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Robotics and Digital Guidance in ENT-H&N Surgery

Robotics and Digital Guidance in ENT-H&N Surgery

Bertrand Lombard | Philippe Céruse | Carole FUMAT

(2017)

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Book Details

Abstract

Robotics and Digital Guidance in ENT-H&N Surgery

Table of Contents

Section Title Page Action Price
Cover\r Cover
Robotics and Digital Guidance in ENT–H&N Surgery\r III
Copyright IV
Editors V
List of contributors VII
Abbreviations IX
Table of content XI
Foreword XV
Preface XVII
Introduction XIX
Chapter 1 Using the past to understand the present : A short history of digital guidance in ENT\r 1
From stereotactic frames to image-guided surgery 2
The beginnings of stereotactic frame surgery 2
Cranial and brain radiology 3
Frameless stereotaxis 5
Computer-assisted craniofacial surgery 5
References 5
From the hand-held motor to the motor-held hand 6
References 7
Chapter 2 Principles and concepts of surgical navigation 9
Spatial localization 10
Electromechanical systems 10
Ultrasound-beam systems 10
Opto-electronic systems 10
Electromagnetic systems 12
Other tracking technologies 12
Image dataset registration 13
Principle 13
Paired points registration 13
Surface registration 13
Photo- and video-based registration 14
Mathematical limits of registration 14
Estimating registration accuracy 14
Patient referencing system 15
Navigated surgical instrument calibration 15
Navigation with a surgical microscope 15
Augmented reality navigation 16
References 17
Chapter 3 Surgical navigation in ENT 19
Evidence of benefit of surgical navigation in ENT 20
General rules for using navigation systems 20
Imaging protocols 21
Navigation for sinus and anterior skull base surgery 21
Surgical planning 21
Ethmoidectomy 22
Sphenoid sinus surgery 22
Arterial pedicle hemostasis 22
Location and closure of meningeal breaches 22
Frontal sinus surgery 22
Anterior skull base surgery 25
Infratemporal fossa surgery 25
Navigation for sellar and parasellar approaches 25
Computer-assisted (image-guided) surgery in pediatric ENT 27
Introduction 27
Specificities of pediatric image-guided surgery 27
Instrumentation and technologies 27
Comparisons between adults and children 27
Indications 29
Case reports 29
Conclusion 33
Image-guided neurotologic surgery 33
Imaging protocol 33
Translabyrinthine approach 34
Retrosigmoid approaches 34
Middle cranial fossa approach 34
Lateral approaches to petrous apex cholesterol granuloma 35
References 35
Chapter 4 Fundamentals of surgical robotics 37
Degrees of freedom of a manipulator 38
Kind of joints possibly involved in a manipulator 38
Kinematic structures 38
Serial manipulators 39
Parallel manipulators 40
Hybrid manipulators 40
Continuum robots 41
Spine continuum manipulators 41
Concentric tubes 41
Virtual RCM kinematics 42
SCARA structure 43
Robot actuators 43
Electromagnetic motors 43
Piezoelectric actuators 43
Pneumatic actuators 44
Hydraulic actuators 44
Cartesian direct magnetic actuators 44
Cable-driven actuation 44
Flexible cable-conduits 45
Cables and pulleys 45
Thermo-electric actuators 45
Artificial muscles (electro-active polymers) 46
Speed-to-torque converters 46
Motors encoders and brakes 46
Knowing and ordering the pose of a robot: computational kinematics 46
Trajectory planners 46
Robot movement dynamics 47
Controlling a robot (the control loop) 48
Robot end effector precision 49
Working volume 50
Manipulability index 51
References 51
Chapter 5 Surgical robots at work 53
Classes of surgical robots 54
Master-slave manipulators 54
Automated machines 55
Collaborative robots 55
In vivo microrobots 55
Hand-held surgical robots 55
NOTES-robots 56
Human-robot input interfaces 56
Haptic and force feedbacks 57
Linking robots to navigation systems 58
Virtual fixtures 58
Giving robots surgical intelligence 59
Surgical workflows\r 59
Artificial intelligence: neural networks, deep learning and hidden Markov models 59
Knot-tying 60
Comparing surgeon to robot 62
References 62
Chapter 6 The da Vinci® system: technology and surgical analysis 65
The main parts of the da Vinci® 66
Slave design® 67
Passive arms® 67
Actuated arms 67
EndoWrist® instruments 67
3D endoscopes 70
The master control 70
Handles 70
Foot pedals 70
Control touch screen 70
Video display 71
