Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Centre, Ulm, Germany.
Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany.
Laryngoscope. 2021 Feb;131(2):E561-E568. doi: 10.1002/lary.28868. Epub 2020 Jun 25.
Transoral surgery of the larynx with rigid instruments is not always possible. This may result in insufficient therapy or in an increased need for open surgery. For these patients, alternative surgical systems are needed. Here, we demonstrate a curved prototype for laryngeal surgery equipped with flexible instruments.
Pre-clinical user study in an ex vivo porcine laryngeal model.
The prototype was built from established medical devices, namely a hyperangulated videolaryngoscope and modified flexible instruments as well as three-dimensional printed parts. Feasibility of laryngeal manipulation was evaluated in a user study (n = 19) with a porcine ex vivo laryngeal model. Using three different visualization technologies, the participants performed various fine motor skills tasks and rated the usability of the system on a 5-point Likert scale.
Exposure, accessibility, and manipulation of important laryngeal structures were always possible using the new prototype. The participants needed considerably less time (mean, 96.4 seconds ± 6.4 seconds vs. 111.5 seconds ± 4.5 seconds, P = .18), reported significantly better general impression (mean score 3.0 vs. 3.8, P = .041) and significantly lower user head and neck strain (2.6 vs. 1.7, P = .022) using a 40-inch television screen as compared to a standard videolaryngoscope monitor.
The results indicate that our curved prototype and large monitor visualization may provide a cost-effective minimally invasive alternative for difficult laryngeal exposure. Its special advantages include avoiding the need for a straight line of sight and a simple and cost-effective construction. The system could be further improved through advances in camera chip technology and smaller instruments. Laryngoscope, 131:E561-E568, 2021.
经口硬性仪器喉部手术并非总是可行。这可能导致治疗不足或需要更多的开放性手术。对于这些患者，需要替代的手术系统。在此，我们展示一种配备柔性器械的喉部手术用弯曲型原型。
在离体猪喉模型中的临床前用户研究。
该原型由成熟的医疗设备构建，即高角度视频喉镜和改良的柔性器械以及三维打印部件。在使用离体猪喉模型的用户研究（n=19）中评估了喉部操作的可行性。参与者使用三种不同的可视化技术执行各种精细运动技能任务，并使用 5 分制 Likert 量表对系统的可用性进行评分。
使用新原型始终可以实现对重要喉部结构的暴露、接近和操作。参与者所需的时间明显减少（平均 96.4 秒±6.4 秒 vs. 111.5 秒±4.5 秒，P=.18），总体印象明显更好（平均评分 3.0 分 vs. 3.8 分，P=.041），并且用户头部和颈部的疲劳程度明显更低（2.6 分 vs. 1.7 分，P=.022），与标准视频喉镜监视器相比，使用 40 英寸电视屏幕。
结果表明，我们的弯曲型原型和大监视器可视化可能为困难的喉部暴露提供一种具有成本效益的微创替代方案。其特殊优势包括避免需要直线视线以及简单且具有成本效益的构造。通过摄像机芯片技术和更小的器械的进步，可以进一步改进该系统。喉镜，131：E561-E568，2021。
