Evolution of robotic systems for transoral head and neck surgery

A piezoresistive-based 3-axial MEMS tactile sensor and integrated surgical forceps for gastrointestinal endoscopic minimally invasive surgery

In robotic-assisted surgery (RAS), traditional surgical instruments without sensing capability cannot perceive accurate operational forces during the task, and such drawbacks can be largely intensified when sophisticated tasks involving flexible and slender arms with small end-effectors, such as in gastrointestinal endoscopic surgery (GES). In this study, we propose a microelectromechanical system (MEMS) piezoresistive 3-axial tactile sensor for GES forceps, which can intuitively provide surgeons with online force feedback during robotic surgery. The MEMS fabrication process facilitates sensor chips with miniaturized dimensions. The fully encapsulated tactile sensors can be effortlessly integrated into miniature GES forceps, which feature a slender diameter of just 3.5 mm and undergo meticulous calibration procedures via the least squares method. Through experiments, the sensor's ability to accurately measure directional forces up to 1.2 N in the Z axis was validated, demonstrating an average relative error of only 1.18% compared with the full-scale output. The results indicate that this tactile sensor can provide effective 3-axial force sensing during surgical operations, such as grasping and pulling, and in ex vivo testing with a porcine stomach. The compact size, high precision, and integrability of the sensor establish solid foundations for clinical application in the operating theater.

Interim Phase II Results Using Panitumumab-IRDye800CW during Transoral Robotic Surgery in Patients with Oropharyngeal Cancer

PURPOSE

The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has continually increased during the past several decades. Using transoral robotic surgery (TORS) significantly improves functional outcomes relative to open surgery for OPSCC. However, TORS limits tactile feedback, which is often the most important element of cancer surgery. Fluorescence-guided surgery (FGS) strategies to aid surgeon assessment of malignancy for resection are in various phases of clinical research but exhibit the greatest potential impact for improving patient care when the surgeon receives limited tactile feedback, such as during TORS. Here, we assessed the feasibility of intraoperative fluorescence imaging using panitumumab-IRDye800CW (PAN800) during TORS in patients with OPSCC.

PATIENTS AND METHODS

Twelve consecutive patients with OPSCC were enrolled as part of a nonrandomized, prospective, phase II FGS clinical trial using PAN800. TORS was performed with an integrated robot camera for surgeon assessment of fluorescence. Intraoperative and ex vivo fluorescence signals in tumors and normal tissue were quantified and correlated with histopathology.

RESULTS

Intraoperative robot fluorescence views delineated OPSCC from normal tissue throughout the TORS procedure (10.7 mean tumor-to-background ratio), including in tumors with low expression of the molecular target. Tumor-specific fluorescence was consistent with surgeon-defined tumor borders requiring resection. Intraoperative robot fluorescence imaging revealed an OPSCC fragment initially overlooked during TORS based on brightfield views, further substantiating the clinical benefit of this FGS approach.

CONCLUSIONS

The results from this patient with OPSCC cohort support further clinical assessment of FGS during TORS to aid resection of solid tumors.

Comparative analysis of GoPro and digital cameras in head and neck flap harvesting surgery video documentation: an innovative and efficient method for surgical education

BACKGROUND

An urgent need exists for innovative surgical video recording techniques in head and neck reconstructive surgeries, particularly in low- and middle-income countries where a surge in surgical procedures necessitates more skilled surgeons. This demand, significantly intensified by the COVID-19 pandemic, highlights the critical role of surgical videos in medical education. We aimed to identify a straightforward, high-quality approach to recording surgical videos at a low economic cost in the operating room, thereby contributing to enhanced patient care.

METHODS

The recording was comprised of six head and neck flap harvesting surgeries using GoPro or two types of digital cameras. Data were extracted from the recorded videos and their subsequent editing process. Some of the participants were subsequently interviewed.

RESULTS

Both cameras, set at 4 K resolution and 30 frames per second (fps), produced satisfactory results. The GoPro, worn on the surgeon's head, moves in sync with the surgeon, offering a unique first-person perspective of the operation without needing an additional assistant. Though cost-effective and efficient, it lacks a zoom feature essential for close-up views. In contrast, while requiring occasional repositioning, the digital camera captures finer anatomical details due to its superior image quality and zoom capabilities.

