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A handheld flexible manipulator system for frontal sinus surgery.

Suat Coemert1, Robert Roth2, Gero Strauss3

  • 1Institute of Micro Technology and Medical Device Technology, Technical University of Munich, Boltzmannstr. 15, 85748, Garching, Germany. suat.coemert@tum.de.

International Journal of Computer Assisted Radiology and Surgery
|July 3, 2020
PubMed
Summary

Surgeons can now reach challenging frontal sinus areas using a new flexible manipulator system, improving treatment for complex diseases. This novel device enhances surgical access beyond the limits of rigid instruments.

Keywords:
Endoscopic surgeryFlexible manipulatorFrontal sinus surgeryHandheld

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Area of Science:

  • Minimally Invasive Surgery
  • Medical Robotics
  • Otolaryngology

Background:

  • Frontal sinus disease treatment typically uses Draf drainage with rigid endoscopes and instruments.
  • Rigid instrumentation limits access to laterally located frontal sinus pathologies.
  • A need exists for advanced tools to overcome limitations in rigid endoscopic sinus surgery.

Purpose of the Study:

  • To introduce a novel handheld flexible manipulator system for enhanced frontal sinus surgery.
  • To improve surgical access to difficult-to-reach lateral frontal sinus regions.
  • To provide surgeons with a tool for complex frontal sinus disease cases.

Main Methods:

  • A transnasal flexible endoscope (1.4 mm) and surgical instrument (1.8 mm) are guided via a 3 mm x 4.6 mm cross-section manipulator arm.
  • The system features a nitinol manipulator arm with a flexure hinge and a mechanical handheld control unit.
  • Control unit functions include bending, translation, rolling, actuation, and instrument exchange; performance verified by reachability and payload tests.

Main Results:

  • The flexible manipulator arm successfully reached lateral frontal sinus regions after a Draf IIa procedure.
  • The system demonstrated sufficient force exertion: at least 2 N vertically and 1 N laterally.
  • These forces are adequate for manipulating frontal sinus pathologies.

Conclusions:

  • The proposed flexible manipulator system addresses limitations of current instruments for frontal sinus anatomy.
  • Its small cross-section and dexterity offer significant potential for therapeutic applications.
  • This technology enhances surgical capabilities in treating complex frontal sinus conditions.