Robotic microlaryngeal phonosurgery: Testing of a “steady-hand” microsurgery platform

Objectives/Hypothesis: To evaluate gains in microlaryngeal precision achieved by using a novel robotic “steady hand” microsurgery platform in performing simulated phonosurgical tasks. Study Design: Crossover comparative study of surgical performance and descriptive analysis of surgeon feedback. Methods: 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. Results: 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). Conclusions: 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. Level of Evidence: NA. Laryngoscope, 128:126–132, 2018.