CONCLUSION

Merging these two systems could significantly advance the field of surgical video recording. This innovation holds promise for enhancing technical communication and bolstering video-based medical education, potentially addressing the global shortage of specialized surgeons.

Transoral Robotic Surgery for Oropharyngeal and Hypopharyngeal Squamous Cell Carcinoma

With oropharyngeal cancer incidence rising globally, largely due to human papillomavirus (HPV), and hypopharyngeal cancer known for poor outcomes, innovative treatments are needed. Transoral robotic surgery (TORS) offers a minimally invasive approach that may improve upon traditional open surgery and radiotherapy/chemoradiotherapy (RT/CRT) methods. We conducted a literature review and included 40 PubMed studies comparing TORS, open surgery, and RT/CRT for oropharyngeal and hypopharyngeal squamous cell carcinoma (SCC), focusing on survival rates and swallowing function outcomes. TORS provides favorable survival outcomes and typically results in superior swallowing function post-treatment compared to other therapeutic modalities in both oropharyngeal and hypopharyngeal SCCs. The clinical benefits of TORS, including improved operative precision and minimized tissue disruption, along with the elimination of surgical incision recovery and reduced RT toxicity, suggest it is a valuable surgical approach for head and neck cancers.

Comparison of da Vinci Single Port vs Si Systems for Transoral Robotic-Assisted Surgery: A Review With Technical Insights

Importance

Transoral robot-assisted surgery (TORS) continues to have a major role in the treatment of oropharyngeal cancer. As new iterations of robotic technology are increasingly utilized, it is important to share learning experiences and clinical outcomes data, to optimize technical efficiency and clinical care.

Observations

This was a retrospective review of a large academic institution's initial clinical use of the da Vinci Single Port (SP) compared with the da Vinci Si (Si) system. A total of 205 TORS cases were reviewed: 109 in the SP group (November 22, 2018, through September 30, 2020), and 96 in the Si group (January 1, 2016, through November 12, 2018). Both groups had comparable operative times, rates of postoperative pharyngeal hemorrhage, length of hospital stay, and duration of nasogastric feeding tube use. There was no difference in pathological characteristics, rates of positive margins, or indications for or time to initiation of adjuvant therapy between the groups. The collective experience of 6 faculty members-who have trained 139 TORS surgeons for the SP system rollout-was compiled to provide a summary of learning experiences and technical notes on safe and efficient operation of the SP system.

Conclusions and Relevance

This Review found that the functional and oncologic outcomes were comparable between TORS cases performed with the Si and SP systems, and they had similar complication rates. Recognized advantages of the SP over the Si system include the availability of bipolar-energized instruments, a usable third surgical arm, and improved camera image quality.

Model-free control for autonomous prevention of adverse events in robotics

Introduction: Preventive control is a critical feature in autonomous technology to ensure safe system operations. One application where safety is most important is robot-assisted needle interventions. During incisions into a tissue, adverse events such as mechanical buckling of the needle shaft and tissue displacements can occur on encounter with stiff membranes causing potential damage to the organ. Methods: To prevent these events before they occur, we propose a new control subroutine that autonomously chooses a) a reactive mechanism to stop the insertion procedure when a needle buckling or a severe tissue displacement event is predicted and b) an adaptive mechanism to continue the insertion procedure through needle steering control when a mild tissue displacement is detected. The subroutine is developed using a model-free control technique due to the nonlinearities of the unknown needle-tissue dynamics. First, an improved version of the model-free adaptive control (IMFAC) is developed by computing a fast time-varying partial pseudo derivative analytically from the dynamic linearization equation to enhance output convergence and robustness against external disturbances. Results and Discussion: Comparing IMFAC and MFAC algorithms on simulated nonlinear systems in MATLAB, IMFAC shows 20% faster output convergence against arbitrary disturbances. Next, IMFAC is integrated with event prediction algorithms from prior work to prevent adverse events during needle insertions in real time. Needle insertions in gelatin tissues with known environments show successful prevention of needle buckling and tissue displacement events. Needle insertions in biological tissues with unknown environments are performed using live fluoroscopic imaging as ground truth to verify timely prevention of adverse events. Finally, statistical ANOVA analysis on all insertion data shows the robustness of the prevention algorithm to various needles and tissue environments. Overall, the success rate of preventing adverse events in needle insertions through adaptive and reactive control was 95%, which is important toward achieving safety in robotic needle interventions.

