The robotic ENT microsurgery system: A novel robotic platform for microvascular surgery

Feng, Allen L.; Razavi, Christopher R.; Lakshminarayanan, P.; Ashai, Zaid; Olds, Kevin; Balicki, Marcin; Gooi, Zhen; Day, Andrew T.; Taylor, Russell H.; Richmon, Jeremy D.

doi:10.1002/lary.26667

Cited by 24 publications

(32 citation statements)

References 29 publications

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Section: Introductionmentioning

confidence: 99%

“…Intraoperative neural monitoring (IONM) for thyroid and parathyroid surgery is one of several important technological advancements incorporated into head and neck surgery. [1][2][3][4][5][6][7][8] IONM has become increasingly prevalent, with many surgeons using it routinely. [9][10][11][12][13] Although IONM has become more widespread, universal incorporation and attitudes toward its utility in preventing recurrent laryngeal nerve (RLN) dysfunction have remained heterogeneous.…”

Section: Introductionmentioning

confidence: 99%

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Increased prevalence of neural monitoring during thyroidectomy: Global surgical survey

et al. 2019

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Objective To investigate intraoperative nerve monitoring (IONM) use among thyroid surgeons. Methods A 25‐question survey was used to assess attitudes regarding IONM use. Surveys were sent to surgeons registered to the American Academy of Otolaryngology–Head and Neck Surgery, International Association of Endocrine Surgeons, and American Head and Neck Society. Results Among 1,015 respondents, 83% reported using IONM (65.1% always using IONM and 18.1% reporting selective use). For selective users, a majority reported using IONM for reoperative cases (95.1%) and in cases with preoperative vocal cord paralysis (59.8%). When comparing location, there was a significant difference in IONM implementation (P < 0.001), with 70.4% of North American responders using it ubiquitously compared to 27.4% of non‐North American responders. Preoperative laryngeal exam was performed more universally by North American surgeons and more selectively by non‐North American surgeons (P < 0.001). Other attitudes toward their implementation and the postoperative laryngeal exam were similar. Surgeons ≤45 years of age and those with ≤15 years of practice used IONM more than their peers (P < 0.001). Thyroid surgery volume, fellowship training, and type of practice had no bearing on IONM use. Conclusion The prevalence of IONM in thyroid and parathyroid surgeries has increased significantly over the past decade, with 83% of surgeons using IONM in some or all cases. Although IONM use may be more ubiquitous in North America, attitudes toward its implementation and pre‐ and postoperative laryngeal exams are fairly uniform. IONM use is more prevalent among younger surgeons, whereas its use has no correlation with thyroid surgery volume or type of practice. Level of Evidence 4 Laryngoscope, 130:1097–1104, 2020

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Increased prevalence of neural monitoring during thyroidectomy: Global surgical survey

et al. 2019

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“…Details of the REMS platform, its design, and its function have been previously described within both the robotic and OHNS literature. [15][16][17][18][19] In brief, the technology was developed at the Johns Hopkins Laboratory for Computational Sensing and Robotics (Baltimore, MD) and is now under a licensing agreement with Galen Robotics, Inc. It consists of a robotic gantry arm that stabilizes the user's primary instrument along six degrees of freedom.…”

Section: The Remsmentioning

confidence: 99%

“…The Robotic ENT (Ear, Nose, and Throat) Microsurgery System (REMS) (Galen Robotics, Inc., Sunnyvale, CA) is a novel robotic platform designed specifically for otolaryngology–head and neck surgery (OHNS). Previously, we have demonstrated its feasibility and utility in performing simulated microsurgical and microlaryngeal tasks with heightened precision and dampened tremor . The REMS operates via a cooperative‐control mechanism with which the user and robot manipulate the surgical instrument together.…”

Section: Introductionmentioning

confidence: 99%

“…Previously, we have demonstrated its feasibility and utility in performing simulated microsurgical and microlaryngeal tasks with heightened precision and dampened tremor. 15,16 The REMS operates via a cooperative-control mechanism with which the user and robot manipulate the surgical instrument together. Conventional surgical instruments ranging from microvascular needle drivers to microlaryngeal forceps are fitted with custom adapters to articulate with the gantry arm of the REMS.…”

