Mattos Leonardo S, Acemoglu Alperen, Geraldes André, Laborai Andrea, Schoob Andreas, Tamadazte Brahim, Davies Brian, Wacogne Bruno, Pieralli Christian, Barbalata Corina, Caldwell Darwin G, Kundrat Dennis, Pardo Diego, Grant Edward, Mora Francesco, Barresi Giacinto, Peretti Giorgio, Ortiz Jesùs, Rabenorosoa Kanty, Tavernier Laurent, Pazart Lionel, Fichera Loris, Guastini Luca, Kahrs Lüder A, Rakotondrabe Micky, Andreff Nicolas, Deshpande Nikhil, Gaiffe Olivier, Renevier Rupert, Moccia Sara, Lescano Sergio, Ortmaier Tobias, Penza Veronica
Istituto Italiano di Tecnologia, Genoa, Italy.
Department of Otorhinolaryngology, Guglielmo da Saliceto Hospital, Piacenza, Italy.
Front Robot AI. 2021 Sep 8;8:664655. doi: 10.3389/frobt.2021.664655. eCollection 2021.
Laser microsurgery is the current gold standard surgical technique for the treatment of selected diseases in delicate organs such as the larynx. However, the operations require large surgical expertise and dexterity, and face significant limitations imposed by available technology, such as the requirement for direct line of sight to the surgical field, restricted access, and direct manual control of the surgical instruments. To change this status quo, the European project μRALP pioneered research towards a complete redesign of current laser microsurgery systems, focusing on the development of robotic micro-technologies to enable endoscopic operations. This has fostered awareness and interest in this field, which presents a unique set of needs, requirements and constraints, leading to research and technological developments beyond μRALP and its research consortium. This paper reviews the achievements and key contributions of such research, providing an overview of the current state of the art in robot-assisted endoscopic laser microsurgery. The primary target application considered is phonomicrosurgery, which is a representative use case involving highly challenging microsurgical techniques for the treatment of glottic diseases. The paper starts by presenting the motivations and rationale for endoscopic laser microsurgery, which leads to the introduction of robotics as an enabling technology for improved surgical field accessibility, visualization and management. Then, research goals, achievements, and current state of different technologies that can build-up to an effective robotic system for endoscopic laser microsurgery are presented. This includes research in micro-robotic laser steering, flexible robotic endoscopes, augmented imaging, assistive surgeon-robot interfaces, and cognitive surgical systems. Innovations in each of these areas are shown to provide sizable progress towards more precise, safer and higher quality endoscopic laser microsurgeries. Yet, major impact is really expected from the full integration of such individual contributions into a complete clinical surgical robotic system, as illustrated in the end of this paper with a description of preliminary cadaver trials conducted with the integrated μRALP system. Overall, the contribution of this paper lays in outlining the current state of the art and open challenges in the area of robot-assisted endoscopic laser microsurgery, which has important clinical applications even beyond laryngology.
激光显微手术是目前治疗喉部等精细器官特定疾病的金标准手术技术。然而，这些手术需要高超的手术专业技能和灵活性，并且面临现有技术带来的重大限制，例如需要直接观察手术视野、进入受限以及对手术器械进行直接手动控制。为了改变这种现状，欧洲的μRALP项目率先开展研究，旨在对当前的激光显微手术系统进行全面重新设计，重点是开发机器人微技术以实现内镜手术。这引发了对该领域的关注和兴趣，该领域呈现出一系列独特的需求、要求和限制，促使了超越μRALP及其研究联盟的研究和技术发展。本文回顾了此类研究的成果和关键贡献，概述了机器人辅助内镜激光显微手术的当前技术水平。所考虑的主要目标应用是语音显微手术，这是一个具有代表性的用例，涉及用于治疗声门疾病的极具挑战性的显微手术技术。本文首先阐述了内镜激光显微手术的动机和基本原理，进而引入机器人技术作为一种使能技术，以改善手术视野的可达性、可视化和管理。然后，介绍了不同技术的研究目标、成果以及当前状态，这些技术可构建一个有效的机器人辅助内镜激光显微手术系统。这包括微机器人激光转向、柔性机器人内窥镜、增强成像、辅助外科医生 - 机器人接口以及认知手术系统等方面的研究。这些领域的每一项创新都朝着更精确、更安全和更高质量的内镜激光显微手术取得了显著进展。然而，真正的重大影响预计将来自于将这些个体贡献完全整合到一个完整的临床手术机器人系统中，本文结尾通过描述使用集成的μRALP系统进行的初步尸体试验对此进行了说明。总体而言，本文的贡献在于概述了机器人辅助内镜激光显微手术领域的当前技术水平和开放挑战，该领域甚至在喉科学之外也具有重要的临床应用。
