μRALP and Beyond: Micro-Technologies and Systems for Robot-Assisted Endoscopic Laser Microsurgery
Creators: name: Mattos, Leonardo S.
name: Acemoglu, Alperen
name: Geraldes, André
name: Laborai, Andrea
name: Schoob, Andreas
name: Tamadazte, Brahim
name: Davies, Brian
name: Wacogne, Bruno
name: Pieralli, Christian
name: Barbalata, Corina
name: Caldwell, Darwin G.
name: Kundrat, Dennis
name: Pardo, Diego
name: Grant, Edward
name: Mora, Francesco
name: Barresi, Giacinto
name: Peretti, Giorgio
name: Ortiz, Jesùs
name: Rabenorosoa, Kanty
name: Tavernier, Laurent
name: Pazart, Lionel
name: Fichera, Loris
name: Guastini, Luca
name: Kahrs, Lüder A.
name: Rakotondrabe, Micky
name: Andreff, Nicolas
name: Deshpande, Nikhil
name: Gaiffe, Olivier
name: Renevier, Rupert
name: Moccia, Sara
name: Lescano, Sergio
name: Ortmaier, Tobias
name: Penza, Veronica
Publisher: name: Lausanne : Frontiers Media
Year: 2021
Subjects: subject: Augmented reality
subject: Cancer imaging
subject: Cognitive surgical system
subject: Computer-assisted surgery
subject: Flexible robotic endoscope
subject: Laser microsurgery
subject: Micro-robot
subject: Surgeon-robot interface
subject: Dewey Decimal Classification::000 | Allgemeines, Wissenschaft::000 | Informatik, Wissen, Systeme::004 | Informatik

description: Laser microsurgery is the current gold standard surgical technique for the treatment of selected diseases in delicate organs such as the larynx. However, the operations require large surgical expertise and dexterity, and face significant limitations imposed by available technology, such as the requirement for direct line of sight to the surgical field, restricted access, and direct manual control of the surgical instruments. To change this status quo, the European project μRALP pioneered research towards a complete redesign of current laser microsurgery systems, focusing on the development of robotic micro-technologies to enable endoscopic operations. This has fostered awareness and interest in this field, which presents a unique set of needs, requirements and constraints, leading to research and technological developments beyond μRALP and its research consortium. This paper reviews the achievements and key contributions of such research, providing an overview of the current state of the art in robot-assisted endoscopic laser microsurgery. The primary target application considered is phonomicrosurgery, which is a representative use case involving highly challenging microsurgical techniques for the treatment of glottic diseases. The paper starts by presenting the motivations and rationale for endoscopic laser microsurgery, which leads to the introduction of robotics as an enabling technology for improved surgical field accessibility, visualization and management. Then, research goals, achievements, and current state of different technologies that can build-up to an effective robotic system for endoscopic laser microsurgery are presented. This includes research in micro-robotic laser steering, flexible robotic endoscopes, augmented imaging, assistive surgeon-robot interfaces, and cognitive surgical systems. Innovations in each of these areas are shown to provide sizable progress towards more precise, safer and higher quality endoscopic laser microsurgeries. Yet, major impact is really expected from the full integration of such individual contributions into a complete clinical surgical robotic system, as illustrated in the end of this paper with a description of preliminary cadaver trials conducted with the integrated μRALP system. Overall, the contribution of this paper lays in outlining the current state of the art and open challenges in the area of robot-assisted endoscopic laser microsurgery, which has important clinical applications even beyond laryngology.