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DeVore EK, Chiluisa AJ, Minch EV, Mihaleva R, Do H, Tougas R, Fichera L, Carroll TL. Benefits of Side-Firing Optical Fibers in Endoscopic Laser Treatment of the Larynx. Laryngoscope 2023; 133:1205-1210. [PMID: 36062945 PMCID: PMC9985660 DOI: 10.1002/lary.30363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To elucidate potential tissue coverage of side-firing optical fibers in office-based endoscopic laser treatment of larynx, as well as to demonstrate their enhanced ability to address challenging anatomic areas. METHOD We performed a comparative study of four different fiber designs: a traditional forward-facing fiber, and three side-firing fibers that emit light at an angle of 45°, 70°, and 90°, respectively. The study was conducted in simulation, using eight three-dimensional models of the human larynx generated from microtomography x-ray scans. A computer program simulated the insertion of the endoscope into the larynx, and the Möller-Trumbore algorithm was used to simulate the application of laser light. RESULTS Side-firing laser fibers increased potential tissue coverage by a mean of 50.2 (standard deviation [SD] 25.8), 73.8 (SD 41.3), and 84.0 (SD 47.6) percent for angles of 45°, 70°, and 90°, respectively, compared to forward-facing fibers. Angled fibers provided access to areas of the larynx considered difficult to address by traditional methods, including the infraglottis, laryngeal ventricle, and right vocal fold. CONCLUSION Simulation results suggest that side-firing optical fibers have the potential to enhance anatomical access during in-office endoscopic laser procedures in the larynx. Further research is needed to better understand the benefits and any potential risks or contraindications of side-firing optical fibers. LEVEL OF EVIDENCE NA Laryngoscope, 133:1205-1210, 2023.
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Affiliation(s)
- Elliana Kirsh DeVore
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
- Department of Otolaryngology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Alex J Chiluisa
- Department of Robotics Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Emily V Minch
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Rositsa Mihaleva
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Hoang Do
- Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Ryan Tougas
- Department of Robotics Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Loris Fichera
- Department of Robotics Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Thomas L. Carroll
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
- Department of Otolaryngology, Brigham and Women’s Hospital, Boston, Massachusetts
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Management of retraction pockets: historic and novel approaches. The Journal of Laryngology & Otology 2022; 136:582-587. [DOI: 10.1017/s0022215121004321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundRetraction pockets are collapsed segments of the tympanic membrane. Their formation is associated with a disruption in middle-ear ventilation pathways, leading to the loss of organised collagen of the tympanic membrane. There are several approaches in treating retraction pockets, which aim either to improve ventilation or repair the retraction pockets themselves.MethodsA review of the literature regarding the classification and associated management of retraction pockets was conducted, using Medline and Cochrane Library databases, with the addition of our institution's experience in undertaking novel techniques.ResultsAll the current classification systems fail to guide treatment or prognosticate the disease. Commonly, an initial conservative approach is suggested for early stages, with no clear indication regarding when a surgical solution should be offered. There are conflicting data concerning the effectiveness of these treatments in terms of disease prevention, recurrence and hearing outcomes.ConclusionMinimally invasive approaches utilising novel techniques may be key to reducing peri-operative morbidity and improving the overall patient experience.
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Shi K, Zhou Y, Ebrahimi A, Li G, Iordachita I. Optimization-based Concurrent Control of a High Dexterity Robot for Vitreoretinal Surgery. ... INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS. INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS 2022; 2022:10.1109/ismr48347.2022.9807485. [PMID: 36212509 PMCID: PMC9540340 DOI: 10.1109/ismr48347.2022.9807485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Vitreoretinal surgery requires dexterity and force sensitivity from the clinician. A system to cooperatively control an integrated surgical robot for high dexterity manipulation within the eye's vitreous space was developed and validated in simulation. The system is composed of a 2 degrees of freedom (DoF) snake-like continuum manipulator that is attached to the end-effector of a 5-DoF rigid robot arm. It is capable of receiving position and orientation commands from a 5-DoF input device in real-time, as well as following pre-planned trajectories. The manipulator is moved to each target pose in real-time, using an optimization method to calculate the inverse kinematics solution. Constraints on the position and orientation ensure the target pose does not harm the patient within the vitreous space, enabling the robot to safely assist the clinician with vitreoretinal surgery when operating in real-time. The simulation demonstrates the system's feasibility and benefits over the existing non-dexterous system.