Section: Introductionmentioning

confidence: 99%

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Real‐time robotic airway measurement: An additional benefit of a novel steady‐hand robotic platform

et al. 2018

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Objective Describe the secondary capability of a robotic system to provide real‐time measurements of airway dimensions with high fidelity. Methods Seven unique phantoms of laryngotracheal stenosis (LTS) were modeled using a computer‐aided design tool and were three dimensionally printed. These stenoses were of different dimensions and orientations, and some were purposefully oblique. The dimensions of the stenoses were then measured with the novel Robotic ENT (Ear, Nose, and Throat) Microsurgery System (REMS; Galen Robotics, Inc., Sunnyvale, CA) because it is capable of tool position memory in three dimensional (3D) space. Five participants (two laryngologists, two otolaryngology–head and neck surgery residents, one neurotology fellow) measured each axis of stenosis (anteroposterior, lateral, and craniocaudal) three times for each of the seven stenosis phantoms. These measurements were then compared to the known design dimensions. Mean magnitude of error (MOE) and interrater reliability (IRR) using an intraclass correlation coefficient (ICC) were then calculated. Results Mean MOE and standard deviation for all measurements was 0.306 ± 0.247 mm. Mean MOE was 0.374 ± 0.292 mm, 0.300 ± 0.237 mm, and 0.244 ± 0.185 mm for the anteroposterior, lateral, and craniocaudal dimensions of stenosis, respectively. Eighty‐two percent of all measurements had MOE < 0.5 mm. ICC was 0.945 (95% confidence interval [CI]: 0.847–0.989), 0.995 (95% CI: 0.984–0.999), and 0.993 (95% CI: 0.987–0.999) for anteroposterior, lateral, and craniocaudal dimensions, respectively, indicating excellent agreement among participants. Conclusion The REMS can be used to reliably and accurately measure airway dimensions in 3D regardless of the orientation of stenosis. This ability may be easily extrapolated to the measurement of any airway lesion during laryngotracheal surgery. Level of Evidence 4 Laryngoscope, 129:324–329, 2019

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Laryngeal force sensor metrics are predictive of increased perioperative narcotic requirements

et al. 2019

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Objectives/Hypothesis: To determine the relationship between force metrics measured by the laryngeal force sensor (LFS) during suspension microlaryngoscopy (SML) and perioperative narcotic requirements.Study Design: Prospective observational study. Methods: Compressive tissue forces were recorded during SML using the LFS and correlated with postoperative narcotic requirements in the postanesthesia care unit (PACU) at an academic tertiary center. Patients were prospectively enrolled and had force metrics recorded throughout each procedure including maximum force, average force, suspension time, and total impulse. Narcotic administration in the intraoperative period and PACU were also recorded and converted into intravenous morphine equivalents (ME). Surgeons were blinded to the force recordings during surgery to prevent operator bias.Results: Eighty-two patients completed the study. Of these patients, the mean perioperative ME requirement was 16.96 mg (range, 0.15-79.82 mg). Univariate analysis demonstrated a positive correlation between perioperative narcotic requirements and total suspension time (P < .001) as well as total impulse (P = .007). A positive correlation was also seen with maximum force, although not significantly. On multiple linear regression, total suspension time was a significant predictive variable for perioperative narcotic use, with a marginal incremental increase of 0.273 mg of ME per minute of total suspension time (0.273 mg/min, 95% confidence interval: 0.040-0.507 mg/min, P = .022).Conclusions: Intraoperative force metrics including total suspension time are predictive of increased perioperative narcotic requirement after SML. Total impulse during SML may also correlate with increased perioperative narcotic requirements.

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The robotic ENT microsurgery system: A novel robotic platform for microvascular surgery

Abstract: NA. Laryngoscope, 127:2495-2500, 2017.

Cited by 24 publications

References 29 publications

Increased prevalence of neural monitoring during thyroidectomy: Global surgical survey

Increased prevalence of neural monitoring during thyroidectomy: Global surgical survey

Real‐time robotic airway measurement: An additional benefit of a novel steady‐hand robotic platform

Laryngeal force sensor metrics are predictive of increased perioperative narcotic requirements

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