An Innovative Computerized Control System in Transoral Laser Surgery of the Larynx

Abstract

Objectives: 1) Describe a new computerized system in transoral laser surgery of the larynx based on a tablet stylus interface. The mechanical joystick interface currently used is the major limiting factor for surgical precision, quality, and safety, requiring extensive surgeon practice. 2) Analyze the statistical reduction of absolute and root-mean-square error (RMS error) with the stylus interface in path-follow trials. Methods: A new robotic system for transoral laser surgery has been created to improve the surgeon’s control. It offers a more ergonomic, intuitive, and programmable laser control device: a touch interface with dynamic intraoperative planning capabilities. The system is based on a large-range laser scanner fully controlled by a stylus on a tactile sensor. It aims the laser in real-time over the whole surgical field and allows path memorization, providing accurate repetitions of surgeon-defined laser paths. This enables pre-execution surgical action tracking and unmatched control for long cuts. Paths of any shape and length are dynamically planned too with the plain stylus device. Results: Trials on ex-vivo pig larynges and artificial targets performed by experienced and non-experienced surgeons demonstrate a drop of 80% in max absolute error and about 50% in RMS error with the stylus interface in path-follow trials. Dynamic planning has also demonstrated its benefits. No error was observed in trials, getting only .03 mm mean RMS error under a 40× microscope magnification. Conclusions: Trials so far have assessed the new system as highly intuitive and effective. It improves surgical precision, quality, and safety.