Revista de medicina pulmonar

Robotic microlaryngeal surgery – Where we are and where we’re going

Lee M Akst

This presentation will review limitations of current robotic approaches to microlaryngoscopy, and will introduce the audience to a new robotic technology with the potential to change how microlaryngeal surgeries are performed. The evolution of laryngeal surgical techniques has been driven by the promise of increased operative precision. Coincident with advances in microlaryngeal surgery have been similar, though more rapid, advances in robot-assisted surgery within Otolaryngology. From well-established use of the da Vinci surgical robot for ablative procedures of the pharynx to newer applications for robot-assisted procedures such as thyroid surgery and skull base surgery, robotic-assisted surgery is growing. Despite these advances, robot-assisted surgery is not yet routinely incorporated into microlaryngeal surgery. Current limitations for existing commercial systems include size of available instrumentation; difficulty manipulating robotic effector arms within narrow working space afforded by standard retractors, and reduced haptic feedback that comes from working remotely rather than handling tissues directly. Even as smaller instruments and new retractors are being developed, existing robots have been largely limited to laryngeal procedures such as vocal cord stripping, cordectomy, and partial epiglottectomy – procedures in which preservation of normal vocal fold anatomy and function are not prioritized. To address these issues and create a role for robotic assistance in microlaryngoscopy, a novel robotic ENT microsurgery system (REMS) has been developed. This system emphasizes cooperative control, rather than remote control, of a microsurgical instrument; traditional microlaryngoscopy instruments are utilized with both the robot arm and surgeon controlling the same instrument. The ability of this REMS system to improve precise performance of simulated microlaryngoscopy tasks has been demonstrated in a variety of research studies. These preliminary studies, their methods, and their results will be reviewed; surgical videos will demonstrate the robot ‘in action’. The REMS platform may represent the next step in the evolution of robotic microlaryngeal surgery