Robotic endolaryngeal flexible (Robo‐ELF) scope: A preclinical feasibility study

Olds, Kevin; Hillel, Alexander T.; Cha, Elizabeth; Curry, Martin; Akst, Lee M.; Taylor, Russell H.; Richmon, Jeremy D.

doi:10.1002/lary.22341

Cited by 17 publications

(12 citation statements)

References 6 publications

(9 reference statements)

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“…The da Vinci robot (Intuitive Surgical, Inc., Sunnyvale, CA) has been used extensively in transoral robotic surgery of the oropharynx; however, it has been sparsely used in endonasal surgery . This is because the da Vinci robot (Intuitive Surgical, Inc., Sunnyvale, CA) was primarily designed with opposing arms via widely spaced ports for abdominal and thoracic surgery, which is very different from the coaxial manipulation and entry through the narrow nostril for endonasal surgery . To use the da Vinci robot (Intuitive Surgical, Inc., Sunnyvale, CA) to operate within the nasal cavity would therefore require external incisions, rendering the use of this system relatively invasive.…”

Section: Introductionmentioning

confidence: 99%

Foot‐controlled robotic‐enabled endoscope holder for endoscopic sinus surgery: A cadaveric feasibility study

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Foot‐controlled robotic‐enabled endoscope holder for endoscopic sinus surgery: A cadaveric feasibility study

et al. 2015

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“…An initial publication documented ability of the flexible robot to visualize the larynx without suspension laryngoscopy, and a further preclinical study has shown successful epiglottectomies in five cadaver specimens and a vocal cord excision in a single cadaver specimen . Similar robotic systems have been described for manipulation of rigid and flexible endoscopes, though the benefits in each case are limited to robotic control of the endoscope itself rather than any robotically enhanced precision of surgical tools otherwise.…”

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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“…The da Vinci master‐slave type robotic surgical system has been used to demonstrate safe and feasible TORS,27, 28, 34 and evidence of decreased length of hospital stay and morbidity is now also becoming available 12, 16. Based on favorable oncologic and functional outcomes demonstrated in multiple studies12, 16–18, 21, 35, 36 and the increasing incidence of oropharyngeal carcinoma secondary to the HPV epidemic in younger healthier patients, TORS is gaining increasing adoption as a useful surgical technique for these tumors.…”

Section: Discussionmentioning

confidence: 99%

Objective assessment in residency‐based training for transoral robotic surgery

Curry

Malpani

et al. 2012

The Laryngoscope

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Objective To develop a robotic surgery training regimen integrating objective skill assessment for otolaryngology and head and neck surgery trainees consisting of training modules of increasing complexity and leading up to procedure specific training. In particular, we investigate applications of such a training approach for surgical extirpation of oropharyngeal tumors via a transoral approach using the da Vinci Robotic system. Study Design Prospective blinded data collection and objective evaluation (OSATS) of three distinct phases using the da Vinci Robotic surgical system. Setting Academic University Medical Engineering/Computer Science laboratory Methods Between September 2010 and July 2011, 8 Otolaryngology Head and Neck Surgery residents and 4 staff “experts” from an academic hospital participated in three distinct phases of robotic surgery training involving 1) robotic platform operational skills, 2) set-up of the patient side system, and 3) a complete ex-vivo surgical extirpation of an oropharyngeal “tumor” located in the base of tongue. Trainees performed multiple (4) approximately equally spaced training sessions in each stage of the training. In addition to trainees, baseline performance data was obtained for the experts. Each surgical stage was documented with motion and event data captured from the application programming interfaces (API) of the da Vinci system, as well as separate video cameras as appropriate. All data was assessed using automated skill measures of task efficiency, and correlated with structured assessment (OSATS, and similar Likert scale) from three experts to assess expert and trainee differences, and compute automated and expert assessed learning curves. Results Our data shows that such training results in an improved didactic robotic knowledge base and improved clinical efficiency with respect to the set-up and console manipulation. Experts (e.g. average OSATS 25, Stdev. 3.1, module 1 – suturing) and trainees (average OSATS 15.9, Stdev. 3.9, week 1) are well separated at the beginning of the training, and the separation reduces significantly (expert average OSATS 27.6, Std. 2.7, trainee average OSATS 24.2, Std. 6.8, module 3) at the conclusion of the training. Learning curves in each of the three stages show diminishing differences between the experts and trainees, also consistent with expert assessment. Subjective assessment by experts verified the clinical utility of the module 3 surgical environment and a survey of trainees consistently rated the curriculum as very useful in progression to human operating room assistance. Conclusions Structured curricular robotic surgery training with objective assessment promises to reduce the overhead for mentors, allow detailed assessment of human-machine interface skills and create customized training models for individualized training. This preliminary study verifies the utility of such training in improving human-machine operations skills (module 1), and operating room and surgical skills (module 2 and 3). In contrast to cur...

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Robotic endolaryngeal flexible (Robo‐ELF) scope: A preclinical feasibility study

Abstract: The Robo-ELF is a novel robot to assist in driving a flexible endoscope for surgery of the upper aerodigestive tract.

Cited by 17 publications

References 6 publications

Foot‐controlled robotic‐enabled endoscope holder for endoscopic sinus surgery: A cadaveric feasibility study

Foot‐controlled robotic‐enabled endoscope holder for endoscopic sinus surgery: A cadaveric feasibility study

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

Objective assessment in residency‐based training for transoral robotic surgery

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