Robotic-assisted micro-surgery of the throat: The trans-nasal approach

Minimally Invasive Surgery of the throat is predominantly performed trans-orally. Although trans-oral (TO) access provides a scarless access into the airways, its outcomes are affected by complications, high cost, and long setup time. This paper investigates the clinical motivation for trans-nasal (TN) access to the throat and presents the design and hybrid position/compliant motion control of a rapidly deployable endo-nasal telerobotic system. The system exploits a unique Ø5 mm surgical slave with force sensing capabilities used to enable semi-automating the insertion process. Working channels allow the deployment of surgical tools such as a fiberscope, positioning sensors, grippers, suction tubes, cautery, and laser fibers. The treatment of vocal fold paralysis is chosen as a benchmark application and a feasibility study for collagen injection is conducted. Experiments on a realistic human intubation trainer demonstrated successful and safe TN deployment of the end-effector and the feasibility of robotic-assisted treatment of vocal nerve paralysis. We believe this system constitutes a first step toward low-cost office-based head and neck surgical procedures.