Clinical Feasibility of a Dual-Arm Robotic System for ENT Procedures: A Pilot Workload Assessment

OBJECTIVE: To evaluate operator workload and usability of a dual-arm teleoperated robotic platform designed for solo-physician outpatient otorhinolaryngology (ENT) procedures. METHODS: A dual-arm system integrating a flexible endoscope manipulator (EndoBot) and an instrument manipulator (ToolBot) was developed and controlled via dual joysticks and a multi-view interface. Five otolaryngologists performed simulated nasal and oral procedures on an anatomical phantom and completed standardized workload (NASA-Task Load Index [TLX]) and usability questionnaires. RESULTS: All scheduled trials were completed successfully. Workload was higher for nasal than for oral tasks (NASA-TLX total score, sum of six 0-10 subscales; nasal: 44.0 vs oral: 22.2), which may reflect the narrower nasal workspace and more frequent view management. Key limitations included conservatively-restricted motion speed, limited depth perception in multi-view teleoperation, and timing metrics defined from entry pose to task completion (excluding full setup/docking steps). CONCLUSION: These preliminary phantom-based findings characterize early-operator workload and interface constraints of a dual-arm teleoperated system for outpatient ENT procedures. The results provide hypothesis-generating signals to guide system refinement. Future patient-based, head-to-head studies are required to assess full workflow performance and clinical applicability.