Setup and initial testing of an endoscope manipulator system for assistance in transoral endoscopic surgery
-
Axel Boese
,
Philipp Hündorf
Abstract
Purpose
For the treatment of malignant diseases of the oral cavity and the larynx, a total or partial resection is the standard therapy, while in special cases chemo- and/or external radiation therapy is considered. Transoral access reduces trauma and hospitalization time. Transoral surgery is usually executed using external microscopic imaging. Therefore, the microscope is placed in the visual line of the opening of the mouth and throat. However, specific anatomical structures like the posterior commissure (dorsal end of the vocal cords) are not visible in these procedures. An endoscopic approach can improve this problem. We introduce a new prototype system for endoscopic assisted transoral surgery.
Methods
Based on clinical observation and discussions with professional users and surgeons, the clinical need was identified and specified. A general concept or an endoscopic manipulator to assist microlaryngeal surgery was designed. For that a steerable rigid endoscope was combined with an actuator that allows translational and rotational movement. A quick release fastener was designed allowing for fast change of the endoscope and independence from its shape and type. The actuator was fixed on a commercially available, semi-active medical holding arm for easy positioning. The holder can be fixed to the standard rails of the surgical table. The piezoelectric drives integrated in the actuator are activated with a foot pedal. This allows easy and fast fine positioning, while the hands are free to perform the surgery with standard instruments for microlaryngeal surgery.
Results
A prototype of the system for endoscopic assisted transoral surgery was developed. The entire technical setup was tested in terms of usability and performance in a simulated surgical scenario. A basic phantom, representing the throat and vocal cords was created and placed on a surgical table. The system was installed on the table and the clinical workflow of a simulated endoscopic assisted surgery on the vocal cords was performed. The performance of the setup and the procedure success was evaluated by clinical users.
Conclusion
Fixture of the system on the surgical table is fast and easy due to its low weight and compact design. The medical holder allows a fast initial positioning of the system in front of the phantom patient. An easy insertion and removal of the endoscope was realized using the quick release fastener. The developed endoscope fixation is universally adaptable and not limited to a single type of endoscope. The piezoelectric drives, combined with the foot pedal, allow a precise placement and readjustment of the endoscope during surgery. The use of a multi view endoscope enables a variable view on the surgical situs. The size and shape of the whole setup offer excellent access to the targeted structures. The development was classified beneficial by the clinical users.
Acknowledgments
The authors would like to thank their colleagues at the chair of INKA Catheter Technologies at the Otto-von-Guericke-University of Magdeburg and Olympus Germany for support with equipment.
Author Statement
Research funding: This study was financially supported by the Federal Ministry of Education and Research (BMBF) in the context of the “INKA” project (Grant Number 03IPT7100X).
Conflict of interest: Michael Friebe is a shareholder of Medineering GmbH (<1%). All other authors declare that they have no conflict of interest. For testing of the system, a multi view endoscope and a pendulum camera were provided free of charge by Olympus Germany.
Informed consent: This article does not contain patient data.
Ethical approval: This article does not contain any studies with animals or human beings performed by any of the authors.
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©2019 Walter de Gruyter GmbH, Berlin/Boston
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- Setup and initial testing of an endoscope manipulator system for assistance in transoral endoscopic surgery
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Articles in the same Issue
- Frontmatter
- Review
- Current state of total artificial heart therapy and introduction of the most important total artificial heart systems
- Research articles
- Impact of strut dimensions and vessel caliber on thrombosis risk of bioresorbable scaffolds using hemodynamic metrics
- A coefficient-free and continuous blood pressure estimation method based on the arterial lumen area model
- High-frequency wall vibrations in a cerebral patient-specific aneurysm model
- Study of a retinal layer model to generate a spike waveform for a color deficient and strabismus individual
- Retinal images benchmark for the detection of diabetic retinopathy and clinically significant macular edema (CSME)
- Robust EOG-based saccade recognition using multi-channel blind source deconvolution
- Investigation of the mirrored-word reading paradigm for BCI implementation
- Biomechanical analysis of spinal implants with different rod diameters under static and fatigue loads: an experimental study
- Setup and initial testing of an endoscope manipulator system for assistance in transoral endoscopic surgery
- A theoretical study of digital silicon photomultiplier utilization in diffuse optical imaging systems
- Evaluation of a new non-invasive measurement technique based on bioimpedance spectroscopy to estimate blood alcohol content: a pilot study
