Development and image-guided control of a robotic endoscope system for nasotracheal intubation

Abstract

Nasotracheal intubation (NTI) is an advanced airway management technique, in which a flexible endoscope is inserted into the patient’s trachea from the nasal cavity. Due to the hand-eye coordination requirement, the operation of the flexible endoscope in a narrow workspace is a challenge, even for experienced surgeons. In this study, a novel robotic nasotracheal intubation system (RNIS) is proposed to automatically steer the endoscope along the upper respiratory tract. The configuration of the RNIS meets the motion requirement of the flexible endoscope. A lumen center detection method with Kalman filter is designed to determine the position of the lumen center in endoscopic images. Then, a fuzzy logic-based control strategy is developed to enable the RNIS to achieve automatic endoscope steering. Control parameters are updated online using a fuzzy logic algorithm to handle uncertainty. Movements in three degrees of freedom of the endoscope are controlled by the RNIS using visual feedback. Finally, experiments based on a motion simulator and a training mannequin are conducted. Results demonstrate that the proposed RNIS can successfully steer the flexible endoscope along the upper respiratory tract. Automated robotic endoscopes outperform manual operations in terms of operational accuracy.