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![Maxillary sinus anatomy. (a),Location of the paranasal sinuses (Adapted from²); (b) Maxillary sinus and nasal cavity anatomy in the coronal plane; (c) Maxillary sinus and nasal cavity anatomy with medial antrostomy dimensions and procedure in the axial (left) and coronal plane (right): resection of the tissues in red; (d) Insertion of some conventional instruments for sinus surgery into the maxillary sinus: transversal (left) and coronal (right) views: a 3.2 mm diameter forceps 45∘\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$45^{\circ }$$\end{document} upturned (11), a 2.5 mm diameter Heuwieser grasping forceps (12) and a 4 mm diameter double spoon forceps of 110∘\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$110^{\circ }$$\end{document} (10), and finally, insertion of an envisioned dexterous flexible instrument (gray). The gray surfaces represent cavities. The white areas are bony structures. 1. maxillary ostium; 2. uncinate process; 3. orbit; 4. maxillary sinus; 5. molar dentition; 6. nasal cavity; 7. lacrimal canal; 8. antrostomy; 9. inferior turbinate.](publication/357877630/figure/fig1/AS:1122143546941440@1644551278358/Maxillary-sinus-anatomy-a-Location-of-the-paranasal-sinuses-Adapted-from-b.png)
Maxillary sinus anatomy. (a),Location of the paranasal sinuses (Adapted from²); (b) Maxillary sinus and nasal cavity anatomy in the coronal plane; (c) Maxillary sinus and nasal cavity anatomy with medial antrostomy dimensions and procedure in the axial (left) and coronal plane (right): resection of the tissues in red; (d) Insertion of some conventional instruments for sinus surgery into the maxillary sinus: transversal (left) and coronal (right) views: a 3.2 mm diameter forceps 45∘\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$45^{\circ }$$\end{document} upturned (11), a 2.5 mm diameter Heuwieser grasping forceps (12) and a 4 mm diameter double spoon forceps of 110∘\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$110^{\circ }$$\end{document} (10), and finally, insertion of an envisioned dexterous flexible instrument (gray). The gray surfaces represent cavities. The white areas are bony structures. 1. maxillary ostium; 2. uncinate process; 3. orbit; 4. maxillary sinus; 5. molar dentition; 6. nasal cavity; 7. lacrimal canal; 8. antrostomy; 9. inferior turbinate.
Source publication
In endoscopic maxillary sinus surgery, the maxillary sinus is accessed through the nasal cavity which constitutes a narrow and tortuous pathway. However, surgeons still use rigid endoscopes and rigid, straight or pre-bent instruments for this procedure. Resection of the uncinate process and creation of a medial antrostomy is warranted to access the...
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Background: Open septorhinoplasty is a common facial plastic surgery procedure that requires extensive planning and knowledge to achieve predictable outcomes. Many patients want to keep their nasal tip characteristics, and the surgeon's task is to reliably meet this expectation and provide stable long-term results. Techniques used to reconstruct na...
Citations
... Apart from robotic scope holders, several research prototypes of scopes with an inbuilt actuation mechanism have also been developed. [17,18,19]. These scopes consist of a rigid shaft that transitions into a flexible distal end, enabling changes in the viewing direction. ...
... These scopes consist of a rigid shaft that transitions into a flexible distal end, enabling changes in the viewing direction. Legrand et al. [17] introduced the PliENT system, specifically designed to visualize nasal cavity pathologies without resecting healthy tissues. Another nasal system, presented by Song et al. [18], featured a custom designed endoscope incorporating a flexible bending section linked to a rigid shaft. ...
Objective:
Variable-view rigid scopes offer advantages compared to traditional angled laparoscopes for examining a diagnostic site. However, altering the scope's view requires a high level of dexterity and understanding of spatial orientation. This requires an intuitive mechanism to allow an operator to easily understand the anatomical surroundings and smoothly adjust the scope's focus during diagnosis. To address this challenge, the objective of this work is to develop a mechanized arm that assists in visualization using variable-view rigid scopes during diagnostic procedures.
Methods:
A system with a mechanized arm to maneuver a variable-view rigid scope (EndoCAMeleon - Karl Storz) was developed. A user study was conducted to assess the ability of the proposed mechanized arm for diagnosis in a preclinical navigation task and a simulated cystoscopy procedure.
