RESUMO
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.
RESUMO
The development of the narrow-band imaging (NBI) has been increasing the interest of medical specialists in the study of laryngeal microvascular network to establish diagnosis without biopsy and pathological examination. A possible solution to this challenging problem is presented in this paper, which proposes an automatic method based on anisotropic filtering and matched filter to extract the lesion area and segment blood vessels. Lesion classification is then performed based on a statistical analysis of the blood vessels' characteristics, such as thickness, tortuosity, and density. Here, the presented algorithm is applied to 50 NBI endoscopic images of laryngeal diseases and the segmentation and classification accuracies are investigated. The experimental results show the proposed algorithm provides reliable results, reaching an overall classification accuracy rating of 84.3%. This is a highly motivating preliminary result that proves the feasibility of the new method and supports the investment in further research and development to translate this study into clinical practice. Furthermore, to our best knowledge, this is the first time image processing is used to automatically classify laryngeal tumors in endoscopic videos based on tumor vascularization characteristics. Therefore, the introduced system represents an innovation in biomedical and health informatics.