Clinical Characteristics and Treatment Outcomes of Oral Cancers Using Transoral Robotic Surgery in an Endemic Region

Oral cancer poses a major health challenge in Taiwan, consistently ranking among the highest globally in both incidence and cancer-related mortality. Transoral robotic surgery (TORS) has potential advantages over open surgery, but its long-term oncologic outcomes are not well established. In this study, we sought to elucidate the role of TORS in improving treatment outcomes among oral cancer patients. A case-control study with propensity score matching was conducted in a single teaching hospital in Taiwan. It included 72 oral cancer patients in each group to analyze and compare survival outcomes between the surgical approaches. The TORS group demonstrated a higher negative resection margin rate, a lower mortality risk and better overall survival than the open-surgery group. Multivariate Cox regression analysis confirmed TORS's association with a reduced risk of death. Kaplan-Meier survival analysis and log-rank tests indicated significantly better survival outcomes for the TORS group across all cancer stages. Moreover, the TORS group exhibited improved overall survival rates for stage III and IV patients compared to the conventional open-surgery group. In conclusion, this study suggests that TORS may offer better overall survival rates and potential advantages over conventional surgery for oral cancer treatment.

Tongue Base Ectopic Thyroid Tissue-Is It a Rare Encounter?

Failure in the embryological development of the thyroid in adults is rarely seen. We present the case of a 79-year-old female patient who complained of dysphagia and progressive upper respiratory obstruction, which started 12 months prior to her admission. An ENT clinical exam revealed a tongue base, spherical, well-defined tumour covered by normal mucosa. Further assessments established the diagnosis of the tongue base ectopic thyroid tissue. Due to the patient's symptoms, a transhyoid tongue base tumour removal was performed. The selected patient gave consent for participation and inclusion in this paper, in compliance with the 1964 Helsinki declaration.

Compliant and Flexible Robotic System with Parallel Continuum Mechanism for Transoral Surgery: A Pilot Cadaveric Study

As one of the minimally invasive surgeries (MIS), transoral robotic surgery (TORS) contributes to excellent oncological and functional outcomes. This paper introduces a compliant and flexible robotic system for transoral surgery, consisting of an execution part with flexible parallel mechanisms and a positioning part with a continuum structure. A pilot cadaveric study that mimics the procedure of the TORS using an intact cadaveric human head was conducted to evaluate the feasibility and efficiency of this robotic system. Both the initial setup time and the time cost by the robot to safely access the deep surgical area in the upper aerodigestive tract are shortened due to the enlarged workspace, compact structure, and increased flexibility. The proposed surgical robotic system is preliminarily demonstrated to be feasible for TORS, especially for the in-depth surgical sites in the upper aerodigestive tract.

Shedding light in otolaryngology: A brief history on the surgical tools of visualization and access

Visualization and access. Historically, these have been the two major factors that have limited advancement in the field of Otolaryngology. No other surgical specialty deals with anatomical challenges quite like those presented by the structures of the head and neck. Otolaryngology is a field of dark cavities, complex and miniscule structures, and awkward angles. The aim of this article is to briefly explore how Otolaryngologists have historically met these challenges, with a specific focus on technological advancements in illumination, visualization, and access. From mirrors reflecting candlelight to fiberoptic illuminated scopes, from bamboo nasal speculums to Transoral Robotic Surgery (TORS), tracing the historical arc of these technologies highlights the innovative spirit that has come to define the field of Otolaryngology.

Development and experiments of a continuum robotic system for transoral laryngeal surgery

PURPOSE

Currently, self-retaining laryngoscopic surgery is not suitable for some patients, and there are dead zones relating to surgical field exposure and operation. The quality of the surgery can also be affected by the long periods of time required to complete it. Teleoperated continuum robots with flexible joints are expected to solve these issues. However, at the current stage of developing transoral robotic surgery systems, their large size affects the precision of surgical operative actions and there are high development and treatment costs.