Results:
The mechanized arm performed significantly better than direct maneuvering of the rigid scope. In the preclinical navigation task, it reduced the percentage of time the scope's focus shifted outside a predefined track. Similarly, for simulated cystoscopy procedure, it reduced the duration and the perceived workload.
Conclusion:
The proposed mechanized arm enhances the operator's ability to accurately maneuver a variable-view rigid scope and reduces the effort in performing diagnostic procedures.Clinical and Translational Impact Statement: The preclinical research introduces a mechanized arm to intuitively maneuver a variable-view rigid scope during diagnostic procedures, while minimizing the mental and physical workload to the operator.
... This creates new challenges for surgical operations and places greater demands on surgical instruments in MIS [2], [3]. For microsurgery such as transnasal surgery [4], transoral surgery [5], and fetal surgery [6], a sufficiently small outer diameter (OD) of the surgical instruments is a primary requirement, followed by precise motion control and other characteristics, such as large inner diameter (ID) to OD ratio, stability, etc. [7]. Miniaturized flexible instruments with large ID to OD ratios are suitable for narrow and curved human lumen environments such as the external auditory canal [8], nasal cavity, and bronchus [9], while allowing for the delivery of many diagnostic or therapeutic instruments, for example, ultrasound catheter, optical coherence tomography (OCT) probe, and laser ablation fiber, to the target location with minimal tissue collision. ...
... These designs face the same miniaturization and clearance issues. Another type of continuum manipulator is machined from nickel-titanium (Ni-Ti) alloy tubes with regularly distributed notches [4], [28], [29]. This manipulator can be easily miniaturized thanks to its specific structure, but its short fatigue life due to stress concentration around the cutouts should be taken into account for safety purposes. ...
Minimally invasive surgery is gaining wide-spread attention in the laboratory and the clinic due to its advantages of less trauma, less pain, and faster recovery. Miniature continuum instruments with a large central channel are needed for reducing damage to healthy tissue and delivering multiple surgical tools in microsurgery such as fetal surgery and maxillary sinus surgery. In this article, we proposed a novel miniature spring-based cable-driven continuum manipulator characterized by its offset neutral bending plane and its simple and clever structure. These features enable the manipulator to have several advantages such as easy miniaturization, bending stability and uniformity, a large central channel, smaller cable tension required, and low cost. A piecewise constant curvature model, with the offset neutral bending plane taken into account, is presented for the kinematic control of the proposed manipulator. To explore the relationship between the cable tension and manipulator bending angle, the statics model based on the equivalent model principle, is exhaustively discussed. The accuracy of kinematics and statics models, as well as the design superiority, was verified experimentally. Furthermore, teleoperation experiments of peg-transfer tasks and porcine tissue laser ablation are conducted to verify the feasibility and effectiveness of the proposed manipulator in different forms. Final, design variations are showcased to enrich manipulator design and functionality.
... The total NASA-TLX score was 62 (49-75). In the subscales of NASA-TLX, mental demand, physical demand, temporal demand, perceived performance, effort, and frustration were 7 (5-10), 8 (5-10), 16 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), 10 (6-16), 15 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and 5 (4-10), respectively (Table 1). Temporal demand and effort were significantly higher than the other four subscales (Figure 1). ...
... The total NASA-TLX score was 62 (49-75). In the subscales of NASA-TLX, mental demand, physical demand, temporal demand, perceived performance, effort, and frustration were 7 (5-10), 8 (5-10), 16 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), 10 (6-16), 15 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and 5 (4-10), respectively (Table 1). Temporal demand and effort were significantly higher than the other four subscales (Figure 1). ...
... Stelter et al. investigated four experienced rhinologists' mental workload during transnasal endoscopic surgeries for variety of diseases including chronic rhinosinusitis, mucoceles of frontal sinuses, cerebral spinal fluid leaks, and skull-base surgeries (12). Mental workload also has been investigated as part of studies on utility of new devices, such as augmented reality (AR) image guidance (18), Virtual reality (VR) (19), and flexible endoscopes for ESS (20). In addition, the role of surgical ergonomics on the surgeons' mental workload was evaluated (21,22). ...