The control unit and motion mapping between master and slave 71
Force and haptic feedbacks 73
Dual master control and simulator 73
Technical critical analysis 73
Surgical critical analysis 74
References 76
Chapter 7 Transoral robotic surgery (with the da Vinci® system) 79
Chapter 8 Other ENT applications of the da Vinci® system 117
Robot-assisted surgery in thyroid procedures 118
Introduction 118
Surgical technique 118
Indications and contraindications 118
Oncologic aspects and safety in robot-assisted surgery 119
Functional issues and patient satisfaction 120
Operating time and learning curve 120
Future prospects 120
References 121
Robot-assisted neck dissection in thyroid and head and neck squamous cell carcinoma 122
Clinical background 122
Advantages and disadvantages of various surgical methods of neck dissection 122
Indications and contraindications 123
Special equipment 123
Surgical procedure 124
Selective neck dissection (levels I–III) 124
Skin incision design 124
Work-space creation 124
Upper neck dissection under direct vision 124
Robot-assisted neck dissection (RAND) technique 125
Modified radical neck dissection (levels I–V or II–V) 125
Skin incision and flap elevation 125
Upper neck dissection under direct vision 128
Robot-assisted neck dissection (RAND) technique 129
Postoperative care and results 130
Future perspectives 131
References 131
Robotic surgery of the nasopharynx 132
Robotic surgery approaches to the nasopharynx 132
Minimally invasive surgery for nasopharyngeal tumors 132
Exclusive transoral robotic approach for nasopharyngeal surgery 132
Combined transoral and transnasal approaches in robotic surgery of the nasopharynx 132
Combined transantral and transnasal approaches in robotic surgery of the nasopharynx 133
Next-generation flexible single-port robotic surgery of the nasopharynx 133
Indications and contraindications for robotic surgery of the nasopharynx 134
Preoperative assessment 134
Consensual features based on experience with open and transnasal endoscopic approaches 134
Contraindications for robotic nasopharyngectomy result from the previously described assessment of resectability 134
Results of robotic salvage nasopharyngectomy 135
Conclusion 135
References 135
Transoral robotic surgery for sellar tumor 136
Introduction 136
Cadaveric study 136
Anatomical study 136
Clinical study 136
References 137
Attempts at robotic surgery for the anterior skull base 137
Introduction 137
Rationale 137
Limitations 138
References 139
Chapter 9 Alternative solutions for transoral robotic surgery (TORS) 141
Micro-technologies and systems for robot-assisted laser phonomicrosurgery (μRALP): a new microrobot prototype driven b ... 142
A new three-dimensional vision with augmented reality 142
Interactive laser focus positioning 142
Motion compensation during planning 144
New surgeon-robot interfaces with dynamic planning 144
The teleoperation control console 144
Cognitive controllers for incision and ablation depth control 145
Safety supervision 146
Microrobot 147
Micromechatronic design 147
Control of laser displacement on the vocal folds 148
Fluorescence-based cancer detection 148
Medical robot design 151
References 153
The Flex® Robotic System for transoral surgery 154
Introduction 154
Technology and device design 154
Limitations of the Medrobotics Flex® Robotic System 156
Conclusions 156
References 156
Chapter 10 Robot-assisted endo- and transnasal surgery 157
The challenge of endo- and transnasal surgery 158
What to expect from a robotized manipulator in endonasal surgery 158
Improving surgical workflow by restoring two-hand surgery 158
Management of the introduction and removal of surgical instruments 159
Managing several instruments simultaneously 159
Navigation-based endonasal robotics 160
Augmented endoscopy 161
Endoscope fulcrum points and reaction forces/torques 162
Summary of experimental work in endonasal robotics 163
The SurgiMotion Project 164
Objectives 165
Project development iterations 165
Current status 167
Prototype K-1\r 167
Prototype K-2\r 168
Prototype K-3\r 168
Set-up, control and surgical workflow 168
Preclinical evaluation 171
Conclusion and future work 172
References 176
Chapter 11 Robot-based otological surgery 177
Introduction 178
Robot-based devices for middle ear and otosclerosis surgery 178
Specific requirements of middle ear surgery, and in particular in otosclerosis surgery 178