METHODS

We fabricated a flexible joint based on selective laser melting technology and designed a shallow neural network-based kinematic modeling approach for a continuum surgical robot. Then, human model and animal experiments were completed by master-slave teleoperation to verify the force capability and dexterity of the robot, respectively.

RESULTS

As verified by human model and animal experiments, the designed continuum robot was demonstrated to achieve transoral laryngeal surgical field exposure without laryngoscope assistance, with sufficient load capability to finish the biopsy of vocal fold tissue in living animals.

CONCLUSION

The designed continuum robotic system allows the biopsy of vocal fold tissue without laryngoscope assistance. Its stiffness and dexterity indicate the system's potential for applications in the diagnosis and treatment of vocal fold nodules and polyps. The limitations of this robotic system as shown in the experiments were also analyzed.

Robotic and Endoscopic Approaches to Head and Neck Surgery

Technological developments have disrupted the practice of medicine throughout history. Endoscopic and robotic techniques in head and neck surgery have emerged over the past half-century and have been incrementally adapted to expanding indications within otolaryngology. Robotic and endoscopic surgery have an established role in treatment of oropharyngeal and laryngeal cancers, reducing surgical morbidity and improving survival relative to traditional open approaches. Surgical treatment of human papillomavirus-mediated oropharyngeal cancer via transoral robotic surgery offers equivalent oncologic and functional outcomes relative to radiotherapy. Newer iterations of single-port robotic systems continue to expand the scope of robotics in head and neck surgery.

Is Transoral Robotic Surgery the Best Surgical Treatment for Lingual Thyroid?: A Case-Report and Literature Review

OBJECTIVES

To highlight the specific outcomes of the current surgical procedures for lingual thyroid excision, for benign and malignant lesions.

METHODS

We carried out a systematic review of surgical treatments of lingual thyroid, according to the PRISMA method. We conducted our literature search in PubMed and Ovid. Data was collected concerning patient demographics, tumor characteristics, types of surgery performed, and specific intra- and postoperative outcomes of each procedure. Surgical procedures were classified in 4 categories: transcervical approaches, "invasive" transoral approaches (transmandibular and/or tongue splitting), "non-invasive" transoral approaches, and transoral robotic surgery. We detailed the transoral robotic surgical technique through a case report, along with a surgical video.

RESULTS

Of 373 peer-reviewed articles found, 40 provided adequate information on surgical management and outcomes for patients with lingual thyroid. "Non-invasive" transoral approaches and transoral robotic surgeries required significantly fewer tracheostomies than "invasive" transoral and transcervical approaches (P < .001), while there was no statistical difference in the rate of surgical complications between each procedure.

CONCLUSIONS

Transoral robotic surgery appears to be a feasible, effective, and fast solution for lingual thyroid excision, with excellent short- and long-term surgical outcomes.

Present and Future Trends in Transoral Surgical Intervention: Maximal Surgery, Minimally Invasive Surgery, and Transoral Robotic Surgery

Oral and maxillofacial surgery (OMFS) has undergone a renaissance/metamorphosis as a specialty and in the technologic innovations that have enhanced the surgical care of patients. This article reviews traditional maximal transoral approaches in the management of common pathologic lesions seen by OMFS, and compares these techniques with a literature review that applies minimally invasive technology and innovative robotic surgery (transoral robotic surgery) to treat similar lesions. The traditional approaches described in this article have transcended generations and future trends are suggested that will improve the training of the OMFS legacy as clinicians move forward in the care of patients.

