First 3D printed medical robot for ENT surgery - Application specific manufacturing of laser sintered disposable manipulators
06 Nov 2014-pp 4278-4283
TL;DR: The first laser sintered disposable manipulator for ENT surgery is presented, which allows the surgeon to move a micro hook in three directions via a joystick console, while his/her hands are located on an armrest, which may increase the surgical outcome by enhancing the ergonomics and therefore may reduce the number of revision operations.
Abstract: The Stapedotomy is a standard ENT (ear, nose and throat) surgery, where the surgeons use surgical micro hooks and forceps to replace the stapes with a small titanium implant. However, there are some challenges with this procedure. Especially, the non-ergonomic posture of the surgeon increases the hand tremor and leads to an inaccurate positioning of the implant. This may cause hearing loss and the patient may need a revision operation. In this paper, we present the first laser sintered disposable manipulator for ENT surgery, which allows the surgeon to move a micro hook in three directions via a joystick console, while his/her hands are located on an armrest. This may increase the surgical outcome by enhancing the ergonomics and therefore may reduce the number of revision operations. We show that the fabrication cost of the single-use robot does not increase the operation expenses drastically. To conclude, our preliminary evaluation with a middle ear phantom indicates that a basic surgical maneuver can be performed via the presented robotic system.
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TL;DR: In this paper, a comprehensive overview and classification of additively manufactured medical instruments for diagnostics and surgery by identifying medical and technical aspects is provided, and a tendency of using material extrusion technology and polymeric materials (86% of the applications) was shown.
Abstract: Goal Additive manufacturing, also known as 3D printing, has begun to play a significant role in the field of medical devices. This review aims to provide a comprehensive overview and classification of additively manufactured medical instruments for diagnostics and surgery by identifying medical and technical aspects. Methods A scientific literature search on additively manufactured medical instruments was conducted using the Scopus database. Results We categorized the relevant articles (71) by considering the novelty of each proposed instrument and its clinical application. Then, we analyzed the relevant articles by examining the reasons behind choosing additive manufacturing technology to produce instruments for diagnostics and surgery. Possible customization (27%) and Cost-effectiveness (23%) were the main reasons expressed. Technical specifications of the additive manufacturing technology and the material used were also analyzed, and a tendency of using material extrusion technology (35% of the applications) and polymeric materials (86% of the applications) was shown. Conclusions Additive manufacturing is opening the door to a new approach in the production of medical devices, which allows the complexity of their designs to be pushed to the extreme. However, we found that technical limitations need to be tackled and important aspects such as sterilization or debris contamination are still not considered to be relevant factors during the design and fabrication process. Keeping in mind the challenges of such a new field, additive manufacturing technology can be considered as a great opportunity to provide easy access to healthcare in developing countries as well as an important step toward patient-specific medicine.
194 citations
TL;DR: The application of compliant mechanisms to surgical interventions is reviewed and the surgical applications of CMs are assessed by classification into five major groups, namely, grasping and cutting, reachability and steerability, transmission, sensing, implants and deployable devices.
Abstract: Current surgical devices are mostly rigid and are made of stiff materials, even though their predominant use is on soft and wet tissues. With the emergence of compliant mechanisms (CMs), surgical tools can be designed to be flexible and made using soft materials. CMs offer many advantages such as monolithic fabrication, high precision, no wear, no friction, and no need for lubrication. It is therefore beneficial to consolidate the developments in this field and point to challenges ahead. With this objective, in this article, we review the application of CMs to surgical interventions. The scope of the review covers five aspects that are important in the development of surgical devices: (i) conceptual design and synthesis, (ii) analysis, (iii) materials, (iv) maim facturing, and (v) actuation. Furthermore, the surgical applications of CMs are assessed by classification into five major groups, namely, (i) grasping and cutting, (ii) reachability and steerability, (iii) transmission, (iv) sensing, and (v) implants and deployable devices. The scope and prospects of surgical devices using CMs are also discussed.
40 citations
Cites background or methods from "First 3D printed medical robot for ..."
