In the development of telemanipulated surgical robots, a class of continuum robots known as concentric tube robots has drawn particular interest for clinical applications in which space is a major limitation. One such application is transnasal surgery, which is used to access surgical sites in the sinuses and at the skull base. Current techniques for performing these procedures require surgeons to maneuver multiple rigid tools through the narrow confines of the nasal passages, leaving them with limited dexterity at the surgical site. In this article, we present a complete robotic system for transnasal surgery featuring concentric tube manipulators. It illustrates a bagging concept for sterility, and intraoperatively interchangeable instruments that work in conjunction with it, which were developed with operating room workflow compatibility in mind. The system also includes a new modular, portable surgeon console, a variable view-angle endoscope to facilitate surgical field visualization, and custom motor control electronics. Furthermore, we demonstrate elastic instability avoidance for the first time on a physical prototype in a geometrically accurate surgical scenario, which facilitates use of higher curvature tubes than could otherwise be used safely in this application. From a surgical application perspective, this article presents the first robotic approach to removing tumors growing behind the eyes in the orbital apex region, which has not been attempted previously with a surgical robot.

在遥控外科手术机器人的发展中，一类称为同心管机器人的连续体机器人引起了对空间有限的临床应用的特别兴趣。一种这样的应用是经鼻手术，经鼻手术用于进入鼻窦和颅底的手术部位。用于执行这些程序的当前技术要求外科医生通过鼻道的狭窄范围来操纵多个刚性工具，从而使它们在外科手术部位的灵活性受限。在本文中，我们介绍了具有同心管操纵器的用于经鼻手术的完整机器人系统。它说明了无菌的装袋概念，以及与之配合使用的术中可互换的器械，这些器械在开发时就考虑到了手术室工作流程的兼容性。该系统还包括一个新的模块化便携式外科医生控制台，一个便于手术视野可视化的可变视角内窥镜以及定制的电机控制电子设备。此外，我们首次在几何精确的外科手术场景中的物理原型上展示了避免弹性不稳定性的方法，这比使用本应用中安全使用的曲率更高的管更容易使用。从外科手术的应用角度来看，本文提出了第一种机器人方法，用于去除眼眶顶端区域眼后生长的肿瘤，这是外科手术机器人以前从未尝试过的方法。我们首次在几何精确的外科手术场景中的物理原型上展示了避免弹性不稳定性的方法，这比使用本应用中安全使用的弯曲管更容易使用。从外科手术的应用角度来看，本文提出了第一种机器人方法，用于去除眼眶顶端区域眼后生长的肿瘤，这是外科手术机器人以前从未尝试过的方法。我们首次在几何精确的外科手术场景中的物理原型上展示了避免弹性不稳定性的方法，这比使用本应用中安全使用的弯曲管更容易使用。从外科手术的应用角度来看，本文提出了第一种机器人方法，用于去除眼眶顶端区域眼后生长的肿瘤，这是外科手术机器人以前从未尝试过的方法。