Micromanipulators for the ENT Surgery

本申请研究了用于引导中耳手术的显微器械的显微操纵器的构造和使用。这是第二个研究阶段（后续应用）。在中耳的显微外科手术中，例如镫骨切开术，它是在不符合人体工程学的条件下使用手动引导的精细器械在最小的结构上操作的。对手术区域的受限视野、抖动（震颤）和人手的有限准确性加剧了这种干预。这导致外科医生的高负荷，并可能恶化手术结果。在临床使用中，迄今为止还没有机器人辅助系统来支持外科医生。在以前的研究方法远程操纵和自动系统存在。然而，除了我们在第一阶段（2009-2012年）开发的显微操作器外，它们不能用于临床。第一个项目阶段的显微操作系统完全实现了这一目标。可以表明，与手动准备相比，可以减少力震颤，并且可以提高准确性、可见性和人体工程学。由于其高效率，显微操作器可以用于一些工作步骤，如。例如，在一个实施例中，在第二阶段，由于存在进一步的问题和改进的潜力，该系统应进一步发展。为了增加仪器的运动自由度，在不中断操作的情况下设置仪器的方向，并执行更多的不同工作步骤，显微操作器应扩展三个旋转自由度。因此，外科医生可以快速轻松地在手动和操纵器辅助手术之间切换，用于对准的铰接支架应该由机器人载体系统代替。这应该有一个更大的工作空间，应该能够很容易地操作。为了帮助外科医生测量解剖结构的距离，G.为确定假体长度，应开发和集成一个显微测量系统。在前一个项目阶段开发的输入设备应加强，使控制将被简化，并适应于整个系统组成的显微操作器和载体系统。为了确保一个良好的视野，以situs新的可视化方法与微型相机进行了研究。对于实验室条件下的术前测试，应创建真实模拟中耳结构的中耳体模。最终，应进行机械手系统的临床评价。

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.