In transoral laser microsurgery (TLM), the close curved cylindrical structure of the laryngeal region offers functional challenges to surgeons who operate on its malignancies with rigid, single degree-of-freedom (DOF) forceps. These challenges include surgeon hand tremors, poor reachability, poor tissue surface perception, and reduced ergonomy in design. The integrated robotic microsurgical forceps presented here is capable of addressing the above challenges through tele-operated tissue manipulation in TLM.
The proposed device is designed in compliance with the spatial constraints in TLM. It incorporates a novel 2-DOF motorized microsurgical forceps end-effector, which is integrated with a commercial 6-DOF serial robotic manipulator. The integrated device is tele-operated through the haptic master interface, Omega.7. The device is augmented with a force sensor to measure tissue gripping force. The device is called RMF-2F, i.e. robotic microsurgical forceps with 2-DOF end-effector and force sensing. RMF-2F is evaluated through validation trials and pick-n-place experiments with subjects. Furthermore, the device is trialled with expert surgeons through preliminary tasks in a simulated surgical scenario.
RMF-2F shows a motion tracking error of less than 400 μm. User trials demonstrate the device’s accuracy in task completion and ease of manoeuvrability using the Omega.7 through improved trajectory following and execution times. The tissue gripping force shows better regulation with haptic feedback (1.624 N) than without haptic feedback (2.116 N). Surgeons positively evaluated the device with appreciation for improved access in the larynx and gripping force feedback.
RMF-2F offers an ergonomic and intuitive interface for intraoperative tissue manipulation in TLM. The device performance, usability, and haptic feedback capability were positively evaluated by users as well as expert surgeons. RMF-2F introduces the benefits of robotic teleoperation including, (i) overcoming hand tremors and wrist excursions, (ii) improved reachability and accuracy, and (iii) tissue gripping feedback for safe tissue manipulation.
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This is within the HS thickness of 8 mm.
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Conflict of interest
The authors declare that they have no conflict of interest.
For this type of study, formal ethics approval was not required. The Ethics Committee of Liguria Region granted the exemption for the use of human subjects and ex vivo pig larynxes for the trials.
Informed consent was obtained from all individual participants included in the study.
Site of research and experiments
The research was carried out at the Istituto Italiano di Tecnologia (IIT) in Genova, Italy.
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Chauhan, M., Deshpande, N., Pacchierotti, C. et al. A robotic microsurgical forceps for transoral laser microsurgery. Int J CARS 14, 321–333 (2019). https://doi.org/10.1007/s11548-018-1887-3
- Robot-assisted microsurgical forceps
- Robotic teleoperation
- Tissue gripping haptic feedback
- Robotic medical instruments
- Minimally invasive surgery
- Transoral laser microsurgery