Expectations for robot-based assistance in middle-ear and otosclerosis surgery 179
Examples of robot-based applications for middle-ear and otosclerosis surgery 180
The Steady Hand (Johns Hopkins University) 180
The smart micro-drill (Birmingham University, UK) 180
The Micromanipulator System II (MMSII; Technische Universität München, University Hospital of Leipzig) 181
The RobOtol System (Pierre et Marie Curie University, Paris) 181
Specifications 181
External workspace requirements 182
Internal workspace requirements 183
Minimal force requirement and accuracy to set actuation specifications 183
Kinematic choice and topological optimization 183
Description of the system 185
Components 185
Command 186
Concept validation in cadaveric assessment 186
External workspace evaluation 186
Internal workspace and task achievement evaluation 187
Where we are now, and future developments of the RobOtol system 188
Robot-based devices for cochlear implantation 188
Introduction 188
Prerequisites of cochlear implant surgery and expectations for robot-based assistance 189
First step: access to the cochlea 189
Second step: opening the cochlea 189
Third step: insertion of the electrode array 190
Examples of robot-based devices for cochlear implantation 191
First step: access to cochlea 191
Minimally Invasive Robotic-Assisted Cochlear Implantation (ARTOG, University of Bern, Switzerland) 191
System overview 191
Surgical procedure 191
Preoperative imaging and surgical planning 191
Robotic middle-ear access 192
Implant management 193
Clinical validation 193
Results 193
Preoperative imaging and planning 193
Robotic middle-ear access 194
Implant management and electrode array insertion 196
Surgical outcome 198
Discussion 198
The Hannover device (Hannover University, Germany) 199
The Vanderbilt system (Nashville, United States) 200
Modification of the Steady Hand device (Johns Hopkins University) 201
Hannover insertion tool with Vanderbilt modification (Hannover, Germany; Nashville, TN) 202
The ARMA steerable cochlear implant (Advanced Robotics and Mechanism Applications, Columbia University/Vanderbilt Univer ... 202
The Parisian insertion tool (UMR-S 1159, Inserm/Université Pierre et Marie Curie) 202
Second step: cochlea opening 201
Third step: array insertion 201
Robot-based devices for otology: other applications 205
Endoscopic surgery 205
Other temporal bone approaches 206
Conclusion and perspectives 206
References 207
Chapter 12 Robot-assisted suturing and microsurgery 213
The Smart Tissue Autonomous Robot (STAR): the role of intelligence and autonomy in surgical robotics 214
Unmet need 214
Paradigm shift 214
Democratization of surgery 214
Smart Tissue Autonomous Robot (STAR) 214
Robot-assisted microsurgery: the next step in reconstructive surgery 215
Chapter 13 Surgical simulation and training for ENT surgery 219
Surgical simulation: gadget, teaching tool, or surgical strategy aid? 220
Introduction 220
Why bother about simulation? 220
Traditional surgical simulation 220
Low-fidelity” models 220
Integrating virtual reality simulation in clinical practice 221
Advantages of surgery simulation 221
Limitations 221
Research 221
Conclusion 221
References 221
Simulation in endoscopic endonasal surgery: review and perspectives 222
Introduction 222
Review of simulation supports 222
Physical supports 222
High-fidelity supports 222
Cadaver dissection 222
Animal dissection 223
Artificial supports 223
Low-fidelity supports 223
Virtual reality 223
Cyrano 223
Role of simulation in endoscopic endonasal surgery training 224
Conclusion 225
References 225
Surgical robotics: safety, legal, ethical and economic aspects 227
Safety and normalization in surgical robotics 228
General safety design strategies 228
European directives applicable to surgical robotics 229
CE mark 229
Norms involved in medical robotics 229
Risk management at the surgeon's level 229
References 231
Economic assessment of transoral robotic-assisted surgery 231
Introduction 231
Extra costs of the robotic system 231
Cost-savings 231
Comparison with laparoscopic surgery 232
Availability of the robot 232
Conclusion 232
References 232
Law, ethics, robots and surgery 232
General aspects 232
The particularities of robotic surgery 233
Conclusion 234
References 234
Concluding remarks 235
Index 237
Imprint\r 241