Robotic Technology in Laryngology with Professors Marc Remacle and Martin Birchall

The final episodes of BLA Connections: A Clear Voice, current series provides an overview of highlights from the Cutting Edge Laryngology 2024 conference in London. Host Natalie Watson introduces keynote speakers, including Prof Marc Remacle, reflecting on 30 years of work in laryngology; Dr Anais Rameau, discussing the role of artificial intelligence in the future of the field; and Dr Nupur Nerurkar, covering vocal fold cysts, sulci, and mucosal bridges. Additional contributions include Prof Martin Birchall discussing soft robotics and Prof David Howard reflecting on his career and advancements in laryngology, how far we have come and where we are going.  Conference talks are also available on Talking Slides for BLA members and delegates.

In the episode, Profs Remacale and Birchall focus on the use of soft and hard robotics in medicine. Hard robotics, commonly used in surgeries, have limitations in laryngology due to size and access challenges. Soft robotics, inspired by biological systems, offer potential for flexible applications such as dynamic vocal cord implants and adaptable surgical tools, though further development is required. Both professors highlight the importance of combining artificial intelligence with robotics to improve precision and outcomes. The podcast provides an informative summary of recent advancements and ongoing innovations in laryngology.

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Transcript

Host Natalie Watson

Hello and welcome to the BLA Connections: A Clear Voice, Series 6 - this is the finale! We'll be closing with a collection of five podcasts, which we recorded back at Cutting Edge Laryngology, 2024 in London, UK. We have three amazing keynote speakers, Marc Remacle, talking about his 30 years; ‘What did I learn?’ Anais Rameau from New York, talking about AI and the future of laryngology. And Nupur Nerurkar on vocal folds, cysts, sulci and mucosal bridges.

We also listened to Martin Birchall and Marc Remacle talk on hard and soft robotics. Martin was one of our previous presidents. And we finally have the remarkable, amazing Professor David Howard, our first president of the BLA, talking about his career in laryngology, and also what he's doing now and what he is planning to do in the future.

With regards to Cutting Edge 2024, we're very pleased to announce that all the talks and presentations are live on talking slides, which you can access if you're a BLA member or delegate of the conference. We hope that you enjoy our podcast. Please do have a listen.

Cutting Edge: Prof Martin Birchall + Prof Marc Remacle

Host Natalie Watson

Welcome to the BLA Connections: A Clear Voice podcast. This is live from Cutting Edge Laryngology 2024, and we are delighted to introduce Professor Marc Remacle from Luxembourg, and Professor Martin Birchall from here in London. Today, we're going to be talking about soft and hard robotics. What is soft robotics?

Prof Martin Birchall

I think everybody will be very familiar with hard robotics, which is conventional robots that we've seen building cars, and in the operating theatre. They are based on pulleys, and levers, and structures, and pumps and are quite bulky. Clearly, we've been able to make big advances with conventional robotics. Soft robotics, however, is based on biomimetics, so there are materials that will deform predictably when you put an impulse to it, and so like a balloon. So like a magician at a children's party, blowing a balloon to make different shapes, and you can use those to move things, also electrical impulses where materials move. And so you can essentially create synthetic muscles.

Examples might be, wearables that will help people stand up out of a chair, or something that will improve continence, or new endoscopes that will crawl through the bowel, and you can, I mean soft robots have been used to build birds that fly, and fish that swim, but the potential for medicine is huge. It's just there's quite a lot of boundaries to get over before we start to really see it in our ENT clinics and theatres.

Host Natalie Watson

Right. So I'll come back to you about the advances in laryngology and soft robotics, but Marc, your experience of hard robotics?

Prof Marc Remacle

Yes, well, I started to work with a Garmin robot more than 20 years ago, and I learned a little bit from an American guy, and I went back, using this. So basically, what we have seen over the years is that it is efficient when you can use it in a proper way, because it was not made for us. We have to adapt ourselves to the robot, and this is a major issue, because, as Martin says, you have to go through the nose with big tubes, so in a safe way, you can approach the base of the tongue and the pharynx. But for the larynx, the larynx is too small for such big tubes. I was a believer in a new technology proposal some 10 years ago by an American company. It was a kind of semi-robotic robot, with flexible ends, and then you were able to use it for laryngology. And unfortunately, it was a startup company, and due to the COVID times, they went bankrupt, so it's not available anymore. But if it would be possible to start with this concept of something flexible? I'm a believer. So I'm a strong believer in robotic surgery using flexible technology in a way, or in order.

Host Natalie Watson

Yeah absolutely. So with regards to soft robotics, what are the new advances in laryngology?

Prof Martin Birchall

So well we haven’t, we've yet to really apply it to laryngology. I've spent some years seeing if we can develop a total laryngeal replacement based on soft robotics. And again, many challenges, but we've also learned a great deal in the meantime. I think what we know from experience in France, and elsewhere, is that if you have a complete metal replacement for the larynx or even heavier plastic, it's not well tolerated, and so we have to think laterally. But there's such a range of different soft robotic materials that we should be able to replicate what vocal cords can do, and even make dynamic implants. The new voice implant, for example, can be inflated and deflated. But if you could actually just inflate it and deflate it with a press of a button or on an app, that would be much better.

Host Natalie Watson

And that would be termed as soft robotics? Because I think the concept of robots, as you think, is externally operated? And, of course, it's the same thing. It is externally operated by the person, by the human, containing it.

Prof Martin Birchall

Absolutely, or if it had a sufficient learning set, enough experience of that person, AI could start to do it on its own. So I think that's a real possibility. But certainly, as Marc says, to your experience of working with flexible arms, that's where soft robotics is going. For laparoscopic surgery, you can deal with soft materials that are less likely to traumatise, and they can get around corners in a way that hard robots can't.

Host Natalie Watson

Yeah, excellent. So where do we see the future of hard robotics in laryngology?

Prof Marc Remacle

Well, it's a question of business. If we are able to find a company wishing to work, I think that the technology basically would be there. With artificial intelligence, I cannot imagine that they cannot be developed. If we would already be able to restart with the semi-flexible system from metrobotic, it would be a really big step. It's a question of finding a new startup, or find the fundings, but it will happen.

Host Natalie Watson

And the advantages of having a hard robot with a flexible system, is access, being able to assess everything, being able to see everything, and also to eliminate the shakes, to have a more precise, and even how they're doing robotic knee and hip replacements and things like that, to really accurately, pre operatively, assess a patient and then use the dimensions to then go into the operating room and duplicate that exactly. All pre planned, the way that you would want it.

Prof Marc Remacle

Yes. And I think with improvement in artificial intelligence for diagnosis on something like this, that this would just be the beginning. When we remember that time.

Host Natalie Watson

Amazing. The future is bright and the future potentially is robotic! Brilliant. Thank you so much for joining us both today. It's lovely to kickstart Cutting Edge with this lovely podcast. So thank you very much.

Prof Marc Remacle

My pleasure.

Prof Martin Birchall

Thank you Natalie.