Robotic Micromanipulator Can Strengthen Laryngeal Surgery Skills

Clinical Question

How well do experienced and novice participants perform using a prototype robotic micromanipulator controller (RMC) in a simulated, microlaryngeal operative setting?

Background: The majority of robotic surgical procedures involve explicit human operator direction and control. Over the last four decades, the coincident advances of robotic surgical technology, microlaryngeal surgical technique, CO2 laser laryngeal surgery, and computer-controlled surgical CO2 laser guidance have led to the development of the prototype (RMC).

Study design: Observational cross-sectional study of 22 recruited participants.

Setting: University of North Carolina Department of Otolaryngology, Chapel Hill.

Synopsis: Participants were presented with a preformed, curvilinear target path and were asked to guide the helium-neon (HeNe) target beam as close as possible to the center of the 4-mm-wide path for three consecutive repetitions. In addition, a predesigned path was transferred onto a block of extra firm tofu; participants were asked to trace the pattern in a consistent and continuous fashion. There was a moderate negative correlation between increasing previous laser surgical experience and error percentage, cumulative error, and performance repeatability in those using a manual micromanipulator (MMM). A statistically significantly lower error percentage was identified for surgeons with fewer than 50 previous laser cases. A similar significant difference in cumulative error was observed for surgeons with fewer than 10 previous laser surgical cases. A moderate negative correlation was observed between repetition error and level of previous laser experience. There was no statistical ablation consistency and there were no significant differences in error percentage, cumulative error, or repetition error difference across any subject variables. No correlation with improved performance was seen with the RMC device across laser experience. The RMC P/A mode trended toward less repetition error compared to human participants as a group. A statistically significant repetition error difference was observed between the RMC programmed (P/A) mode and participants with fewer than 100 cases of laser experience. Limitations include known shortcomings of the prototype RMC.

Bottom line: Experienced laser surgeons perform better than novice surgeons on accuracy and repeatability tasks using the MMM but roughly equivalently using the RMC. In P/A mode, the RMC performs equivalently or superior to experienced laser surgeons using the industry standard MMM for all measured parameters and delivers an ablation consistency nearly an order of magnitude better than human laser operators.

Citation: Buckmire RA, Wong YT, Deal AM. The application of robotics to microlaryngeal laser surgery. Laryngoscope. 2015;125:1393-1400.