Pattanshetti, Shivanand1; Van Kalker, Sara1; Ravi, Pooja1; Kozin, Elliott2; Lee, Daniel2; Ryu, Seok Chang1
1 Department of Mechanical Engineering, Texas A&M University, College Station, TX, USA;
2 Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
Despite the improved visualization with Transcanal Endoscopic Ear Surgery (TEES), surgical instrumentation is still limited by line-of-sight designs that do not fully exploit the potential of TEES. Numerous attempts have been made to design TEES-compatible surgical dissectors, but no instrument has been successful in addressing all the unique challenges faced during TEES. A comprehensive instrument should incorporate 1) functionality for one-handed maneuvers; 2) tip steering ability to reach structures in the middle ear at various angles seen by an endoscope, and 3) feedback preventing surgeons from applying excessive forces and heat. Further, micro-robotics in otologic surgery is also gaining traction due to the ability to finely control instruments in narrow corridors.
We present a ‘smart’ dissector for use in micro-robotic TEES. The dissector is sized for easy one-handed maneuver alongside the endoscope. Ports for suction and drug delivery during surgery are provided. The tip angle variation is achieved by implementing a laser machined distal joint and wire-actuation mechanisms. Force and temperature feedbacks are supplied by a fiber optic sensor attached at the distal component.
This smart dissector improves both the efficiency and safety of TEES operations by significantly reducing the number of tool exchanges, extending a reachable workspace where traditional fixed angle tools have been limited, and displaying the sensor information in real-time. Future steps will include device validation regarding sensing capability, increase in tool workspace, and strength of the device. We are confident this ‘smart’ dissector will improve current TEES approaches and open new pathways for operative innovation, especially in drug delivery and transcanal lateral skull base procedures.