Micromanipulators for the ENT Surgery

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The present application investigates the construction and use of micromanipulators for guiding micro-instruments for the middle ear surgery. It is the second research phase (Follow-up application).In microsurgical interventions at the middle ear, such as in the stapedotomy, it is operated under unergonomic conditions with manually guided fine instruments on smallest structures. The restricted view to the operating field, the shaking (tremor) and the limited accuracy of the human hand aggravate this intervention. This leads to a high load of the surgeon and may worsen the surgical outcome.In clinical use there are no robotic assistance systems to support the surgeon so far. In prior research approaches telemanipulated and automatic systems exist. However, with the exception of the Micromanipulator, developed by us in the first period (2009-2012), they cannot be used clinically. The micromanipulator system of the first project phase completely fulfills the aim. It could be shown that compared to the manual preparation, the force tremor can be reduced, as well as the accuracy, the visibility and the ergonomics can be improved. Due to its high efficiency, the micromanipulator can be used for some working steps, e. g., in the stapedotomy.In the second period, the system should be advanced because of further questions and improvement potentials. In Order to increase the freedom of movement of the instruments, to set the orientation of the instruments without interrupting the operation and to perform a higher number of different working steps, the Micromanipulator should be extended by three rotational degrees of freedom. Thereby the surgeon can quickly and easily switch between manual and manipulator-assisted surgery, the hinged bracket for the alignment should be replaced by a robotic carrier system. This should have a larger working space and should be able to be operated easily. To assist the surgeon in the distance measurement of anatomical structures, e. g. for determination of the prosthesis length, a micro-measuring system should be developed and integrated. The input device developed in the previous project phase should be enhanced, so that the control will be simplified and adapted to the overall system consisting of micromanipulator and carrier system. To ensure a good view to the situs new visualization approaches with a miniature camera are investigated. For pre-surgery testing under laboratory conditions, a middle ear phantom that realistically simulates the middle ear structures should be created. Ultimately, a clinical evaluation of the manipulator system should take place.