Lasers form an increasingly common tool for precision treatment of pathological conditions on delicate and vital human organs. Laser phonomicrosurgery, which involves a set of complex otolaryngological surgical techniques for the treatment of minute abnormalities in the larynx, is one such example. In this case, meticulous surgery is required to treat a range of malignant and benign pathologies that can affect this important organ, including cancer, cysts, polyps, and reactive lesions.
|Normal larynx: Medial edges of the vocal folds are straight and touch smoothly during phonation.||Vocal fold cyst||Vocal fold carcinoma.
Pictures reproduced from ENT USA
In laser phonomicrosurgeries a CO2 surgical laser is commonly used to perform the precise ablation or cutting procedures involved in the pathology treatment. Accurate laser aiming is extremely important since preserving healthy tissue while completely removing the pathology is a major goal to minimize surgical impact on voice quality. However, traditional laser aiming control relies entirely on the dexterity of surgeons, who must operate through a microscope and deal with its associated poor ergonomics, and this can have a strong impact on the quality of the procedures.
Fig. 2. Montage illustrating a typical operative setup for laser phonomicrosurgery. Ergonomic issues negatively influence the precision and safety of the procedures, and the surgeon’s longstanding neck and back health.
Our research in laser phonomicrosurgery aims at the development of assistive robotic systems to provide accuracy, safety, better ergonomics, and reduced training period for these procedures.
These goals are being pursued through research in:
- New motorized laser micromanipulators
- Medical robotic systems integration
- New interfaces for surgical laser control
- Mixed-reality environments, intraoperative planning and automation
The premise behind our efforts is that assisted teleoperation can provide the desired improvements in precision, controllability, safety and ergonomics. Therefore, in addition to the creation of new tools and systems, our research also aims at transforming the surgical scenario by designing more intuitive and comfortable operating environments to microsurgeons.
Fig. 3. Tele-surgery concept for robot-assisted laser laryngeal microsurgery: Surgical control is performed from a computer station, which offers an ergonomic operating setting and added safety via a mixed-reality environment. Surgeon commands are processed and sent to a motorized laser micromanipulator, which controls the laser beam in real-time with micrometer accuracy.
Mattos, L., Dagnino, G., Becattini, G., Dellepiane, M., Caldwell, D., “A virtual scalpel system for computer-assisted laser microsurgery,” Proceedings of the IEEE International Conference on Intelligent Robots and Systems, IROS 2011, September 2011
Mattos, L., Dellepiane, M. , Caldwell, D., “Next-Generation Micromanipulator for Computer-Assisted Laser Phonomicrosurgery,” Proceedings of the 2011 International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2011, August 2011
Dagnino, G., Mattos, L., Becattini, G., Dellepiane, M., Caldwell, D., “Comparative Evaluation of User Interfaces for Robot-Assisted Laser Phonomicrosurgery,” Proceedings of the 2011 International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2011, August 2011
Dagnino, G., Mattos, L., Becattini, G.,Dellepiane, M., Caldwell, D., “New Control Device for Computer-Assisted Laser Phonomicrosurgery,” Proceedings of The Hamlyn Symposium on Medical Robotics, ISBN 978-0-9563776-2-3, pp. 31–32 London, UK, June, 2011
Mattos, L.S., Grant, E., Caldwell, D.G., “A Novel Robotic System for Laser Phonomicrosurgery,” Proceedings of the Royal Academy of Engineering Young Researchers Futures Meeting on Medical Robotics, RAE 2010, September 2010
Mattos, L., Caldwell, D., Dellepiane, M., Grant, E., “Design and Control of a Robotic System for Assistive Laser Phonomicrosurgery,” Proceedings of the 32nd Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2010, September 2010