3D Printer Application for Endoscope-Assisted Spine Surgery Instrument Development: From Prototype Instruments to Patient-Specific 3D Models

양희석,박정윤 연세대학교의과대학 2020 Yonsei medical journal Vol.61 No.1

Developing new surgical instruments is challenging. While making surgical instruments could be a good field of application for3D printers, attempts to do so have proven limited. We designed a new endoscope-assisted spine surgery system, and using a 3Dprinter, attempted to create a complex surgical instrument and to evaluate the feasibility thereof. Developing the new surgical instrumentsusing a 3D printer consisted of two parts: one part was the creation of a prototype instrument, and the other was the productionof a patient model. We designed a new endoscope-assisted spine surgery system with a cannula for the endoscope andworking instruments and extra cannula that could be easily added. Using custom-made patient-specific 3D models, we conducteddiscectomies for paramedian and foraminal discs with both the newly designed spine surgery system and conventional tubularsurgery. The new spine surgery system had an extra portal that can be well bonded in by a magnetic connector and greatly expandedthe range of access for instruments without unnecessary bone destruction. In foraminal discectomy, the newly designed spinesurgery system showed less facet resection, compared to conventional surgery. We were able to develop and demonstrate the usefulnessof a new endoscope-assisted spine surgery system relying on 3D printing technology. Using the extra portal, the usabilityof endoscope-assisted surgery could be greatly increased. We suggest that 3D printing technology can be very useful for the realizationand evaluation of complex surgical instrument systems.

A Pilot Study of Endoscopic Submucosal Dissection Using an Endoscopic Assistive Robot in a Porcine Stomach Model

김병곤,Hyuk Soon Choi,Sei Hoon Park,Jun Ho Hong,Jung Min Lee,Seung Han Kim,Hoon Jai Chun,Daehie Hong,Bora Keum 거트앤리버 소화기연관학회협의회 2019 Gut and Liver Vol.13 No.4

Background/Aims: Endoscopic assistive devices have been developed to reduce the complexity and improve the safety of surgeries involving the use of endoscopes. We developed an assistive robotic arm for endoscopic submucosal dissection (ESD) and evaluated its efficiency and safety in this in vitro pilot study. Methods: ESD was performed using an auxiliary transluminal endoscopic robot. An in vitro test bed replicating the intra-abdominal environment and pig stomachs were used for the experiment. Participants were divided into skilled operators and unskilled operators. Each group performed ESD 10 times by using both conventional and robot-assisted methods. The perforation incidence, operation time, and resected mucous membrane size were measured. Results: For the conventional method, significant differences were noted between skilled and unskilled operators regarding operation time (11.3 minutes vs 26.7 minutes) and perforation incidence (0/10 vs 6/10). Unskilled operators showed a large decrease in the perforation incidence with the robot-assisted method (conventional method vs robot-assisted method, 6/10 vs 1/10). However, the operation time did not differ between the conventional and robotassisted methods. On the other hand, skilled operators did not show differences in the operation time and perforation incidence between the conventional and robot-assisted methods. Among both skilled and unskilled operators, the operation time decreased with the robot-assisted method as the experiment proceeded. Conclusions: The surgical safety of unskilled operators greatly improved with robotic assistance. Thus, our assistive robotic arm was beneficial for ESD. Our findings suggest that endoscopic assistive robots have positive effects on surgical safety.

Lateral override 과두하골절에서 내시경을 이용한 관혈적 정복술 및 내고정의 결과

최은주(Eun-Joo Choi),차인호(In-Ho Cha),남 웅(Woong Nam) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.1

Introduction: Endoscope-assisted open reduction and internal fixation (EAORIF) reduces the amount of facial scaring, but limitations, such as the possibility to convert to the open technique and the large learning curve, remain. Materials and Methods: The medical records of 19 patients diagnosed as lateral overridden subcondyle fractures and treated with endoscopeassisted open reduction and internal fixation at Yonsei University Health System from December 2006 to August 2010 were reviewed. Results: 11 patients underwent temporary discomfort or pain such as limitation of mouth opening, temporomandibular joint discomfort, lip paresthesia or facial weakness, but the symptoms disappeared within 3 months. There was no severe long-term complication except 2 patients with re-fractures of operated subcondyles. Conclusion: Subcondyle fracture with lateral overridden proximal segment is a better indication of endoscope-assisted open reduction and internal fixation than a condylar head/neck fracture, or medial overridden subcondyle fracture: allowing an anatomic reduction.

