ACTORS: Adaptive and Compliant Transoral Robotic Surgery With Flexible Manipulators and Intelligent Guidance

There exist limitations to transoral robotic surgery in curvilinear navigation and tremor suppression. To address these challenges, this chapter introduces an adaptive and compliant transoral robotic surgery (ACTORS) with flexible manipulators and intelligent guidance. The patient-side manipulators are based on a flexible parallel mechanism with three sets of chains composed of superelastic nickel-titanium rods and universal joints. Compared to conventional parallel mechanisms, this design optimizes the structure for adaptiveness and compliance by introducing superelastic structures. Due to adjoining of the head-neck-brain anatomical structures, transoral surgery raises a crucial demand for navigation accuracy. However, the transoral environment poses a prominent challenge because of the textureless surface, irregular shape, and nonrigid characteristics. Furthermore, it is notably tough for surgeons to determine the location of the endoscope instrument on account of the narrow field of view. For precise navigation during transoral surgical procedures, endoscopic simultaneous localization and mapping can provide real-time localization of the endoscope and the three-dimensional map of the surgical site, which can further be registered to preoperative imaging data to enhance visual understanding. This chapter elaborates on the ACTORS robot and the intelligent guidance in detail, with a performance test and cadaveric trials.