On the merits of using angled fiber tips in office-based laser surgery of the vocal folds

Chan, Isabelle A.; d'Almeida, Jesse F.; Chiluisa, Alex J.; Carroll, Thomas L.; Liu, Yuxiang; Fichera, Loris

doi:10.1117/12.2580454

Cited by 4 publications

(13 citation statements)

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“…Physicians can control the laser aiming by bending the distal tip of the endoscope; however, this does not provide sufficient anatomical coverage [8], [9]. In recent work, our group characterized the reachable workspace of laryngeal endoscopes and identified the regions within the larynx where access is problematic [6]. These regions include, among others, the two cavities immediately above the vocal folds and the inferior surface of the vocal folds (see Fig.…”

Section: B Challenges Of Office Proceduresmentioning

confidence: 99%

“…Patients who develop tumors in one of these areas are not suitable candidates for office surgery and have to resort to the traditional (and more expensive) surgical treatment in the operating room. Reachable workspace maps from our earlier study [6] are reproduced in this paper (sec. IV) and compared to the reachable workspace of the new steerable fiber we propose in the following.…”

Section: B Challenges Of Office Proceduresmentioning

confidence: 99%

“…1) Range of Motion: Based on our prior analysis of the laryngeal workspace in [6], we anticipate that a mechanism able to bend the optical fiber by at least 90°would double the extent of reachable anatomy and enable access to several challenging areas, including those immediately above and below the vocal folds mentioned earlier.…”

Section: Design Specificationsmentioning

confidence: 99%

“…This section reports the studies we performed to characterize the reachable workspace of our new steerable fiber. These studies used the same computational simulation framework we previously developed in [6]. Briefly, we first let a computer program manipulate the endoscope and the laser fiber in simulation, and perform an extensive exploration of the reachable workspace with a sampling-based motion planning algorithm.…”

Section: Reachable Workpace Characterizationmentioning

confidence: 99%

“…One of the key limitations is the lack of articulation in the optical fibers used for laser delivery: it is only possible to control the laser aiming indirectly, i.e., bending the endoscope's distal tip. This greatly limits anatomical access [6], and it also makes the procedure disorienting for the operating physician due to the inability to control the laser aiming without also moving the field of vision [7]- [9]. Patients who present with a disease in hard-to-reach locations are not good candidates for office treatment; and even if a procedure is attempted, it can result in incomplete treatment, and therefore the need for additional follow-up care [8].…”

Section: Introductionmentioning

confidence: 99%

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Light in the Larynx: a Miniaturized Robotic Optical Fiber for In-office Laser Surgery of the Vocal Folds

Chiluisa¹,

Pacheco²,

Do³

et al. 2022

Preprint

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This paper reports the design, construction, and experimental validation of a novel hand-held robot for inoffice laser surgery of the vocal folds. In-office endoscopic laser surgery is an emerging trend in Laryngology: It promises to deliver the same patient outcomes of traditional surgical treatment (i.e., in the operating room), at a fraction of the cost. Unfortunately, office procedures can be challenging to perform; the optical fibers used for laser delivery can only emit light forward in a line-of-sight fashion, which severely limits anatomical access. The robot we present in this paper aims to overcome these challenges. The end effector of the robot is a steerable laser fiber, created through the combination of a thin optical fiber ( 0.225 mm) with a tendon-actuated Nickel-Titanium notched sheath that provides bending. This device can be seamlessly used with most commercially available endoscopes, as it is sufficiently small ( 1.1 mm) to pass through a working channel. To control the fiber, we propose a compact actuation unit that can be mounted on top of the endoscope handle, so that, during a procedure, the operating physician can operate both the endoscope and the steerable fiber with a single hand. We report simulation and phantom experiments demonstrating that the proposed device substantially enhances surgical access compared to current clinical fibers.

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Section: B Challenges Of Office Proceduresmentioning

confidence: 99%

Section: B Challenges Of Office Proceduresmentioning

confidence: 99%

Section: Design Specificationsmentioning

confidence: 99%

Section: Reachable Workpace Characterizationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Light in the Larynx: a Miniaturized Robotic Optical Fiber for In-office Laser Surgery of the Vocal Folds

Chiluisa¹,

Pacheco²,

Do³

et al. 2022

Preprint

Self Cite

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Benefits of Side‐Firing Optical Fibers in Endoscopic Laser Treatment of the Larynx

et al. 2022

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Objective: To elucidate potential tissue coverage of side-firing optical fibers in office-based endoscopic laser treatment of larynx, as well as to demonstrate their enhanced ability to address challenging anatomic areas.Method: We performed a comparative study of four different fiber designs: a traditional forward-facing fiber, and three side-firing fibers that emit light at an angle of 45 , 70 , and 90 , respectively. The study was conducted in simulation, using eight three-dimensional models of the human larynx generated from microtomography x-ray scans. A computer program simulated the insertion of the endoscope into the larynx, and the Möller-Trumbore algorithm was used to simulate the application of laser light.Results: Side-firing laser fibers increased potential tissue coverage by a mean of 50.2 (standard deviation [SD] 25.8), 73.8 (SD 41.3), and 84.0 (SD 47.6) percent for angles of 45 , 70 , and 90 , respectively, compared to forward-facing fibers. Angled fibers provided access to areas of the larynx considered difficult to address by traditional methods, including the infraglottis, laryngeal ventricle, and right vocal fold.Conclusion: Simulation results suggest that side-firing optical fibers have the potential to enhance anatomical access during in-office endoscopic laser procedures in the larynx. Further research is needed to better understand the benefits and any potential risks or contraindications of side-firing optical fibers.

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Optical Fiber Coupling System for Steerable Endoscopic Instruments

Zhu

Shen

Chiluisa

et al. 2021

2021 43rd Annual International Conference of the IEEE Engineering in Medicine &Amp; Biology Society (EMBC)

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On the merits of using angled fiber tips in office-based laser surgery of the vocal folds

Cited by 4 publications

References 0 publications

Light in the Larynx: a Miniaturized Robotic Optical Fiber for In-office Laser Surgery of the Vocal Folds

Light in the Larynx: a Miniaturized Robotic Optical Fiber for In-office Laser Surgery of the Vocal Folds

Benefits of Side‐Firing Optical Fibers in Endoscopic Laser Treatment of the Larynx

Optical Fiber Coupling System for Steerable Endoscopic Instruments

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