µRALP and Beyond: Micro-Technologies and Systems for Robot-Assisted Endoscopic Laser Microsurgery.

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.

Non-Contact Tissue Ablations with High-Speed Laser Scanning in Endoscopic Laser Microsurgery.

The use of laser scanners in soft tissue microsurgery results in high quality ablations with minimal thermal damage to surrounding tissue. However, current scanner technologies for microsurgery are limited to free-beam lasers, requiring direct line-of-sight from outside the patient to the surgical site. Developing compact laser manipulation systems is crucial to introduce laser scanning capabilities in hard-toreach surgical sites. Recently, we developed a magnetic laser scanner as a tip module of an endoscopic system. The device provides 2D position control and fast scanning of a laser beam. In this work, the previous prototype is revised to enable its use with a CO2 laser source. The advantages of non-contact tissue ablations with fast scanning are discussed with comparative tissue ablation experiments coupling the system with a $CO_{2$ laser source. Results show that the magnetic laser scanner provides narrower ablations and less thermal damage compared to ablations performed with a bare flexible waveguide. These results highlight the potential of the proposed technology to improve soft tissue ablation quality in hard-to-reach surgical sites.

Effects of geometric parameters on swimming of micro organisms with single helical flagellum in circular channels.

We present a computational fluid dynamics (CFD) model for the swimming of micro organisms with a single helical flagellum in circular channels. The CFD model is developed to obtain numerical solutions of Stokes equations in three dimensions, validated with experiments reported in literature, and used to analyze the effects of geometric parameters, such as the helical radius, wavelength, radii of the channel and the tail and the tail length on forward and lateral swimming velocities, rotation rates, and the efficiency of the swimmer. Optimal shapes for the speed and the power efficiency are reported. Effects of Brownian motion and electrostatic interactions are excluded to emphasize the role of hydrodynamic forces on lateral velocities and rotations on the trajectory of swimmers. For thin flagella, as the channel radius decreases, forward velocity and the power efficiency of the swimmer decreases as well; however, for thick flagella, there is an optimal radius of the channel that maximizes the velocity and the efficiency depending on other geometric parameters. Lateral motion of the swimmer is suppressed as the channel is constricted below a critical radius, for which the magnitude of the lateral velocity reaches a maximum. Results contribute significantly to the understanding of the swimming of bacteria in micro channels and capillary tubes.