Robot-Assisted Nephrectomy Using the Newly Developed EDGE SP1000 Single-Port Robotic Surgical System: A Feasibility Study in Porcine Model

Objectives: To evaluate the feasibility and safety of the EDGE SP1000 single-port robotic platform by performing nephrectomy in live porcine model. Materials and Methods: Robotic nephrectomy was performed on sample group of five gilts using the EDGE SP1000 single-port robotic system. The continuous vital signs of all gilts were monitored throughout the operation to examine the safety of the operation. Data regarding surgical complications and technical difficulties throughout the operation were recorded for future evaluation. Finally, the survival of the sample gilts 2 weeks after the operation were recorded. Results: The robot-assisted nephrectomy yielded an impressive result that all sample gilts survived after 2 weeks. Furthermore, neither surgical complications nor technical difficulties were encountered during the operation. The average duration to establish the operation channel was 12.4 ± 1.52 minutes, the average time taken to install EDGE SP1000 single-port robotic system was 2.8 ± 0.84 minutes, the average time to dissociate and remove the kidney was 47 ± 5.61 minutes, and average total operational duration was 71 ± 5.24 minutes. Most importantly, the surgeon and assistant who were using the system found it convenient and performed excellently during the operation. Conclusions: This study shows that the EDGE SP1000 single-port robotic surgical system is safe and feasible for the use of nephrectomy in gilts. Our further research will expand the application of the EDGE SP1000 system to other urologic procedures and accumulate more preclinical data for further clinical trial.

A Century of Change towards Prevention and Minimal Intervention in Cariology

Better understanding of dental caries and other oral conditions has guided new strategies to prevent disease and manage its consequences at individual and public health levels. This article discusses advances in prevention and minimal intervention dentistry over the last century by focusing on some milestones within scientific, clinical, and public health arenas, mainly in cariology but also beyond, highlighting current understanding and evidence with future prospects. Dentistry was initially established as a surgical specialty. Dental caries (similar to periodontitis) was considered to be an infectious disease 100 years ago. Its ubiquitous presence and rampant nature-coupled with limited diagnostic tools and therapeutic treatment options-meant that these dental diseases were managed mainly by excising affected tissue. The understanding of the diseases and a change in their prevalence, extent, and severity, with evolutions in operative techniques, technologies, and materials, have enabled a shift from surgical to preventive and minimal intervention dentistry approaches. Future challenges to embrace include continuing the dental profession's move toward a more patient-centered, evidence-based, less invasive management of these diseases, focused on promoting and maintaining oral health in partnership with patients. In parallel, public health needs to continue to, for example, tackle social inequalities in dental health, develop better preventive and management options for existing disease risk groups (e.g., the growing aging population), and the development of reimbursement and health outcome models that facilitate implementation of these evolving strategies. A century ago, almost every treatment involved injections, a drill or scalpel, or a pair of forceps. Today, dentists have more options than ever before available to them. These are supported by evidence, have a minimal intervention focus, and result in better outcomes for patients. The profession's greatest challenge is moving this evidence into practice.

Cadaveric feasibility study of a teleoperated parallel continuum robot with variable stiffness for transoral surgery

Robot-assisted technologies are overcoming the limitations of the current approaches for transoral surgeries, which are suffering from limited vision and workspace. As a result, we develop a novel teleoperated parallel continuum robot with variable stiffness for collision avoidance. This paper focuses on the feasibility study on a cadaveric model for the robotic system as a first trial. We introduce the configuration of the robotic system, the description of the processes of the trial, including the setting of the robotic system, the test of stiffness, and the action of the manipulation. The contact force between the manipulators with different stiffness and the surrounding tissues and a series of surgical operations of the manipulator, including grasping, cutting, pushing, and pulling tissues under the master-slave control mode, were recorded and analyzed. Experimental results suggest that the typical surgical procedure on a cadaveric model was successfully performed. Moreover, the efficacy and feasibility of the developed robotic system are verified to satisfy the requirements of transoral robotic surgery (TORS). Graphical abstract.

Novel Energy Devices in Head and Neck Robotic Surgery - A Narrative Review

The advent of trans-oral robotic surgery (TORS) has facilitated removal of tumors previously deemed unresectable, by providing access to the deep structures of the head and neck. Despite this, the wider dissemination of TORS has been restricted due to issues with line of access, as the da Vinci robot was never designed with head and neck surgery in mind. Flexible instruments and novel energy delivery devices offer great potential in overcoming some of the existing challenges surrounding TORS. This review aimed to summarize the existing literature surrounding energy delivery in TORS and highlight areas of future innovation. MEDLINE was searched for studies relating to energy delivery in TORS in November 2019. The existing literature surrounding monopolar and bipolar electrocautery, LASER (CO₂, Tm:YAG and blue LASER), Ligasure and Harmonic was reviewed. Additionally, the latest iteration of the da Vinci; the SP, and the FLEX robot were evaluated as novel methods of energy delivery in TORS. Overall, these novel energy devices and robotic systems are predicted to further improve energy delivery to the head and neck. The use of flexible LASER in particular is well substantiated in the literature. This has the potential to achieve treatment de-escalation, based on the excellent outcomes demonstrated for disease-free margins and post-operative morbidity.

