Purpose

Draf drainage is the standard treatment procedure for frontal sinus diseases. In this procedure, rigid angled endoscopes and rigid curved instruments are used. However, laterally located pathologies in the frontal sinus cannot be reached with rigid instrumentation. In order to assist surgeons with such complicated cases, we propose a novel handheld flexible manipulator system.

Methods

A cross section of 3 mm × 4.6 mm enables transnasal guiding of a flexible endoscope with 1.4 mm diameter and a standard flexible surgical instrument with up to 1.8 mm diameter into the frontal sinus with increased reachability. The developed system consists of an electrical discharge-machined flexure hinge-based nitinol manipulator arm and a purely mechanical handheld control unit. The corresponding control unit enables upward and left–right bending of the manipulator arm, translation, rolling, actuation and also quick exchange of the surgical instrument. In order to verify the fulfillment of performance requirements, tests regarding reachability and payload capacity were conducted.

Results

Reachability tests showed that the manipulator arm can be inserted into the frontal sinus and reach its lateral regions following a Draf IIa procedure. The system can exert forces of at least 2 N in the vertical direction and 1 N in the lateral direction which is sufficient for manipulation of frontal sinus pathologies.

Conclusion

Considering the fact that the anatomical requirements of the frontal sinus are not addressed satisfactorily in the development of prospective flexible instruments, the proposed system shows great potential in terms of therapeutic use owing to its small cross section and dexterity.

中文翻译：

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用于额窦手术的手持式柔性机械手系统。

目的

引流是额窦疾病的标准治疗程序。在此过程中，使用刚性角度内窥镜和刚性弯曲器械。然而，使用刚性器械无法达到额窦的侧向病变。为了协助外科医生处理如此复杂的病例，我们提出了一种新颖的手持式柔性机械手系统。

方法

3 mm × 4.6 mm 的横截面能够将直径为 1.4 mm 的柔性内窥镜和直径最大为 1.8 mm 的标准柔性手术器械经鼻引导到额窦，并提高可达性。开发的系统由放电加工的弯曲铰链镍钛诺机械臂和纯机械手持控制单元组成。相应的控制单元可以实现机械臂的上下弯曲、平移、滚动、驱动以及手术器械的快速更换。为了验证性能要求的满足，进行了有关可达性和有效载荷容量的测试。

结果

可达性测试表明，在 Draf IIa 手术后，机械臂可以插入额窦并到达其外侧区域。该系统可以在垂直方向施加至少 2 N 的力，在横向方向施加至少 1 N 的力，这足以处理额窦病变。

结论

考虑到额窦的解剖学要求在前瞻性柔性器械的开发中没有得到令人满意的解决，所提出的系统由于其小横截面和灵巧性而在治疗用途方面显示出巨大的潜力。