Introduction
Surgeons’ mental workload during endoscopic sinus surgery (ESS) has not been fully evaluated. The assessment was challenging due to the great diversity of each patient’s anatomy and the consequence variety of surgical difficulties. In this study, we examined the mental workload of surgeons with various surgical skill levels during ESS under the standardized condition provided by novel-designed 3D sinus models.
Materials and methods
Forty-seven participants performed a high-fidelity ESS simulation with 3D-printed sinus models. Surgeons’ mental workload was assessed with the national aeronautics and space administration-task load index (NASA-TLX). Associations between the total and subscales score of NASA-TLX and surgical skill index, including the board certification status, the number of experienced ESS cases, and the objective structured assessment of technical skills (OSATS), were analyzed. In addition, 10 registrars repeated the simulation surgery, and their NASA-TLX score was compared before and after the repetitive training.
Results
The total NASA-TLX score was significantly associated with OSATS score (p = 0.0001). Primary component analysis classified the surgeons’ mental burden into three different categories: (1) the skill-level-dependent factors (temporal demand, effort, and performance), (2) the skill-level-independent factors (mental and physical demand), and (3) frustration. After the repetitive training, the skill-level-dependent factors were alleviated (temporal demand; z = −2.3664, p = 0.0091, effort; z = −2.1704, p = 0.0346, and performance; z = −2.5992, p = 0.0017), the independent factors were increased (mental demand; z = −2.5992, p = 0.0023 and physical demand; z = −2.2509, p = 0.0213), and frustration did not change (p = 0.3625).
Conclusion
Some of the mental workload during ESS is associated with surgical skill level and alleviated with repetitive training. However, other aspects remain a burden or could worsen even when surgeons have gained surgical experience. Routine assessment of registrars’ mental burdens would be necessary during surgical training to sustain their mental health.
... An articulated scope comprises a rigid shaft with an articulated distal end to change the viewing direction. These scopes improve navigation of the operating field by: (a) Providing distal adjustment of the viewing direction in confined spaces (such as thoracic [1] or insufflated abdominal [2] cavity) without the need to move the scope's shaft [3]; ...
... These advantages led to development of commercial articulated scopes (such as EndoEyeFlex-Olympus, EndoCAMeleon-Karl Storz, and Ideal Eyes-Stryker). In addition to the commercial products, several prototypes of robotic (or actuated) articulated scopes comprised a rigid shaft and an actuated flexible distal end have been proposed [3,6,7]. The Cardioscope system proposed by Li et al. [6] showed the feasibility of exploring and visualizing the heart through a single incision. ...
... The Cardioscope system proposed by Li et al. [6] showed the feasibility of exploring and visualizing the heart through a single incision. The PliENT system developed by Legrand et al. [3] assisted in accessing the maxillary sinus through the nasal cavity. Similarly, the robotic flexible system developed by Song et al. [7] used an actuated articulated scope in cholecystectomy procedures. ...
Background
An articulated laparoscope comprises a rigid shaft with an articulated distal end to change the viewing direction. The articulation provides improved navigation of the operating field in confined spaces. Furthermore, incorporation of an actuation system tends to enhance the control of an articulated laparoscope.
Methods
A preliminary prototype of a scope actuation system to maneuver an off-the-shelf articulated laparoscope (EndoCAMaleon by Karl Storz, Germany) was developed. A user study was conducted to evaluate this prototype for the surgical paradigm of video-assisted thoracic surgery. In the study, the subjects maneuvered an articulated scope under two modes of operation: (a) actuated mode where an operating surgeon maneuvers the scope using the developed prototype and (b) manual mode where a surgical assistant directly maneuvers the scope. The actuated mode was further assessed for multiple configurations based on the orientation of the articulated scope at the incision.
Results
The data show the actuated mode scored better than the manual mode on all the measured performance parameters including (a) total duration to visualize a marked region, (a) duration for which scope focus shifts outside a predefined visualization region, and (c) number of times for which scope focus shifts outside a predefined visualization region. Among the different configurations tested using the actuated mode, no significant difference was observed.
