep head and neck provides an inexpensive, realistic, and safe model for surgical training for a variety of open laryngotracheal procedures. This is particularly relevant given the recent emphasis on surgical simulation and the relative rarity of some of these procedures in residency training.

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Application of Natural Orifice Transluminal Endoscopic Surgery (NOTES) Instrumentation to the Endolarynx

Abstract: RealHand high-dexterity instrumentation allows for full range-of-motion instrumentation and, with modification, has potential for wider application in endoscopic laryngeal surgery.

Cited by 6 publications

References 10 publications

Ex vivoovine model for suspension microlaryngoscopy training

Ex vivoovine model for suspension microlaryngoscopy training

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

Ex vivo ovine model for teaching open laryngotracheal surgery

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