Tan Melin, Prufer Neil, Chinosornvatana Nina, Park Chan, Woo Peak
Department of Otolaryngology, Mount Sinai School of Medicine, New York, New York, USA.
Ann Otol Rhinol Laryngol. 2012 Jul;121(7):435-41. doi: 10.1177/000348941212100703.
RealHand instruments are high-dexterity instruments that have been designed for natural orifice transluminal endoscopic surgery applications. They provide dexterity by offering a full range of motion to endoscopic instruments. We hypothesize that RealHand instruments will resolve some of the limitations encountered in traditional endolaryngeal surgery. They have the potential to do so in the following ways: (1) they negate the limitation of mobility of traditional laryngoscopy instrumentation, which is rigid and fixed; (2) they maintain the ability of direct visualization through a telescope while precluding the need for an operating microscope; (3) they provide the dexterity to perform tasks that are otherwise not possible with traditional instrumentation; and (4) they provide flexibility that can be advantageous in difficult foreign body retrieval from distal airways.
To test this hypothesis, we developed and optimized a cadaveric lamb larynx model for endolaryngeal microsurgery. To evaluate the feasibility of the RealHand instruments in their application to laryngeal surgery, we had 2 otolaryngology senior residents and 2 laryngology fellows-in-training perform 5 different endoscopic tasks: (1) foreign body removal; (2) arytenoidectomy; (3) microflap elevation; (4) cricopharyngeal myotomy; and (5) endoknot suture tying.
Experience with RealHand instruments demonstrated that although they are limited in application to phonosurgery, they have the potential for more facile tissue manipulation in the supraglottic and hypopharyngeal structures. Endoscopic suturing ability is enhanced.
RealHand high-dexterity instrumentation allows for full range-of-motion instrumentation and, with modification, has potential for wider application in endoscopic laryngeal surgery.
RealHand器械是一种高灵活性器械，专为自然腔道内镜手术应用而设计。它们通过为内镜器械提供全方位的运动来实现灵活性。我们假设RealHand器械将解决传统喉内手术中遇到的一些局限性。它们有潜力通过以下方式做到这一点：（1）消除传统喉镜器械的活动限制，传统喉镜器械是刚性且固定的；（2）在无需手术显微镜的情况下，保持通过望远镜进行直接可视化的能力；（3）提供灵活性以执行传统器械无法完成的任务；（4）提供的灵活性在从远端气道取出困难异物时可能具有优势。
为了验证这一假设，我们开发并优化了一种用于喉内显微手术的尸体羊喉模型。为了评估RealHand器械应用于喉手术的可行性，我们让2名耳鼻喉科高级住院医师和2名喉科学培训学员执行5项不同的内镜任务：（1）取出异物；（2）杓状软骨切除术；（3）微瓣提升术；（4）环咽肌切开术；（5）内镜打结缝合。
使用RealHand器械的经验表明，尽管它们在嗓音外科的应用有限，但在声门上和下咽结构中进行组织操作方面具有更大的潜力。内镜缝合能力得到增强。
RealHand高灵活性器械允许进行全方位的器械操作，并且经过改进后，在喉内镜手术中具有更广泛应用的潜力。
