Design and Preliminary Evaluation of a Stiff Steerable Cutter for Arthroscopic Procedures

Horeman, Tim; Schilder, Frank; Aguirre, Milton E.; Kerkhoffs, Gino M. M. J.; Tuijthof, Gabriëlle J. M.

doi:10.1115/1.4030506

Cited by 12 publications

(23 citation statements)

References 10 publications

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“…Suturing with a curved needle requires a smooth and coupled rotational motion that follows the line of the needle, so it seems relevant to copy the wrist motion of the hand from outside into the abdomen. During other less complex surgical actions, such as cutting a damaged meniscus during a knee arthroscopy, it seems relevant to allow the surgeon to use the steering function only to adjust the tip configuration when following the rim of the meniscus before loose parts are cut and removed [22, 23]. In many other common situations, there is a need to line up the beak of the instrument with the tissue to be manipulated (e.g.…”

Section: Actuation Principlesmentioning

confidence: 99%

“…This can be accomplished by developing intuitive and maintenance-friendly instrumentation that can be used by surgeons working in poorly resourced hospitals with basic CSSDs. We have, therefore, used a “bare-minimum design” methodology, with a strong focus on component interaction analysis and adding functions to standard components [22], in combination with a stepwise development and evaluation plan that involves all key users who come into contact with the innovation to create a new steering mechanism.…”

Section: Complexity Of Steerable Instrumentsmentioning

confidence: 99%

“…In a previous study by Horeman et al [22, 23], a single-DOF shaft-actuated tip articulation (SATA) mechanism was developed and used to build a reusable steerable punch for meniscectomy. Since this operates without cables, the instrument’s inner space remains relatively open, leaving room for extra components required for additional tip functions such as electrosurgery, optics, or mechanical movement to initiate cutting or grasping.…”

Section: Sata Articulation Technologymentioning

confidence: 99%

“…The following requirements for a reusable steerable laparoscopic instrument need to be met to address known clinical functioning prerequisites.To fit most standard trocars for 5 mm instruments, the outer diameter should be less than 5.3 mm.Build out of autoclavable components [22]. Can be disassembled for cleaning [22, 23]. No hidden areas in the components entering the abdomen that cannot be inspected or cleaned [22, 23].…”

Section: Requirementsmentioning

confidence: 99%

“…Can be disassembled for cleaning [22, 23]. No hidden areas in the components entering the abdomen that cannot be inspected or cleaned [22, 23]. Reusable for a minimum of 30 surgical procedures [22, 23].…”

Section: Requirementsmentioning

confidence: 99%

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A new modular mechanism that allows full detachability and cleaning of steerable laparoscopic instruments

et al. 2019

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Background Ever since the introduction of laparoscopic surgery, researchers have been trying to add steerability to instruments to allow the surgeon to operate with better reachability and less tissue interaction force. Traditional solutions to introduce this often use a combination of springs, cables, pulleys, and guiding structures, resulting in instruments that cannot be properly cleaned and thus are very costly to manufacture and maintain. The aim of the study is to develop a novel affordable, sustainable, cableless, and fully steerable laparoscopic grasper, and to test its ease of assembly, disassembly, and use. Methods A set of requirements was defined to ensure that the instrument can be handled efficiently at the sterilization unit and in the operating room. Based on these, a multisteerable, cableless 5 mm laparoscopic instrument that operates based on shaft rotations was developed. To test its assembly and disassembly, ten participants were asked to fully dismantle the instrument and reassemble it a total of 60 times. In addition, ten medical students were asked to use the grasper in the ForceSense box-trainer system on a newly developed 3D pick-and-place task, to determine the control effort based on learning curves of steering errors, task time, instrument path length, and maximum tissue interaction force. Results All important design requirements were met. The recorded data indicates that ten engineering students were able to fully dismantle and reassemble the instrument shaft in 12 s (SD7) and 65 s (SD43) seconds at the sixth attempt. The learning-curve data indicates that three attempts were needed before the ten medical students started to use all steering functions. At the sixth attempt, on average only 1.25 (SD0.7) steering errors were made. The steepest slope in the learning curves for steering errors, path length, and task time was experienced during the first three attempts. In respect of the interaction force, no learning effect was observed. Conclusion The multi-DOF (degree of freedom) cableless grasper can be assembled and disassembled for cleaning and sterilization within an acceptable time frame. The handle interface proved to be intuitive enough for novices to conduct a complex 3D pick-and-place task in a training setting. Electronic supplementary material The online version of this article (10.1007/s00464-019-06849-0) contains supplementary material, which is available to authorized users.

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Section: Actuation Principlesmentioning

confidence: 99%

Section: Complexity Of Steerable Instrumentsmentioning

confidence: 99%

Section: Sata Articulation Technologymentioning

confidence: 99%

Section: Requirementsmentioning

confidence: 99%

Section: Requirementsmentioning

confidence: 99%

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A new modular mechanism that allows full detachability and cleaning of steerable laparoscopic instruments

et al. 2019

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Low cost and alternative robotic surgical systems: a future perspective

Lenssen,

Hardon,

Horeman-Franse

2023

The Technical Principles of Endoscopic Surgery

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A novel Veress needle mechanism that reduces overshooting after puncturing the abdominal wall

Postema

Cefai²,

Straten

et al. 2021

Surg Endosc

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Background Complications that occur in laparoscopic surgery are often associated with the initial entry into the peritoneal cavity. The literature reported incidences of Veress needle (VN) injuries of e.g. 0.31% and 0.23%. In a 2010 national survey of laparoscopic entry techniques in the Canadian General Surgical practice, 57.3% of respondents had either experienced or witnessed a serious laparoscopic entry complication like bowel perforation and vascular injury. As those complications are potentially life threatening and should be avoided at all costs, improving safety of this initial action is paramount. Methods Based on a bare minimum design approach with focus on function expansion of existing components, a new Safety mechanism was developed for the VN that decreases the risks of VN overshooting. The mechanism works by preventing the puncturing acceleration of the tip of the VN by decoupling the surgeon’s hand from the VN immediately after entering the abdomen. Results Based on a set of requirements, a first prototype of the VN+ with force decoupling safety mechanism is presented and evaluated on an ex vivo porcine abdominal wall tissue model in a custom setup. The experiments conducted by two novices and one experienced surgeon indicated a significant difference between the attempts with a standard, conventional working VN (41.4 mm [37.5–45 mm]) and VN+ with decoupling mechanism (20.8 mm [17.5–22.5 mm]) of p < 0.001. Conclusion A new decoupling safety mechanism was integrated successfully in a standard VN resulting in a VN+ . The results from the pilot study indicate that this new VN+ reduces overshooting with a minimum of 50% in a standardised ex vivo setting on fresh porcine abdominal wall specimens.

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Design and Preliminary Evaluation of a Stiff Steerable Cutter for Arthroscopic Procedures

Cited by 12 publications

References 10 publications

A new modular mechanism that allows full detachability and cleaning of steerable laparoscopic instruments

A new modular mechanism that allows full detachability and cleaning of steerable laparoscopic instruments

Low cost and alternative robotic surgical systems: a future perspective

A novel Veress needle mechanism that reduces overshooting after puncturing the abdominal wall

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