아래턱뼈 관절돌기밑 골절에서 내시경을 이용한 관혈적 정복술 및 내부고정술의 임상적 적용

한승열,강석주,박진형 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.6

Purpose: The management of fractures of mandibular subcondyle continues to be controversial between open and closed treatment. The purpose of this article is to explain the endoscopic assisted open reduction and internal fixation and minimize the controversy. Methods: Nine patients of mandibular subcondylar fracture were reduced and fixed by using intraoral endoscopic - assisted open reduction and internal fixation and were followed up for 14 ~ 24 months after surgery. Results: Eight patients of mandibular subcondylar fracture had been treated without significant complications. One patient, whose malocclusion had been remained, was recovered normal occlusion by maxillomandibular fixation using intermaxillary screws for 3 weeks. Conclusion: The advantages of endoscopic - assisted open reduction and internal fixation are direct visualization, accurate fracture repair, minimized scar, decreased morbidity. And maxillomandibular fixation is not needed when it is done by accurate reduction and rigid fixation with one miniplate in the region of subcondylar fracture. With the above consideration, endoscopic - assisted open reduction and internal fixation can be considered as one of the best treament for subcondylar fracture of the mandible.

내시경 보조하에 제거한 추체 첨부의 콜레스테롤 육아종 1예

나지나,배소희,이전미,문인석 대한이비인후과학회 2019 대한이비인후과학회지 두경부외과학 Vol.62 No.1

A cholesterol granuloma is the most common primary lesion of the petrous apex, and accountsfor 40% of the pathologies that arise in this region. The primary treatment for symptomatic lesionsis by surgery to decompress and drain or to completely remove the lesion. Here we describethe use of infralabyrinthine approach to access a lesion through the temporal bone andcompletely remove it with the assistance of a 0-degree endoscope. A 43-year-old man visitedour clinic for diplopia. Magnetic resonance imaging revealed a 2.3-cm cholesterol granulomalocated in the left petrous apex that caused deviation of the left abducens nerve. The tumor wascompletely removed using the endoscopic-assisted infralabyrinthine approach; the patient iscurrently being followed up, and there is no evidence of disease recurrence. This case report describesthe successful completion of a petrous apex cholesterol granuloma that preserved thecochlear and vestibular systems.

Endoscope-Assisted Trans-Sphenoidal Approach for Treatment of Sternberg's Canal

Maselli, Giuliano,Ricci, Alessandro,Galzio, Renato J. The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.52 No.6

We report an uncommon case of a 45-year-old woman who presented with spontaneous rhinorrhea. A computed tomography (CT) scan of the head revealed an abnormally large sphenoid sinus associated with a parasellar bony defect (Sternberg's canal) through which magnetic resonance imaging could detect an encephalocele of the right temporal lobe. An endoscope-assisted trans-sphenoidal approach was performed and, with the aid of image guided surgery, reduction of the encephalocele was obtained and followed by surgical repair of the dural and bony defects. The postoperative course was uneventful and the cerebrospinal fluid fistula was closed as confirmed by the postoperative CT scan and by the absence of rhinorrhea. After three years of monitoring the patient remained asymptomatic.

Endoscope-Assisted Microsurgical Removal of an Epidermoid Tumor within the Cavernous Sinus

정종철,김승민,Burak Sade,김한규,박문선,정승영,박기석 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.6

Epidermoid tumor of the cavernous sinus is rare. The aim of this case report is to discuss the role of neuroendoscopes in the removal of such lesions. A 21-year-old man presented with 6-year history of progressive headache, diplopia, and visual disturbance. Work-up revealed an epidermoid tumor located in the right cavernous sinus. An extradural transcavernous approach was utilized via a traditional frontotemporal craniotomy with endoscopic assistance. The postoperative course was uneventful with immediate improvement of the patient’s headache. Postoperative magnetic resonance imaging demonstrated complete removal of the tumor. There were no signs of recurrence during a 2-year follow-up period. The endoscope is a useful tool for removing epidermoid tumors from the cavernous sinus and enhances visualization of areas that would otherwise be difficult to visualize with microscopes alone. Endoscopes also help minimize the retraction of neurovascular structures.