Trans-oral robotic surgery in the management of parapharyngeal space tumors: A systematic review

PURPOSE

To perform a systematic review of studies evaluating Trans-oral Robotic Surgery (TORS) in the treatment of parapharyngeal space (PPS) tumors.

METHODS

A comprehensive electronic search was performed in PubMed/MEDLINE, Cochrane Library, and Google Scholar databases for appropriate published studies. The last search was conducted on November 9, 2019.

RESULTS

Twenty-two studies were included for the systematic review which analyzed a total of 113 patients (median age 53.5, IQR 41.5-58.1). The most common PPS tumor treated with TORS was the pleomorphic adenoma (n = 66; 58.4%). All tumors were successfully resected. The median tumor size was 4.8 cm (n = 73; IQR 3.8-5.4). Combined transcervical (TORS-TC) and transparotid (TORS-TP) approaches were used in 13 (11.5%) and 5 (4.4%) patients, respectively. Capsule disruption was noted in 11 cases (14.5%), while tumor fragmentation was observed in 7 patients (10.3%). The median time of hospitalization was 3 days (n = 79; IQR 2-4.1). Oral diet was possible from the day after surgery in the majority of patients (n = 34, 68%). The most common complication was dysphagia (n = 5, 4.5%).

CONCLUSIONS

This systematic review confirms the safety and feasibility of TORS in the treatment of PPS lesions. Given the low quality of included studies, further evidence is needed in order to establish clinical guidelines.

Healing acceleration of mastoidectomy through the external auditory canal incisionless approach

PURPOSE

To evaluate a surgical procedure of canal wall-up mastoidectomy without incision of the canal which enables accelerated healing and enhances hearing outcome.

METHODS

A total of 79 patients were enrolled. A canal-incisionless technique was used in 37 patients undergoing canal wall-up/down mastoidectomy (CWU/DM), explo-mastoidectomy, and cochlea implantation as staged operation after obliteration of the mastoid, and canal incision was used in the remaining 42 patients as comparison group.

RESULTS

Preoperative and postoperative pure tone audiometry/word recognition score and postoperative status including the healing time and complications were analyzed. Healing time of the canal-incisionless procedure (2.7 weeks) was shorter than that of conventional mastoidectomy with canal incision (5.7 weeks). Complication rate of the canal-incisionless procedure was lower than that of canal incision approach, even though statistical meaningless.

CONCLUSION

Despite the small sample size of our study, in patients undergoing CWDM, explo-mastoidectomy, and cochlea implantation, more acceptable healing was achieved using the canal-incisionless technique than with the canal incision technique. CWU/DM without canal incision is useful to achieve optimal surgical view, eliminate pathology of the middle ear, and accelerate healing time.

TORS excision of lingual thyroid carcinoma: Technique and systematic review

OBJECTIVE

Clinically significant lingual thyroid tissue has a prevalence of 1/3000-10,000, and in 70% of these individuals, the lingual thyroid is their only thyroid tissue. Malignant transformation is exceedingly rare. Herein, we present a case of lingual thyroid carcinoma with a systematic literature review and description of our treatment technique.

DATA SOURCES

PubMed, Ovid.

REVIEW METHOD

The primary author performed a search of the literature for reports of lingual thyroid carcinoma or ectopic thyroid carcinoma associated with the tongue. Articles that did not present novel data, presented cases of ectopic thyroid carcinoma outside the tongue, non-malignant cases, non-thyroid carcinomas, or were non-English articles were excluded. Studies were limited to those published in the last 60 years.

