Robotic tremor suppression: a tool for stapes surgery?

Abstract

Objective: 1) Create a custom micropick for Micron, a fully handheld robotic micromanipulator. 2) Demonstrate phenomenon of physiologic tremor and evaluate bracing technique in simulated otologic surgery. 3) Evaluate feasibility and efficacy of Micron, to decrease surgeon tremor, positioning error, and force applied in tasks simulating otologic surgery.

Method: Two positioning conditions tested: hovering mid-air and lightly contacting surface. 3D axes error, tremor, and force measurements. Experimental conditions: 1) unaided, 2) unaided with bracing, 3) Micron alone, 4) Micron with bracing. Tremor and position error were analyzed with a high-pass filter. Significance (P < .05)(*) via 2-tailed t test. Results: Positioning Error: Root mean square (RMS) and maximum error (ME) are reported. Reduction in ME was seen in the surface task, with bracing alone and Micron alone. However, the hover task showed significant benefits with only Micron + bracing. Force Error: RMS and maximum force error showed no difference between conditions. Tremor Error: Positioning error contains tremor and overall drift from the goal position. Statistically significant reduction in tremor both in RMS and ME is seen with Micron, bracing, and the combination. Micron + bracing produced the largest reduction in tremor. Conclusion: Our initial results demonstrate Micron significantly reduced maximum positioning error (tremor) in simulated otologic surgery. Additionally, we confirmed bracing significantly dampens tremor. Interestingly, the use of Micron and bracing yielded the largest reduction in tremor, suggesting an additive effect. No difference in force applied was found.