TY - JOUR

T1 - Preclinical Performance Evaluation of a Robotic Endoscope for Non-Contact Laser Surgery

AU - Kundrat, D.

AU - Graesslin, R.

AU - Schoob, A.

AU - Friedrich, D. T.

AU - Scheithauer, M. O.

AU - Hoffmann, T. K.

AU - Ortmaier, T.

AU - Kahrs, L. A.

AU - Schuler, P. J.

N1 - Funding Information: Open Access funding provided by Projekt DEAL. This work was partially supported by the European Seventh Framework Programme FP7-ICT under grant agreement μRALP no. 288663. The authors thank Thomas Piskon and Sontje Ihler for study support and all volunteers at Leibniz Universität Hannover and Ulm University Medical Centre for participation.

PY - 2021/2

Y1 - 2021/2

N2 - Despite great efforts, transoral robotic laser surgery has not been established clinically. Patient benefits are yet to be proven to accept shortcomings of robotic systems. In particular, laryngeal reachability and transition from microscope to accurate endoscopic laser ablation have not been achieved. We have addressed those challenges with a highly integrated robotic endoscope for non-contact endolaryngeal laser surgery. The current performance status has been assessed in multi-level user studies. In addition, the system was deployed to an ex vivo porcine larynx. The robotic design comprises an extensible continuum manipulator with multifunctional tip. The latter features laser optics, stereo vision, and illumination. Vision-based performance assessment is derived from depth estimation and scene tracking. Novices and experts (n = 20) conducted teleoperated delineation tasks to mimic laser ablation of delicate anatomy. Delineation with motion-compensated and raw endoscopic visualisation was carried out on planar and non-planar nominal patterns. Root mean square tracing errors of less than 0.75 mm were feasible with task completion times below 45 s. Relevant anatomy in the porcine larynx was exposed successfully. Accuracy and usability of the integrated platform bear potential for dexterous laser manipulation in clinical settings. Cadaver and in vivo animal studies may translate ex vivo findings.

AB - Despite great efforts, transoral robotic laser surgery has not been established clinically. Patient benefits are yet to be proven to accept shortcomings of robotic systems. In particular, laryngeal reachability and transition from microscope to accurate endoscopic laser ablation have not been achieved. We have addressed those challenges with a highly integrated robotic endoscope for non-contact endolaryngeal laser surgery. The current performance status has been assessed in multi-level user studies. In addition, the system was deployed to an ex vivo porcine larynx. The robotic design comprises an extensible continuum manipulator with multifunctional tip. The latter features laser optics, stereo vision, and illumination. Vision-based performance assessment is derived from depth estimation and scene tracking. Novices and experts (n = 20) conducted teleoperated delineation tasks to mimic laser ablation of delicate anatomy. Delineation with motion-compensated and raw endoscopic visualisation was carried out on planar and non-planar nominal patterns. Root mean square tracing errors of less than 0.75 mm were feasible with task completion times below 45 s. Relevant anatomy in the porcine larynx was exposed successfully. Accuracy and usability of the integrated platform bear potential for dexterous laser manipulation in clinical settings. Cadaver and in vivo animal studies may translate ex vivo findings.

KW - Ablation

KW - Continuum robot

KW - Endoscopy

KW - Haptics

KW - Head

KW - Motion compensation

KW - Neck

KW - Performance

KW - TORS

KW - Tracking

UR - http://www.scopus.com/inward/record.url?scp=85089357325&partnerID=8YFLogxK

U2 - 10.1007/s10439-020-02577-y

DO - 10.1007/s10439-020-02577-y

M3 - Article

AN - SCOPUS:85089357325

VL - 49

SP - 585

EP - 600

JO - Annals of biomedical engineering

JF - Annals of biomedical engineering

SN - 0090-6964

IS - 2

ER -