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Session: Medical Instruments
Session starts: Thursday 24 January, 13:30
Presentation starts: 14:45
Room: Lecture room 557

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Ewout Arkenbout (Delft University of Technology)
Paul Breedveld (Delft University of Technology)

Abstract:
Natural Orifice Translumenal Endoscopic Surgery (NOTES) is a surgical procedure where the surgeon uses flexible endoscopic technology to perform laparoscopic procedures beyond the confines of the gastrointestinal tract. Advantages to this approach include faster patient recovery, less adhesions, absence of abdominal wound infections and less postoperative pain. Since 2006, when the key challenges for NOTES were first identified, several multi-branched instruments, also commonly referred to as multi-tasking platforms, have been developed, with features superior to standard Duel-Channel Endoscopes. These features include improved maneuverability and stability, off-axis visualization and multiple actively controlled instrument branches to facilitate triangulation (i.e. the ability to apply traction and counter-traction to tissue). Most of these instruments are still under development, and none have been commercialized so far. A literature study has been performed to ascertain the state-of-the-art in multi-branched instruments. The identified instruments have been analyzed and categorized with respect to their control strategies and the accompanying (in-vivo) distal tip and/or instrument branch actuation. It is found that all multi-branched instruments, both fully mechanical as well as electromechanical master-slave systems, require a minimum of two operators to actively control all available degrees-of-freedom (DOF), or one operator to intermittently switch between control modalities. In addition, most instruments use a combination of direct and indirect control to allow for the simultaneous constant (re)positioning of the entire endoscope and actuation of two or three separate articulating branches. To date, several multi-branched instruments have been tested and found to allow surgical NOTES procedures to a certain extend. However, the complexity in control of all the separate DOF, the relatively large instrument dimensions, and the insufficient functionality of the branches to perform complex surgical tasks, makes human NOTES procedures thus far unfeasible and unsafe. For this reason, a new research project entitled “Bio-Inspired Maneuverable Dendritic Devices for Minimally Invasive Surgery” has been initiated at the Delft University of Technology, focusing on the highly challenging field of endonasal skull base surgery. The project aims to develop a multi-branched or dendritic maneuverable instrument based on the cable-ring mechanism. This working principle is to be applied to develop a fully mechanical, preferably one-handed, instrument with cable-actuated branches and intuitive direct control strategies.