Robotic Endolaryngeal Flexible (Robo-ELF) Scope: A Preclinical Feasibility Study

Objectives/Hypothesis: This article presents a novel robotic endolaryngeal flexible (Robo-ELF) scope driver for minimally invasive laryngeal surgery. The Robo-ELF consists of a simple, robust robotic scope driver with three active and two passive degrees of freedom, allowing it to manipulate any standard flexible endoscope. The system is controlled by a joystick-like three dimensional mouse that interfaces with the scope driver via a laptop. Because the scope is supported and controlled by the robot, motor control and therefore visualization are enhanced. Additionally, because the robot remains stationary when the mouse is not being manipulated, the surgeon can position it and operate bimanually. Methods: The system was validated by performing visualization and biopsy procedures on two human cadavers with the Robo-ELF and comparing this with standard rigid endoscopes with three different angles. Results: The Robo-ELF outperformed the rigid scopes in both image quality and range of motion, overcoming line of site constraints, and allowing visualization of otherwise hidden anatomy. The system also demonstrated a rapid learning curve and enhanced motor control over a manually operated flexible endoscope. Conclusions: The Robo-ELF is a novel robot to assist in driving a flexible endoscope for surgery of the upper aerodigestive tract.