Robot-assisted system for free-beam transoral laser microsurgery

This paper describes an innovative robot-assisted system for transoral laser microsurgery (TLM) of the larynx. It transforms and greatly advances the state of the art of TLM equipment, offering a more ergonomic, intuitive, and programmable laser control system based on a tablet interface with dynamic intraoperative planning capabilities. The system couples such interface to a motorized and fully programmable free-beam laser micromanipulator, which offers wide range covering the entire surgical field. The system allows path recording, which enables fast and accurate repetitions of surgeon- defined laser trajectories. This feature enhances the laser incision quality and also provides the means for previewing the surgical action before its actual execution, leading to unmatched precision and control during delicate microsurgeries. Laser trajectories of any shape and length can be dynamically planned using the tablet interface. Evaluation experiments performed with experienced surgeons demonstrated the robotic system provides great improvements in terms of system usability and laser aiming accuracy. Trajectory tracing trials recorded a drop of 92% in maximum absolute error and about 86% in RMS error when comparing the robotic system with a modern TLM surgical system. Therefore, the robot-assisted system offers potential for significant improvements in surgical precision, quality, and safety while also minimizing the need for extensive surgeon training by providing a more intuitive laser control interface.