A miniature robotic steerable endoscope for maxillary sinus surgery called PliENT

Abstract

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 pathology inside the maxillary sinus and depending on the location of the pathology (lateral, inferior or anterior wall), additional resection of healthy tissue and/or functional structures like the lacrimal duct and/or inferior turbinate is necessary to gain optimal access. In order to avoid this additional resection, a functional single-handed, steerable endoscope for endoscopic maxillary sinus surgery has been designed and built. This endoscope is, to our knowledge, the most slender active steerable endoscope ever reported for maxillary sinus surgery. The performance of the endoscope was validated by two surgeons on a cadaver. An increased field of view was found in comparison to currently used endoscopes. As a direct consequence, a reduced need for resection of healthy tissue was confirmed.

Continuum robots for endoscopic sinus surgery: Recent advances, challenges, and prospects

“…It was only designed for frontal sinus surgery. As shown in Figure 8D, Legrand et al 39 . developed a miniature robotic steerable endoscope for maxillary sinus surgery.…”

“…(C) A handheld flexible manipulator for frontal sinus surgery 38 (Copyright ⓒ 2020, Coemert et al.). (D) A robotic steerable endoscope for maxillary sinus surgery 39 (Copyright ⓒ 2022, Legrand et al.).…”

“…It contained two segments, and each segment could achieve a planar bending. However, the manipulator could only bend no more than As shown in Figure 8D, Legrand et al 39 developed a miniature robotic steerable endoscope for maxillary sinus surgery. The diameter of the bendable part was 2.3 mm, and its maximum bending angle was 125°, allowing to visualize all maxillary sinus walls.…”

Preliminary design and evaluation of a generic surgical scope adapter

“…Though it provides support for angulated scopes, it lacks the DoF required for actuation of an articulated scope's distal end. Standalone robotic scope assistant systems with an inbuilt scope (which is permanently attached to the system) and an internal mechanism for articulation of the distal end have been designed 3,20,21 . They do exhibit all the 5 DoF required for steering an articulated scope, but cannot be used with existing zero‐degree, angulated, or articulated scopes and camera heads used in the operating room.…”

Commentary: Endoscopic Endonasal Removal of a Laterally Extended Pituitary Adenoma Using Steerable Forceps: 2-Dimensional Operative Video

“…For instance, recent otolaryngology studies are in the process of validating the use of steerable endoscopes in endoscopic ear surgery 15,16 and maxillary sinus surgery. 17 However, in skull base surgery, steerable forceps be more limited to use within EES. 18,19 As highlighted in the video, the authors exploit the flexibility of the steerable forceps to gain controlled access into the lateral cavernous sinus and precisely resect tumor adjacent to the intracavernous carotid artery.…”