TY - JOUR

T1 - Development of a Steerable Miniature Instrument to Manage Internal Carotid Artery Injury in Endoscopic Transsphenoidal Surgery Simulation

AU - Budde, Leon

AU - Hon, Nicole Wing Lam

AU - Kim, Jongwoo

AU - Witterick, Ian

AU - Campisi, Paolo

AU - Chan, Yvonne

AU - Forte, Vito

AU - Drake, James

AU - Looi, Thomas

N1 - Funding Information: This work was supported in part by the Hospital for Sick Children Foundation and in part the Harry Barberian cholarship Award from the Department of Otolaryngology, Head and Neck Surgery at the University of Toronto.

PY - 2020/12/2

Y1 - 2020/12/2

N2 - Endoscopic transsphenoidal surgery is challenged by restricted visualization and dexterity, and the risk of internal carotid artery (ICA) injury. This study pursued two objectives: Development of a steerable, miniature multi-tool combining visualization and suction/irrigation, and development of a simulation model for ICA injury. The multi-tool featured a two degrees of freedom notched nitinol wrist controlled by a joystick. A theoretical range of motion of 90 degrees was intended. The inner lumen of the wrist was designed for suction and irrigation, a miniature camera attached to the tip would provide visualization. During testing, slack in the actuation cables affected the tools workspace and control. A maximum force of 0.45 N was applied through the tip. The simulation model was manufactured from medical grade ABS. It featured a removable nose cartridge for a cost efficient replacement method. A peristaltic pump and a needle tip were used for ICA injury simulation. For future evaluation of the model, a 5 point Likert scale was developed. Despite successful tests, some limitations remained. The tool was affected by slack and did not include illumination. No mucosal layer was included in the simulation model and haemostasis had to be assessed manually.

AB - Endoscopic transsphenoidal surgery is challenged by restricted visualization and dexterity, and the risk of internal carotid artery (ICA) injury. This study pursued two objectives: Development of a steerable, miniature multi-tool combining visualization and suction/irrigation, and development of a simulation model for ICA injury. The multi-tool featured a two degrees of freedom notched nitinol wrist controlled by a joystick. A theoretical range of motion of 90 degrees was intended. The inner lumen of the wrist was designed for suction and irrigation, a miniature camera attached to the tip would provide visualization. During testing, slack in the actuation cables affected the tools workspace and control. A maximum force of 0.45 N was applied through the tip. The simulation model was manufactured from medical grade ABS. It featured a removable nose cartridge for a cost efficient replacement method. A peristaltic pump and a needle tip were used for ICA injury simulation. For future evaluation of the model, a 5 point Likert scale was developed. Despite successful tests, some limitations remained. The tool was affected by slack and did not include illumination. No mucosal layer was included in the simulation model and haemostasis had to be assessed manually.

KW - Minimally-invasive surgery

KW - miniature multi-tool

KW - sphenoid sinus surgery

KW - steerable endoscope

KW - surgical training simulator

UR - http://www.scopus.com/inward/record.url?scp=85115876995&partnerID=8YFLogxK

U2 - 10.1109/tmrb.2020.3041897

DO - 10.1109/tmrb.2020.3041897

M3 - Article

VL - 3

SP - 281

EP - 284

JO - IEEE Transactions on Medical Robotics and Bionics

JF - IEEE Transactions on Medical Robotics and Bionics

SN - 2576-3202

IS - 1

M1 - 9276465

ER -