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Affiliation(s)
- Kaiyu Shi
- Department of Mechanical Engineering and the Laboratory for Computational Sensing and Robotics at the Johns Hopkins University, Baltimore, MD 21218 USA
| | - Yishun Zhou
- Department of Mechanical Engineering and the Laboratory for Computational Sensing and Robotics at the Johns Hopkins University, Baltimore, MD 21218 USA
| | - Ali Ebrahimi
- Department of Mechanical Engineering and the Laboratory for Computational Sensing and Robotics at the Johns Hopkins University, Baltimore, MD 21218 USA
| | - Gang Li
- Department of Mechanical Engineering and the Laboratory for Computational Sensing and Robotics at the Johns Hopkins University, Baltimore, MD 21218 USA
| | - Iulian Iordachita
- Department of Mechanical Engineering and the Laboratory for Computational Sensing and Robotics at the Johns Hopkins University, Baltimore, MD 21218 USA
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Freeman MH, Gafford JB, Fichera L, Noble J, Webster RJ, Labadie RF. Transeustachian Middle Ear Endoscopy Using a Steerable Distal-Camera Tipped Endoscope. Otol Neurotol 2022; 43:206-211. [PMID: 34669684 PMCID: PMC8752488 DOI: 10.1097/mao.0000000000003384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Demonstrate the ability of a novel steerable distal chip endoscope to traverse the Eustachian tube and provide diagnostic quality images of the human middle ear. PATIENTS Three cadaveric temporal bone specimens were used in this work. INTERVENTION Diagnostic transeustachian endoscopy of the middle ear was performed. MAIN OUTCOME MEASURE Diagnostic image quality. RESULTS A novel 1.62 mm steerable endoscope successfully cannulated the Eustachian tube of three human cadaveric temporal bone specimens to reveal intact middle ear anatomy with high optical clarity. CONCLUSIONS A steerable endoscope can be designed to traverse the human Eustachian tube and provide diagnostic quality images of middle ear anatomy.
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Affiliation(s)
- Michael H. Freeman
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Joshua B. Gafford
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN
| | - Loris Fichera
- Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA
| | - Jack Noble
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN
| | - Robert J. Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN
| | - Robert F. Labadie
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN
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Nguyen DVA, Girerd C, Boyer Q, Rougeot P, Lehmann O, Tavernier L, Szewczyk J, Rabenorosoa K. A Hybrid Concentric Tube Robot for Cholesteatoma Laser Surgery. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2021.3128685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pacheco NE, Gafford JB, Atalla MA, Webster RJ, Fichera L. Beyond Constant Curvature: A New Mechanics Model for Unidirectional Notched-Tube Continuum Wrists. JOURNAL OF MEDICAL ROBOTICS RESEARCH 2021; 6:2140004. [PMID: 36017195 PMCID: PMC9400950 DOI: 10.1142/s2424905x21400043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
This paper presents a new mechanics model for unidirectional notched-tube continuum wrists, a class of mechanisms frequently used to implement distal steering in needle-sized surgical robotic instruments. Existing kinematic models available for these devices are based on the simplifying assumption that, during actuation, all the notches undergo the same amount of deflection, so that the shape of a wrist can be approximated by an arc of constant curvature. This approach is analytically attractive, but, as we show in this paper, it can sometimes fail to provide good tracking accuracy. In this article, we provide a new model that relaxes the assumption above, and we report experimental evidence showing its superior accuracy. We model wrist deflection using Castigliano's second theorem, with the addition of a capstan friction term that accounts for frictional losses on the actuation tendon. Because notched-tube wrists are typically made of Nickel-Titanium (Nitinol), which has nonlinear stress-strain characteristics, we use a technique to obtain a local linearized approximation of the material modulus, suitable for use in the deflection model. The result of our modeling is a system of nonlinear equations that can be solved numerically to predict the wrist configuration based on the applied actuation force. Experimental results on physical specimens show that this improved model provides a more accurate estimate of wrist kinematics than prior models assuming constant curvature bending.
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Affiliation(s)
- Nicholas E Pacheco
- Department of Robotics Engineering, Worcester Polytechnic Institute, Worcester, MA 01609, United States
| | | | - Mostafa A Atalla
- Department of Robotics Engineering, Worcester Polytechnic Institute, Worcester, MA 01609, United States
- Department of BioMechanical Engineering, Delft University of Technology, 2628CD Delft, The Netherlands
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, United States
| | - Loris Fichera
- Department of Robotics Engineering, Worcester Polytechnic Institute, Worcester, MA 01609, United States
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Legrand J, Niu K, Qian Z, Denis K, Vander Poorten V, Van Gerven L, Vander Poorten E. A Method Based on 3D Shape Analysis Towards the Design of Flexible Instruments for Endoscopic Maxillary Sinus Surgery. Ann Biomed Eng 2021; 49:1534-1550. [PMID: 33403453 DOI: 10.1007/s10439-020-02700-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/23/2020] [Indexed: 02/02/2023]
Abstract
The emergence of steerable flexible instruments has widened the uptake of minimally invasive surgical techniques. In sinus surgery, such flexible instruments could enable the access to difficult-to-reach anatomical areas. However, design-oriented metrics, essential for the development of steerable flexible instruments for maxillary sinus surgery, are still lacking. This paper proposes a method to process measurements and provides the instrument designer with essential information to develop adapted flexible instruments for limited access surgery. This method was applied to maxillary sinus surgery and showed that an instrument with a diameter smaller than 2.4 mm can be used on more than 72.5% of the subjects' set. Based on the statistical analysis and provided that this flexible instrument can bend up to [Formula: see text] it is estimated that all areas within the maxillary sinus could be reached through a regular antrostomy without resorting to extra incision or tissue removal in 94.9% of the population set. The presented method was partially validated by conducting cadaver experiments.
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Affiliation(s)
- Julie Legrand
- Department of Mechanical Engineering Technology, KU Leuven, Leuven, Belgium.
| | - Kenan Niu
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.
| | - Zhen Qian
- Department of Otorhinolaryngology, Head Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kathleen Denis
- Department of Mechanical Engineering Technology, KU Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology, Head Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Laura Van Gerven
- Department of Otorhinolaryngology, Head Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Allergy and Clinical Immunology Research Unit, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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