Robotic Tele-Operation for Upper Aerodigestive Tract Microsurgery: System Design and Validation

TL;DR

The paper addresses the challenge of manual tissue manipulation during transoral laser microsurgery in the upper aerodigestive tract ($UADT$) by introducing a teleoperation system that enforces a remote center of motion ($RCM$) constraint. A master-slave setup uses a haptic device ($ ext{Omega.7}$) and a Franka Panda robot with a custom forceps end-effector to map surgeon input to $RCM$-constrained motions. Key contributions include the end-effector design, software-implemented $RCM$ constraint, and extensive validation including a pilot silicone vocal fold study, sEMG analysis, and usability assessments. Results show improved grasp stability, reduced muscular effort, and positive user experience, supporting potential improvements in precision and ergonomics for $UADT$ microsurgery.

Abstract

Upper aerodigestive tract (UADT) treatments frequently employ transoral laser microsurgery (TLM) for procedures such as the removal of tumors or polyps. In TLM, a laser beam is used to cut target tissue, while forceps are employed to grasp, manipulate, and stabilize tissue within the UADT. Although TLM systems may rely on different technologies and interfaces, forceps manipulation is still predominantly performed manually, introducing limitations in ergonomics, precision, and controllability. This paper proposes a novel robotic system for tissue manipulation in UADT procedures, based on a novel end-effector designed for forceps control. The system is integrated within a teleoperation framework that employs a robotic manipulator with a programmed remote center of motion (RCM), enabling precise and constrained instrument motion while improving surgeon ergonomics. The proposed approach is validated through two experimental studies and a dedicated usability evaluation, demonstrating its effectiveness and suitability for UADT surgical applications.

Figures (6)

• Figure 1: OR setup example during UADT procedures.
• Figure 2: Proposed teleoperation system. On the surgeon side, the master operator takes control by simultaneously pressing two enabling pedals, thus sending velocity commands with the remote controller. On the patient side, the slave robot moves our custom end-effector, whose open-close movements are controlled directly from the operator.
• Figure 3: Schematic representation of the forceps' manipulator.
• Figure 4: Controller analysis: (a) placement of the position sensors, (b) task requirement on silicone vocal fold with simulated polyps, (c) outcomes of freehand vs. teleoperation in terms of RMS of the acceleration's norm.
• Figure 5: Outcomes of sEMG experiment.