title: The application of robotics to microlaryngeal laser surgery.
abstract: OBJECTIVE
  To evaluate the performance of human subjects, using a prototype robotic micromanipulator controller in a simulated, microlaryngeal operative setting.
  
  
  METHODS
  Observational cross-sectional study.
  
  
  METHODS
  Twenty-two human subjects with varying degrees of laser experience performed CO2 laser surgical tasks within a simulated microlaryngeal operative setting using an industry standard manual micromanipulator (MMM) and a prototype robotic micromanipulator controller (RMC). Accuracy, repeatability, and ablation consistency measures were obtained for each human subject across both conditions and for the preprogrammed RMC device.
  
  
  RESULTS
  Using the standard MMM, surgeons with >10 previous laser cases performed superior to subjects with fewer cases on measures of error percentage and cumulative error (P = .045 and .03, respectively). No significant differences in performance were observed between subjects using the RMC device. In the programmed (P/A) mode, the RMC performed equivalently or superiorly to experienced human subjects on accuracy and repeatability measures, and nearly an order of magnitude better on measures of ablation consistency. The programmed RMC performed significantly better for repetition error when compared to human subjects with <100 previous laser cases (P = .04).
  
  
  CONCLUSIONS
  Experienced laser surgeons perform better than novice surgeons on tasks of accuracy and repeatability using the MMM device but roughly equivalently using the novel RMC. Operated in the P/A mode, the RMC performs equivalently or superior to experienced laser surgeons using the industry standard MMM for all measured parameters, and delivers an ablation consistency nearly an order of magnitude better than human laser operators.
  
  
  METHODS
  NA.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, U.S.A.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Buckmire
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, University of California San Diego School of Medicine, San Diego, California, U.S.A.
authors.forename: Yu-Tung
authors.initials: YT
authors.lastname: Wong
authors.affiliation: and the Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina Hospitals, Chapel Hill, North Carolina, U.S.A.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Deal
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004867:Equipment Design; D005260:Female; D006801:Humans; D007830:Larynx / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D065287:Robotic Surgical Procedures / Q000295:instrumentation
keywords: CO2 laser; Robotic surgery; laser guidance; learning curve; microlaryngeal surgery