Teleoperated tubular continuum robots for transoral surgery – feasibility in a porcine larynx model

Friedrich, Daniel; Modes, Vincent; Hoffmann, Thomas; Greve, Jens; Schuler, I. Patrick J.; Burgner-Kahrs, Jessica

doi:10.1002/rcs.1928

Cited by 13 publications

(6 citation statements)

References 43 publications

(68 reference statements)

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“…Even the flexible robotic systems (Medrobotics®) in transoral surgery were optimized and carried out as described before. 1 -3,6,7,20 -23 Transoral robotic surgery as well as the da Vinci Surgical System cannot be applied in skull base surgery due to the fact that these systems are too big for endonasal surgery. Moreover, there are no surgical instruments which can be used with these systems (eg, forceps, drill, piezo system).…”

Section: Discussionmentioning

confidence: 99%

“…Transoral robotic surgery (TORS) has proven to be an effective tool for resection of head and neck tumors. [1][2][3][4][5][6][7] In this field, 3 approved robotic surgery systems are available: The Intuitive da Vinci system, the Medrobotics Flex Robotic Systems for TORS, and the Medineering Robotic Endoscope Guiding System. Originally designed for robotic endoscope guiding in endoscopic sinus and skull base surgery, the Medineering Robotic Endoscope Guiding System is approved for robotic assistance in all ENT procedures, including transoral endoscopic surgery and endoscopic ear surgery.…”

Section: Introductionmentioning

confidence: 99%

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First Use of a New Robotic Endoscope Guiding System in Endoscopic Orbital Decompression

et al. 2019

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Purpose: Over the last years, robot-assisted surgery gained in importance in head and neck surgery. In our study, we used a new robotic endoscope guiding system in patients undergoing endoscopic balanced orbital decompression. The aim of the study is to evaluate the feasibility and benefit of a robotic arm in endoscopic orbital surgery. Methods: The Medineering Robotic Endoscope Guiding System is a robotic arm designed for holding an endoscope during interventions. An endoscope equipped with a 4K camera was attached at the tip of the robotic arm and placed in the surgical field. The surgeon controlled the movements of the endoscope with foot pedal. Eight patients underwent balanced endoscopic orbital decompression showing typical symptoms of Graves’ orbitopathy preoperatively. Balanced decompression was performed via a combined approach transnasally and laterally via a small skin incision. Results: Attaching the endoscope to the robotic guiding system and placing it in the nasal cavity were relatively simple procedures. Setup time was less than 10 minutes. Tool motion and control using the foot pedal were comfortable and adequately precise. Movements of the attached endoscope inside the nose were feasible and allowed 2-hand surgery. The patients did not show any adverse events or complications. Conclusion: The Medineering Robotic Endoscope Guiding System seems to be a safe and effective support in endoscopic skull base surgery especially for orbital decompression, thus allowing 2-hand or even 4-hand settings. To the best of our knowledge, this is the first study describing the successful application of a robotic system in orbital surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

First Use of a New Robotic Endoscope Guiding System in Endoscopic Orbital Decompression

et al. 2019

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“…Two domestic pig laryngeal specimens with surrounding structures (epiglottis, tongue, trachea, esophagus) were taken to a surgical setting. In order to simulate the anatomy of a patient lying supine, the laryngeal model was clamped in a custom‐made frame as previously described 23 . The surgical system was attached to a horizontal operating rod, which was fastened by two height‐adjustable rods, and the view was adjusted on vocal folds level.…”

Section: Methodsmentioning

confidence: 99%

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

Schild

Böhm

Boos³

et al. 2020

The Laryngoscope

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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

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“…Current robotic instruments are still too bulky for delicate procedures on the vocal cords, limiting their effective use to the oral cavity, pharynx and supraglottic regions. Nevertheless, research continues to push this boundary with the development of small-sized robotic instruments, such as those based on concentric tube technology ( Friedrich et al, 2018 ).…”

Section: Clinical Context and Key Endoscopic Laser Microsurgery Objectivesmentioning

confidence: 99%

μRALP and Beyond: Micro-Technologies and Systems for Robot-Assisted Endoscopic Laser Microsurgery

et al. 2021

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Laser microsurgery is the current gold standard surgical technique for the treatment of selected diseases in delicate organs such as the larynx. However, the operations require large surgical expertise and dexterity, and face significant limitations imposed by available technology, such as the requirement for direct line of sight to the surgical field, restricted access, and direct manual control of the surgical instruments. To change this status quo, the European project μRALP pioneered research towards a complete redesign of current laser microsurgery systems, focusing on the development of robotic micro-technologies to enable endoscopic operations. This has fostered awareness and interest in this field, which presents a unique set of needs, requirements and constraints, leading to research and technological developments beyond μRALP and its research consortium. This paper reviews the achievements and key contributions of such research, providing an overview of the current state of the art in robot-assisted endoscopic laser microsurgery. The primary target application considered is phonomicrosurgery, which is a representative use case involving highly challenging microsurgical techniques for the treatment of glottic diseases. The paper starts by presenting the motivations and rationale for endoscopic laser microsurgery, which leads to the introduction of robotics as an enabling technology for improved surgical field accessibility, visualization and management. Then, research goals, achievements, and current state of different technologies that can build-up to an effective robotic system for endoscopic laser microsurgery are presented. This includes research in micro-robotic laser steering, flexible robotic endoscopes, augmented imaging, assistive surgeon-robot interfaces, and cognitive surgical systems. Innovations in each of these areas are shown to provide sizable progress towards more precise, safer and higher quality endoscopic laser microsurgeries. Yet, major impact is really expected from the full integration of such individual contributions into a complete clinical surgical robotic system, as illustrated in the end of this paper with a description of preliminary cadaver trials conducted with the integrated μRALP system. Overall, the contribution of this paper lays in outlining the current state of the art and open challenges in the area of robot-assisted endoscopic laser microsurgery, which has important clinical applications even beyond laryngology.

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Teleoperated tubular continuum robots for transoral surgery – feasibility in a porcine larynx model

Abstract: Despite proven feasibility, there is a need for further improvements. A version with dual robot arms would be essential to realize a pre-market prototype for further investigation in a human model.

Cited by 13 publications

References 43 publications

First Use of a New Robotic Endoscope Guiding System in Endoscopic Orbital Decompression

First Use of a New Robotic Endoscope Guiding System in Endoscopic Orbital Decompression

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

μRALP and Beyond: Micro-Technologies and Systems for Robot-Assisted Endoscopic Laser Microsurgery

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