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This letter reports the design, construction, and experimental validation ofa novel hand-held robot for in-office laser surgery of the vocal folds.In-office endoscopic laser surgery is an emerging trend in Laryngology: Itpromises to deliver the same patient outcomes of traditional surgical treatment(i.e., in the operating room), at a fraction of the cost. Unfortunately, officeprocedures can be challenging to perform; the optical fibers used for laserdelivery can only emit light forward in a line-of-sight fashion, which severelylimits anatomical access. The robot we present in this letter aims to overcomethese challenges. The end effector of the robot is a steerable laser fiber,created through the combination of a thin optical fiber (0.225 mm) with atendon-actuated Nickel-Titanium notched sheath that provides bending. Thisdevice can be seamlessly used with most commercially available endoscopes, asit is sufficiently small (1.1 mm) to pass through a working channel. To controlthe fiber, we propose a compact actuation unit that can be mounted on top ofthe endoscope handle, so that, during a procedure, the operating physician canoperate both the endoscope and the steerable fiber with a single hand. Wereport simulation and phantom experiments demonstrating that the proposeddevice substantially enhances surgical access compared to current clinicalfibers.

Light in the Larynx: a Miniaturized Robotic Optical Fiber for In-office Laser Surgery of the Vocal Folds