...CMs also serve a secondary function in the device to transmit force/motion, as observed in some surgical robots [9,10]....
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...For example, the translation motion of a medical robot for ENT (ear, nose, and throat) surgery was provided using compliant linear joints fabricated by 3D printing [9]....
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...[9]); tremor compensation (© 2005 IEEE....
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TL;DR: In this paper, a systematic review was conducted of the literature regarding the use of additive manufacturing (AM) in ergonomic-product design, and methodological aspects of the studies were analyzed, and recommendations were developed to facilitate the choice of most suitable AM technologies and materials for specific applications in ergonomics.
20 citations
01 Dec 2015
TL;DR: 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.
Abstract: 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 micro-macro 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.
6 citations
Cites methods from "First 3D printed medical robot for ..."
...As another micro robot, the 3D printed single-use robot presented in [11], and as another macro robot, the smaller Kinova Mico have already been implemented to the system....
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TL;DR: This study demonstrates how 3D printing technologies are the perfect complement to accelerate the design process and build functional prototypes at low costs.
Abstract: This paper aims to describe the development of an internal waste-collection device for patients who have undergone a colostomy or ileostomy. Its design is based on devices that have been produced by 3D printing with acrylonitrile butadiene styrene. The aim is to find an alternative to the external bags that these patients currently use and to evaluate the properties of the device produced by additive manufacturing.,Software for solid modelling has been used, and virtual models allow its visualization and animation, for evaluation, in a simple and fast way. Subsequently, functional prototypes have been developed by a multidisciplinary team, which includes surgeons and engineers, and have been tested to verify their mechanical properties and suitability for function.,The project has developed a functional design that has been patented and is in the clinical trials phase. This study demonstrates how 3D printing technologies are the perfect complement to accelerate the design process and build functional prototypes at low costs. The experimental tests regarding cytotoxicity, printing orientation, dynamic and static loads and temperature resistance have demonstrated the validity of the proposed device.,A device for internal pouch in colostomized patients has been designed, manufactured by fused deposition modelling and validated.
4 citations
References
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15 May 2010
TL;DR: Medical application of rapid prototyping is feasible for specialized surgical planning and prosthetics applications and has significant potential for development of new medical applications.
Abstract: Generation of graspable three-dimensional objects applied for surgical planning, prosthetics and related applications using 3D printing or rapid prototyping is summarized and evaluated. Graspable 3D objects overcome the limitations of 3D visualizations which can only be displayed on flat screens. 3D objects can be produced based on CT or MRI volumetric medical images. Using dedicated post-processing algorithms, a spatial model can be extracted from image data sets and exported to machine-readable data. That spatial model data is utilized by special printers for generating the final rapid prototype model. Patient–clinician interaction, surgical training, medical research and education may require graspable 3D objects. The limitations of rapid prototyping include cost and complexity, as well as the need for specialized equipment and consumables such as photoresist resins. Medical application of rapid prototyping is feasible for specialized surgical planning and prosthetics applications and has significant potential for development of new medical applications.
1,362 citations
Book•
27 Nov 2002TL;DR: The second edition of Compliant Mechanisms: Design of Flexure Hinges as mentioned in this paper provides practical answers to the design and analysis of devices that incorporate flexible hinges by means of a bottom-up compliance (flexibility) approach.
Abstract: With a rigorous and comprehensive coverage, the second edition of Compliant Mechanisms: Design of Flexure Hinges provides practical answers to the design and analysis of devices that incorporate flexible hinges. Complex-shaped flexible-hinge mechanisms are generated from basic elastic segments by means of a bottom-up compliance (flexibility) approach. The same compliance method and the classical finite element analysis are utilized to study the quasi-static and dynamic performances of these compliant mechanisms. This book offers easy-to-use mathematical tools to investigate a wealth of flexible-hinge configurations and two- or three-dimensional compliant mechanism applications.