RESULTS

There are 39 cases reported in the literature. 23 cases occurred in females. Age at diagnosis ranged from 12 to 86; cases were more commonly diagnosed in the second decade of life, then in the 5th and 6th decades of life. Dysphagia, globus sensation, episodes of bleeding, voice changes, and presence of a neck mass were common symptoms at initial presentation. Nearly all patients underwent some form of pre-operative imaging, but practices varied as to the type of imaging. Treatment included surgical excision of the tumor in all but one case that was successfully treated with radioactive iodine therapy alone.

CONCLUSIONS

Surgeons should be aware of lingual thyroid, its presentation, workup, and carcinoma treatment. Tumors are amenable to surgical excision, possibly followed by radioactive iodine therapy. Advances in robotic and endoscopic surgery over the past decade now allow for less morbid excisions of lingual thyroid tumors.

Functional Organ Preservation Surgery in Head and Neck Cancer: Transoral Robotic Surgery and Beyond

In recent years, interest in functional organ preservation surgery (FOPS) in the treatment of head and neck cancer has increased dramatically as clinicians seek to minimize the adverse effects of treatment while maximizing survival and quality of life. In this context, the use of transoral robotic surgery (TORS) is becoming increasingly common. TORS is a relatively new and rapidly-evolving technique, with a growing range of treatment indications. A wide range of novel, flexible surgical robots are now in development and their commercialization is expected to significantly expand the current indications for TORS. In the present review, we discuss the current and future role of this organ-preserving modality as the central element in the multimodal treatment of head and neck cancer.

A Compliant Transoral Surgical Robotic System Based on a Parallel Flexible Mechanism

Transoral robotic surgery (TORS) allows for access to oropharyngeal regions in an effective and minimally invasive manner. However, safe TORS access to deep pharyngeal (such as hypopharynx) sites remains a great challenge for current surgical robotic systems. In this work, we introduce a novel continuum robot with an optimized flexible parallel mechanism, to meet stringent requirements imposed by TORS on size, workspace, flexibility, and compliance. The system is comprised of two parts, a guidance part and an execution part, and achieves 11 controllable degrees of freedom. The execution part of the robot, based on the optimized flexible parallel mechanism, is able to reach deep sites in the oropharynx and larynx with the assistance of the continuum guidance part. In addition to the mechanical design, extensive analysis and experiments were carried out. Kinematic models were derived and the reachable workspace of the robot was verified to cover the entire target surgical area. Experimental results indicate that the robot achieves significantly enhanced compliance. Additionally, the designed robot can withstand a load of 1.5 N within the allowable range of the deflection. The positioning errors caused by the interference between different mechanisms can be effectively eliminated using the proposed compensation method. The maximum displacement error of this system under various conditions is less than 2 mm and the maximum bending error is less than 7.5°, which are satisfied for TORS. Cadaver trials were conducted to further demonstrate the feasibility. The reduced setup time and the reduced time to access the target site indicate that the developed surgical robotic system can achieve better operative efficiency in TORS when compared with current systems.

How 'smart' is smart dentistry?

Background: Latest advances in information and health technologies enabled dentistry to follow the paradigm shift occurring in medicine - the transition to so called smart medicine. Consequently, the aim of this paper is to assess how 'smart' is smart dentistry as of the end of 2018. Methods: We analysed the state of the art in smart dentistry, performing bibliometric mapping on a corpus of smart dentistry papers found in the Scopus bibliographical database. Results: The search resulted in a corpus of 3451 papers, revealing that smart dentistry research is following the progress in smart medicine; however, there are some gaps in some specific areas like gamification and use of holistic smart dentistry systems. Conclusions: Smart dentistry is smart; however, it must become smarter.

How 'smart' is smart dentistry?

Background: Latest advances in information and health technologies enabled dentistry to follow the paradigm shift occurring in medicine - the transition to so called smart medicine. Consequently, the aim of this paper is to assess how 'smart' is smart dentistry as of the end of 2018. Methods: We analysed the state of the art in smart dentistry, performing bibliometric mapping on a corpus of smart dentistry papers found in the Scopus bibliographical database. Results: The search resulted in a corpus of 3451 papers, revealing that smart dentistry research is following the progress in smart medicine; however, there are some gaps in some specific areas like gamification and use of holistic smart dentistry systems. Conclusions: Smart dentistry is smart; however, it must become smarter.