Conclusions
The proposed articulated scope actuation system facilitates better navigation of an operative field as compared to a human assistant. Secondly, irrespective of the orientation in which an articulated scope’s shaft is inserted through an incision, the proposed actuation system can navigate and visualize the operative field.
... As shown in Figure 8D, Legrand et al. 39 For instance, the surgeons have to maintain their hand posture in order for the CRs to reach a specified state in Figure 8A and C, therefore long-term operation may induce tiredness. The design of actuation units in Figure 8B and D alleviates this problem. ...
Purpose:
Endoscopic sinus surgery (ESS) has been recognized as an effective treatment modality for paranasal sinus diseases. Over the past decade, continuum robots (CRs) for ESS have been studied, but there are still some challenges. This paper presents a review on the scientific studies of CRs for ESS.
Methods:
Based on the analysis of the anatomical structure of the paranasal sinus, the requirements of CRs for ESS are discussed. Recent studies on rigid robots, handheld flexible robots, and CRs for ESS are presented. Surgical path planning, navigation, and control are also included.
Results:
Concentric tube CRs and cable-driven CRs have great potential for applications in ESS. The CRs incorporated with multiple replaceable arms with different functions are preferable in ESS.
Conclusion:
Further study on navigation and control is required to improve the performance of CRs for ESS. This article is protected by copyright. All rights reserved.
... The length of the flexible part (where the notches were cut) and the diameter of the catheter are 40 mm and 6 mm, respectively. With a steerable length of 40 mm, applications in minimally invasive orthopedic [14] or ENT [18] could be envisioned. Four custom-made PAMs, which are made up of a bladder, an uninflatable tube, braids and ferrules, are used to actuate the catheter. ...
In this article, a deep learning method for the shape sensing of continuum robots based on multicore fiber bragg grating (FBG) fiber is introduced. The proposed method, based on an artificial neural network (ANN), differs from traditional approaches, where accurate shape reconstruction requires a tedious characterization of many characteristic parameters. A further limitation of traditional approaches is that they require either multiple fibers, whose location relative to the centerline must be precisely known (calibrated), or a single multicore fiber whose position typically coincides with the neutral line. The proposed method addresses this limitation and, thus, allows shape sensing based on a single multicore fiber placed off-center. This helps in miniaturizing and leaves the central channel available for other purposes. The proposed approach was compared to a recent state-of-the-art model-based shape sensing approach. A two-degree-of-freedom benchtop fluidics-driven catheter system was built to validate the proposed ANN. The proposed ANN-based shape sensing approach was evaluated on a 40-mm-long steerable continuum robot in both 3-D free-space and 2-D constrained environments, yielding an average shape sensing error of 0.24 and 0.49 mm, respectively. With these results, the superiority of the proposed approach compared to the recent model-based shape sensing method was demonstrated.
Objective:
To enhance visualization in pediatric Otolaryngology middle ear surgeries and reduce mastoidectomy instances, we introduce a novel Articulating Chip-on-Tip Endoscope (ACoT Endo).
Methods:
The ACoT Endo incorporates a cable driven distal end camera and off-the-shelf Chip-on- Tip camera to improve visualization. We compared its capabilities with standard endoscopes, evaluating its bending capacity (70 ±2) and center axis rotation (360). To test the overall functionality of this device, a Mock Ear was created to simulate the anatomy of the human ear, and the ACoT Endo's ability to be used in this cavity is compared to a standard 0 Karl Storz endoscope through tests with the Mock Ear and respective endoscopes.
Results:
The ACoT Endo accurately captured surgical details similar to standard endoscopes in the ENT field. Compared to the 0° Karl Storz endoscope, the ACoT Endo demonstrated an increased field of view by approximately 69% and captured area by approximately 249%. ACot Endo allowed the surgeon to effortlessly articulate the camera with the rotation of a finger, while an excision tool was inserted in the middle ear, a procedure that is currently extremely difficult with standard endoscopes.
Conclusion:
The ACoT Endo's dynamic viewing angle and Chip-on- Tip camera enable unparalleled surgical visualization within the middle ear using a single endoscope, offering potential benefits in Otolaryngology procedures.
Significance:
By reducing the need for invasive mastoidectomies and providing better visualization tools, the ACoT Endo has significant potential to improve outcomes and safety in pediatric middle ear surgeries.