FEATURES
Introduces a bottom-up compliance-based approach to characterize the flexibility of new and existing flexible hinges of straight- and curvilinear-axis configurations
Develops a consistent linear lumped-parameter compliance model to thoroughly describe the quasi-static and dynamic behavior of planar/spatial, serial/parallel flexible-hinge mechanisms
Utilizes the finite element method to analyze the quasi-statics and dynamics of compliant mechanisms by means of straight- and curvilinear-axis flexible-hinge elements
Covers miscellaneous topics such as stress concentration, yielding and related maximum load, precision of rotation of straight- and circular-axis flexible hinges, temperature effects on compliances, layered flexible hinges and piezoelectric actuation/sensing
Offers multiple solved examples of flexible hinges and flexible-hinge mechanisms.
This book should serve as a reference to students, researchers, academics and anyone interested to investigate precision flexible-hinge mechanisms by linear model-based methods in various areas of mechanical, aerospace or biomedical engineering, as well as in robotics and micro-/nanosystems.
651 citations
"First 3D printed medical robot for ..." refers background in this paper
...The often used flexure hinges can be described as compliant mechanisms with one or more defined bending axes by reducing the bending stiffness in specific locations of the part [18], [20]....
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...Design of the compliant linear joints: Compliant mechanisms consist of one or more flexible structures, which provide elastic deformation to transmit forces or motions [17], [18]....
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01 Jan 1965
609 citations
"First 3D printed medical robot for ..." refers background in this paper
...The often used flexure hinges can be described as compliant mechanisms with one or more defined bending axes by reducing the bending stiffness in specific locations of the part [18], [20]....
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TL;DR: In this article, the drawbacks of typical flexure connectors are investigated and cataloged, and several new designs for highly effective, kinematically-behaved compliant joints are proposed.
Abstract: Flexure joints are widely used to approximate the function of traditional mechanical joints, while offering the benefits of high precision, long life, and ease of manufacture. This paper investigates and catalogs the drawbacks of typical flexure connectors and presents several new designs for highly-effective, kinematically-behaved compliant joints. A revolute and a translational compliant joint are proposed (Figure 1), both of which offer great improvements over existing flexures in the qualities of (1) large range of motion, (2) minimal axis drift, (3) increased off-axis stiffness, and (4) reduced stress-concentrations. Analytic stiffness equations are developed for each joint and parametric computer models are used to verify their superior stiffness properties. A catalog of design charts based on the parametric models is also presented, allowing for rapid sizing of the joints for custom performance. Finally, two multi-degree-of-freedom joints are proposed as modifications to the revolute joint. These include a compliant universal joint and a compliant spherical joint, both designed to provide high degrees of compliance in the desired direction of motion and high stiffness in other directions.Copyright © 2002 by ASME
339 citations
"First 3D printed medical robot for ..." refers background in this paper
...A catalogue of compliant mechanisms can be found in [19]....
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TL;DR: These are the first results showing quantitative improvements in performance during simulated ear surgery using RA and differential effects of RA on performance for users of different experience levels.
Abstract: OBJECTIVE: Micropick fenestration of the stapes footplate, a difficult step in stapedotomy, was selected for trials evaluating the potential for robotic assistance (RA) to improve clinical measures of surgical performance.STUDY DESIGN: In a surgical model of stapedotomy, we measured accuracy of fenestration to a desired point location and force applied to the stapes footplate. Performance variables were measured for 3 experienced and 3 less–experienced surgeons.RESULTS: RA significantly reduced the maximum force applied to the stapes footplate. For fenestration targeting, RA significantly improved accuracy for less–experienced surgeons and significantly worsened targeting for more-experienced surgeons.CONCLUSIONS: RA significantly improves performance for micropick fenestration in a surgical model of stapedotomy. For certain tasks, RA differentially affects performance for users of different experience levels.CLINICAL SIGNIFICANCE: These are the first results showing quantitative improvements in performan...
76 citations
"First 3D printed medical robot for ..." refers background in this paper
...1) [9], a telemanipulation system with 6 DOF [11], an automatic system for drilling the stapes footplate [12], a hand-held manipulator for stapes footplate surgery [13], and a robot for micropick fenestration [14]....
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