Semi-automatic Knob System for Assisting Flexible Endoscope Steering

윤현수,Byung-Ju Yi 제어·로봇·시스템학회 2020 International Journal of Control, Automation, and Vol.18 No.10

In this paper, a semi-automatic knob system for assisting control of a flexible endoscope is introduced. For a conventional flexible endoscope, the torque to bend the bending part is increased proportionally to the curvature of the insertion tube. As the bending angle increases, the required torque is increased. This characteristic makes a surgeon tired. The proposed semi-automatic knob system consists of a knob controller, a power generation unit, and a bending part. The knob controller includes four FSR (force sensitive resistor) sensors to measure the external force applied by the operator. The power generation unit generates the power depending on the signal level of FSR sensors. Using the semi-automatic knob system, a user can control the steering of the flexible endoscope with less power as compared to the conventional flexible endoscope. The usefulness of the proposed system is verified through experiments.

Comparison of Physician-Controlled Maneuver and Assistant-Controlled Maneuver during Endoscopic Retrograde Cholangiopancreatography

정문재,성민제,조정현,이희승,박정엽,방승민 연세대학교의과대학 2024 Yonsei medical journal Vol.65 No.1

Purpose: Cannulation of the major papilla is the most challenging part of endoscopic retrograde cholangiopancreatography (ERCP) for which physician-controlled wire-guided cannulation (PCWGC) and assistant-controlled wire-guided cannulation (AC WGC) are used as the cannulation techniques. PCWGC can reportedly save up to about 30% of the labor cost by reducing the num ber of assistants. This study aims to compare the safety and efficacy of PCWGC and ACWGC. Materials and Methods: Of the 2151 patients aged >20 years (4193 cases) who underwent ERCP at Yonsei University Medical Center between January 2015 and December 2016, 989 were included in this study. Results: Among efficacy outcomes, cannulation success rate, rate of precut sphincterotomy (PCWGC vs. ACWGC: 21.3% vs. 25.9%), bile duct cannulation time (PCWGC vs. ACWGC: median 3.0 minutes vs. 3.6 minutes), and total procedure time (PCWGC vs. ACWGC: median 13.6 minutes vs. 13.1 minutes) were not significantly different. Among safety outcomes, lower rates of post ERCP pancreatitis were observed with PCWGC than with ACWGC (PCWGC vs. ACWGC: 5.8% vs. 8.8%, p=0.128). Among other post-ERCP adverse events (bleeding, perforation, and cholangitis), the difference was not significant between the groups. Radia tion exposure (total dose area product, PCWGC vs. ACWGC: median 1979.9 µGym2 vs. 2062.0 µGym2, p=0.194) and ERCP cost ex cluding labor cost (PCWGC vs. ACWGC: $1576 vs. $1547, p=0.606) were not significantly different. Conclusion: Requiring less assistants, PCWGC showed comparable efficacy and safety to ACWGC. PCWGC can be considered as an alternative option, especially in facilities lacking manpower and resources.

갑상선암에 대한 로봇 보조 내시경적 갑상선 절제술; 100예에 대한 초기 경험

강상욱 ( Sang-wook Kang ),정종주 ( Jong Ju Jeong ),윤지섭 ( Ji-sup Yun ),성태연 ( Tae Yon Sung ),이승철 ( Seung Chul Lee ),이용상 ( Yong Sang Lee ),남기현 ( Kee-hyun Nam ),장항석 ( Hang Seok Chang ),정웅윤 ( Woong Youn Chung ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.2

Background and Objectives: Various surgical procedures have been performed using surgical robot in recent years and most reports proved that application of robotic technology for surgery is technically feasible and safe. The aim of this study is to introduce our technique of robot-assisted endoscopic thyroid surgery and demonstrate its utility in the surgical management of thyroid cancer. Materials and Methods: From October 4^th 2007 through March 14^th 2008, 100 patients with papillary thyroid cancer underwent robot-assisted endoscopic surgeries using a gasless trans-axillary approach. This novel robotic surgical approach allowed adequate endoscopic access for thyroid surgeries. All the procedures were completed successfully using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, California, USA). We used four robotic arms with this system; a 12 mm telescope and three 5 mm instruments. The 3-dimensional magnified visualization obtained by the dual-channel endoscope and tremor-free instruments controlled by robot system helped surgeon do sharp and precise endoscopic dissection. Results: We performed 84 less-than total and 16 total thyroidectomies with ipsilateral central compartment node dissection. Mean operation times was 136.5 min. (range 79∼267 min.) in which the actual time for thyroidectomy with lymphadenectomy (console time) was 60.0 min. (range 25∼157 min). The average number of lymph nodes resected was 5.3 (range 1 to 28). There was no serious complication. Most patients could go home within 3 days after surgery. Conclusion: Our technique of robotic-assisted endoscopic thyroid surgery using a gasless trans-axillary approach is feasible, safe and promising for the selected patients with thyroid cancer. We suggest application of robotic technology for endsocopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.