Development and Evaluation of a Dual-Articulating Rigid Endoscope for Neuroendoscopic Surgery

Neuroendoscopic surgery offers minimally invasive access with enhanced visualization; however, limited maneuverability within narrow corridors often leads to interference between the endoscope shaft and surgical instruments. We developed a dual-articulating rigid endoscope (DARE) to address this limitation.

A prototype DARE (5.4 mm diameter, 200 mm length) with two articulating segments underwent quantitative field-of-view assessment, neuroendoscopic surgery model testing and cadaveric evaluation. Field of view, surgical performance and instrument interference were compared with those of conventional rigid endoscopes. Cadaveric procedures included optic canal decompression via an endonasal paraseptal transsphenoidal approach and pineal region dissection via an endoscopic occipital transtentorial approach.

The DARE provided a wider horizontal angular field and a larger maximum observable angle than conventional rigid endoscopes. In the surgical model, the DARE provided a sufficient field of view at both central and peripheral regions of the model while minimizing interference with instruments in both hands, even when positioned close to the target. In contrast, conventional rigid endoscopes required oblique viewing to visualize the periphery and showed increased interference during close-up manipulation. In cadaveric dissections, the device improved the freedom of bimanual instrument handling in anatomically complex regions where interference is typically problematic. However, operation of the endoscope required an additional operator, and a second endoscope was sometimes necessary for safe monitoring.

The DARE provided a large maximum observable angle and effectively reduced instrument interference and expanded the operative workspace. Although further refinement is needed, this device has the potential to advance neuroendoscopic surgery.