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Robot-assisted transnasal laryngoplasty in cadaveric models: Quantifying forces and identifying challenges
Kelly Groom1, Long Wang, Nabil Simaan
1Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
The Laryngoscope
|February 4, 2015
Summary
Transnasal robotic surgery (TNRS) shows feasibility for laryngoplasty in cadavers, with faster insertion times than flexible fiberoptic laryngoscopy. While forces were higher, no tissue trauma was observed, though tongue base collapse posed a challenge.
Area of Science:
- Minimally Invasive Surgery
- Robotic Surgery
- Laryngeal Surgery
- Otolaryngology
Background:
- Transnasal robotic surgery (TNRS) is an emerging technique for accessing the upper airway.
- Prior work established foundational principles for TNRS.
- Laryngoplasty, a procedure to improve vocal cord function, often requires precise access to the larynx.
Purpose of the Study:
- To evaluate the feasibility of performing laryngoplasty using transnasal robotic surgery (TNRS) in a cadaveric model.
- To quantify robot insertion times and forces compared to a flexible fiberoptic laryngoscope (FFL).
- To identify operational challenges to inform the development of advanced flexible robotic systems for laryngeal interventions.
Main Methods:
- A cadaveric study was conducted using a 5-mm robotic system navigated transnasally to the larynx.
- Insertion times and forces were measured for TNRS and compared with a 4-mm flexible fiberoptic laryngoscope (FFL).
- Telemanipulation was used with TNRS to perform injection laryngoplasty on target sites on the true vocal cords.
Main Results:
- TNRS insertion averaged 5.05 seconds, significantly faster than FFL at 7.97 seconds (P=.0024).
- TNRS insertion forces averaged 2.06 newtons, higher than FFL's 0.43 newtons (P=.0000658), but within a comparable scale.
- Successful injection laryngoplasty was achieved at seven sites; however, tongue base collapse obscured access in two instances.
Conclusions:
- Transnasal robotic surgery (TNRS) provides effective laryngeal access for procedures like laryngoplasty.
- While TNRS insertion forces are higher than FFL, they do not appear to cause tissue trauma.
- Supine positioning in cadaveric models can present challenges like tongue base collapse, requiring further system development.
