Recently, there has been a significant movement in otolaryngology-head and neck surgery (OHNS) toward minimally invasive techniques, particularly those utilizing natural orifices. However, while these techniques can reduce the risk of complications encountered with classic open approaches such as scarring, infection, and damage to healthy tissue in order to access the surgical site, there remain significant challenges in both visualization and manipulation, including poor sensory feedback, reduced visibility, limited working area, and decreased precision due to long instruments. This work presents two robotic assistance systems which help to overcome different aspects of these challenges.
The first is the Robotic Endo-Laryngeal Flexible (Robo-ELF) Scope, which assists surgeons in manipulating flexible endoscopes. Flexible endoscopes can provide superior visualization compared to microscopes or rigid endoscopes by allowing views not constrained by line-of-sight. However, they are seldom used in the operating room due to the difficulty in precisely manually manipulating and stabilizing them for long periods of time. The Robo-ELF Scope enables stable, precise robotic manipulation for flexible scopes and frees the surgeon’s hands to operate bimanually. The Robo-ELF Scope has been demonstrated and evaluated in human cadavers and is moving toward a human subjects study.
The second is the Robotic Ear Nose and Throat Microsurgery System (REMS), which assists surgeons in manipulating rigid instruments and endoscopes. There are two main types of challenges involved in manipulating rigid instruments: reduced precision from hand tremor amplified by long instruments, and difficulty navigating through complex anatomy surrounded by sensitive structures. The REMS enables precise manipulation by allowing the surgeon to hold the surgical instrument while filtering unwanted movement such as hand tremor. The REMS also enables augmented navigation by calculating the position of the instrument with high accuracy, and combining this information with registered preoperative imaging data to enforce virtual safety barriers around sensitive anatomy. The REMS has been demonstrated and evaluated in user studies with synthetic phantoms and human cadavers
