Akst Lee M, Olds Kevin C, Balicki Marcin, Chalasani Preetham, Taylor Russell H
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Department of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Laryngoscope. 2018 Jan;128(1):126-132. doi: 10.1002/lary.26621. Epub 2017 May 12.
OBJECTIVES/HYPOTHESIS: To evaluate gains in microlaryngeal precision achieved by using a novel robotic "steady hand" microsurgery platform in performing simulated phonosurgical tasks.
Crossover comparative study of surgical performance and descriptive analysis of surgeon feedback.
A novel robotic ear, nose, and throat microsurgery system (REMS) was tested in simulated phonosurgery. Participants navigated a 0.4-mm-wide microlaryngeal needle through spirals of varying widths, both with and without robotic assistance. Fail time (time the needle contacted spiral edges) was measured, and statistical comparison was performed. Participants were surveyed to provide subjective feedback on the REMS.
Nine participants performed the task at three spiral widths, yielding 27 paired testing conditions. In 24 of 27 conditions, robot-assisted performance was better than unassisted; five trials were errorless, all achieved with the robot. Paired analysis of all conditions revealed fail time of 0.769 ± 0.568 seconds manually, improving to 0.284 ± 0.584 seconds with the robot (P = .003). Analysis of individual spiral sizes showed statistically better performance with the REMS at spiral widths of 2 mm (0.156 ± 0.226 seconds vs. 0.549 ± 0.545 seconds, P = .019) and 1.5 mm (0.075 ± 0.099 seconds vs. 0.890 ± 0.518 seconds, P = .002). At 1.2 mm, all nine participants together showed similar performance with and without robotic assistance (0.621 ± 0.923 seconds vs. 0.868 ± 0.634 seconds, P = .52), though subgroup analysis of five surgeons most familiar with microlaryngoscopy showed statistically better performance with the robot (0.204 ± 0.164 seconds vs. 0.664 ± 0.354 seconds, P = .036).
The REMS is a novel platform with potential applications in microlaryngeal phonosurgery. Further feasibility studies and preclinical testing should be pursued as a bridge to eventual clinical use.
NA. Laryngoscope, 128:126-132, 2018.
目的/假设：评估在执行模拟喉显微手术任务时，使用新型机器人“稳定手”显微手术平台所实现的喉显微手术精度提升情况。
手术性能的交叉比较研究及外科医生反馈的描述性分析。
一种新型机器人耳鼻喉显微手术系统（REMS）在模拟喉显微手术中进行测试。参与者在有和没有机器人辅助的情况下，将一根0.4毫米宽的喉显微针穿过不同宽度的螺旋线。测量失败时间（针接触螺旋线边缘的时间），并进行统计学比较。对参与者进行调查，以获取他们对REMS的主观反馈。
9名参与者在三种螺旋线宽度下完成任务，产生27组配对测试条件。在27组条件中的24组中，机器人辅助操作的表现优于无辅助操作；5次试验无失误，均借助机器人完成。对所有条件的配对分析显示，手动操作的失败时间为0.769±0.568秒，使用机器人后缩短至0.284±0.584秒（P = 0.003）。对单个螺旋线尺寸的分析表明，在2毫米（0.156±0.226秒对0.549±0.545秒，P = 0.019）和1.5毫米（0.075±0.099秒对0.890±0.518秒，P = 0.002）的螺旋线宽度下，REMS的表现具有统计学上的优势。在1.2毫米时，所有9名参与者在有和没有机器人辅助的情况下表现相似（0.621±0.923秒对0.868±0.634秒，P = 0.52），不过对5名最熟悉喉显微手术的外科医生进行的亚组分析显示，使用机器人的表现具有统计学上的优势（0.204±0.164秒对0.664±0.354秒，P = 0.036）。
REMS是一个在喉显微手术中具有潜在应用价值的新型平台。应开展进一步的可行性研究和临床前测试，作为通向最终临床应用的桥梁。
无。《喉镜》，2018年，第128卷，第126 - 132页
