Robotic Assisted Cleft Palate Repair Using Novel 3 mm Tools: A Reachability and Collision Analysis.

Area of Science:

• Pediatric Surgery
• Robotic Surgery
• Surgical Instrumentation

Background:

• Infant cleft palate repair presents significant surgical challenges due to limited visualization and restricted instrument access.
• Standard surgical instruments often hinder delicate dissection and maneuverability within the confined infant oral cavity.

Purpose of the Study:

• To develop and evaluate a novel 3 mm diameter pin-jointed wristed tool for robotic-assisted infant cleft palate surgery.
• To assess the impact of the new tool on instrument reachability, collision rates, and visual field obstruction.

Main Methods:

• A reachability simulation analysis was conducted to quantify tool-tool and tool-cavity collisions within the oral cavity at various dVRK trocar heights.
• Physical experiments were performed on a high-fidelity cleft palate simulator, comparing 3 mm tools to 8 mm tools for suturing tasks and full robotic-assisted repair.
• The study also investigated the effect of trocar height on tool performance to validate simulation findings.

Main Results:

• The 3 mm wristed tools resulted in fifteen times fewer tool-cavity collisions and 21% less visual obstruction compared to the 8 mm tools.
• Collision rates increased posteriorly within the oral cavity and with greater dVRK trocar height.
• Physical experiments confirmed the enhanced functionality and reduced collision risk of the 3 mm tools.

Conclusions:

• The developed 3 mm wristed tools are effective for robotic-assisted infant cleft palate repair, offering improved maneuverability and reduced collisions.
• Reachability analysis highlights the importance of minimizing trocar height to mitigate collision risks deeper within the oral cavity.