Handheld micromanipulator for robot-assisted stapes footplate surgery

Grande, Gonzalo Montes; Knisely, Anna; Becker, Brian C.; Yang, Sungwook; Hirsch, Barry E.; Riviere, Cameron N.

doi:10.1109/embc.2012.6346206

Cited by 8 publications

(6 citation statements)

References 10 publications

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“…The usage of a hand-held manipulator, which is comparable to the used semiautomated tool in our experimental setting, was superior to any freehand manipulation [Montes Grande et al, 2012]. This holds also true in our series when comparing unsupported and supported freehand insertion in both terms of maximum amplitude changes and peak frequency deviation.…”

Section: Discussionsupporting

confidence: 64%

Effects of Different Insertion Techniques of a Cochlear Implant Electrode on the Intracochlear Pressure

Todt

Ernst

Mittmann³

2016

Audiol Neurotol

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To achieve a functional atraumatic insertion, low intracochlear pressure changes during the procedure are assumed to be important. The aim of this study was to observe intracochlear pressure changes due to different insertion techniques in a cochlear model. Cochlear implant electrode insertions were performed in an artificial cochlear model to record intracochlear pressure changes with a micropressure sensor to evaluate the maximum amplitude and frequency of pressure changes under different insertional conditions. We found statistically significant differences in the occurrence of intracochlear pressure peak changes comparing different techniques. Based on our model results, an insertion should be maximally supported to minimize micromovement-related pressure changes.

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Section: Discussionsupporting

confidence: 64%

Effects of Different Insertion Techniques of a Cochlear Implant Electrode on the Intracochlear Pressure

Todt

Ernst

Mittmann³

2016

Audiol Neurotol

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“…Rothbaum et al described a robotic assistance system that can help with the micropick fenestration of the footplate during stapes surgery . A recent preliminary study on the use of a handheld micromanipulator for robot‐assisted stapes footplate surgery was also published, which indicated a significant reduction in position errors and mean duration time spent in dangerous zones . Moreover, most experimental surgical robots in otology have been developed for direct cochlear access in cochlear implantation procedures, as mentioned above .…”

Section: Discussionmentioning

confidence: 99%

“…The other seven cases did not exhibit any damage and were hence not listed in the table. EAC 5 external auditory canal; LSCC 5 lateral semicircular canal robot-assisted stapes footplate surgery was also published, which indicated a significant reduction in position errors and mean duration time spent in dangerous zones. 19 Moreover, most experimental surgical robots in otology have been developed for direct cochlear access in cochlear implantation procedures, as mentioned above. [4][5][6][7][8][9][10][11]20,21 However, these are totally automated robot systems and have few other clinical applications, as they can only be used for cochlear implantation, which accounts for a small portion of various surgeries requiring mastoidectomy.…”

Section: Ossicles Damage (-1)mentioning

confidence: 99%

A cadaver study of mastoidectomy using an image‐guided human–robot collaborative control system

Yoo

Lee

Yang

et al. 2017

Laryngoscope Investig Oto

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ObjectiveSurgical precision would be better achieved with the development of an anatomical monitoring and controlling robot system than by traditional surgery techniques alone. We evaluated the feasibility of robot‐assisted mastoidectomy in terms of duration, precision, and safety.Study DesignHuman cadaveric study.Materials and MethodsWe developed a multi‐degree‐of‐freedom robot system for a surgical drill with a balancing arm. The drill system is manipulated by the surgeon, the motion of the drill burr is monitored by the image‐guided system, and the brake is controlled by the robotic system. The system also includes an alarm as well as the brake to help avoid unexpected damage to vital structures. Experimental mastoidectomy was performed in 11 temporal bones of six cadavers. Parameters including duration and safety were assessed, as well as intraoperative damage, which was judged via pre‐ and post‐operative computed tomography.ResultsThe duration of mastoidectomy in our study was comparable with that required for chronic otitis media patients. Although minor damage, such as dura exposure without tearing, was noted, no critical damage to the facial nerve or other important structures was observed. When the brake system was set to 1 mm from the facial nerve, the postoperative average bone thicknesses of the facial nerve was 1.39, 1.41, 1.22, 1.41, and 1.55 mm in the lateral, posterior pyramidal and anterior, lateral, and posterior mastoid portions, respectively.ConclusionMastoidectomy can be successfully performed using our robot‐assisted system while maintaining a pre‐set limit of 1 mm in most cases. This system may thus be useful for more inexperienced surgeons.Level of EvidenceNA.

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“…Now the input at the joysticks is interpreted as the desired new orientation of the TCP and the required change of the orientation of the TCP is computed as a HT, see (5). This HT consists of a single rotation matrix where the translation is set to zero.…”

Section: B Rotation and Translationmentioning

confidence: 99%

“…RobOtol is a 6 degrees of freedom (DOF) telemanipulator [3], the MicroManipulator System (MMS) [4], presented of our institute, is a 3 DOF telemanipulator for middle ear surgery. A handheld system with tremor filter [5], a mechatronic drilling tool [6], and another 5 DOF robot system [7] are specialized on stapes footplate surgery. The MMS has been developed further to the Micro-Macro Telemanipulator System (MMTS) to improve the safe coarse positioning of the MMS in the operating area [8].…”

Section: Introductionmentioning

confidence: 99%

A modular micro-macro robot system for instrument guiding in middle ear surgery

Entsfellner¹,

Schuermann²,

Coy³

et al. 2015

2015 IEEE International Conference on Robotics and Biomimetics (ROBIO)

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Surgical interventions at the middle ear are very challenging tasks for surgeons. At an otosclerosis the stapes is immobile because of an abnormal bone growth so that the sound transmission is disturbed. Therefore, a stapedotomy is performed where the stapes is partly replaced by a small implant to reconstruct the path of sound transmission. The state of the art is to use handheld micro instruments. However, the structures are, as well as the required precision, in the range of sub-millimeters, and the view is limited due to the narrow ear canal. Because of the human hand tremor, which goes from some tenth millimeters up to some millimeters, the intervention is very delicate. Until now, there are no assistance systems for guiding surgical instruments available. In this contribution we present the further development of a formerly presented micromacro telemanipulator system. New functionality for coarse and fine positioning was implemented, as well as a processing unit and a quick-changer for exchanging the micro manipulator. In a preliminary experiment standard-based position repeatability is obtained. It is shown that the repeatability of the current macro robot is appropriate for the task and so the approach has high potential for supporting the surgeon in ENT surgery.

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Handheld micromanipulator for robot-assisted stapes footplate surgery

Cited by 8 publications

References 10 publications

Effects of Different Insertion Techniques of a Cochlear Implant Electrode on the Intracochlear Pressure

Effects of Different Insertion Techniques of a Cochlear Implant Electrode on the Intracochlear Pressure

A cadaver study of mastoidectomy using an image‐guided human–robot collaborative control system

A modular micro-macro robot system for instrument guiding in middle ear surgery

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