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The nitinol manipulator arm and mechanical control unit allow bending, translation, rolling, actuation, and instrument exchange, validated by reachability and payload 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can rigid instruments be insufficient for frontal sinus surgery?","Question",{"text":63,"@type":64},"Rigid angled endoscopes and rigid curved instruments cannot reach laterally located pathologies in the frontal sinus, limiting access for complicated cases.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What design feature enables the system to reach the frontal sinus transnasally?",{"text":68,"@type":64},"A 3 mm × 4.6 mm cross section enables transnasal guiding of a 1.4 mm flexible endoscope and a standard flexible surgical instrument up to 1.8 mm into the frontal sinus.",{"name":70,"@type":61,"acceptedAnswer":71},"What performance results were obtained for reachability and force?",{"text":72,"@type":64},"Reachability tests showed the manipulator arm can reach the lateral regions following a Draf IIa procedure, exerting at least 2 N vertically and 1 N laterally for manipulation 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(2020) 15:1549–1559  \n[https://doi.org/10.1007/s1](https://doi.org/10.1007/s1) 1548-020-02220-0  \nA handheld flexible manipulator system for frontal sinus surgery  \nSuat Coemert1 · Robert Roth1 · Gero Strauss2 · Pia M. Schmitz2 · Tim C. Lueth1  \nReceived: 13 January 2020 / Accepted: 19 June 2020 / Published online: 1 July 2020 © The Author(s) 2020  \nAbstract  \nPurpose Draf drainage is the standard treatment procedure for frontal sinus diseases. In this procedure, rigid angled endoscopes and rigid curved instruments are used. However, laterally located pathologies in the frontal sinus cannot be reached with rigid instrumentation. In order to assist surgeons with such complicated cases, we propose a novel handheld flexible manipulator system.  \nMethods A cross section of 3 mm × 4.6 mm enables transnasal guiding of a flexible endoscope with 1.4 mm diameter anda standard flexible surgical instrument with up to 1.8 mm diameter into the frontal sinus with increased reachability. The developed system consists of an electrical discharge-machined flexure hinge-based nitinol manipulator arm and a purely mechanical handheld control unit. The corresponding control unit enables upward and left–right bending of the manipulator arm, translation, rolling, actuation and also quick exchange of the surgical instrument. In order to verify the fulfillment of performance requirements, tests regarding reachability and payload capacity were conducted.  \nResults Reachability tests showed that the manipulator arm can be inserted into the frontal sinus and reach its lateral regions following a Draf IIa procedure. The system can exert forces of at least 2 N in the vertical direction and 1 N in the lateral direction which is sufficient for manipulation of frontal sinus pathologies.  \nConclusion Considering the fact that the anatomical requirements of the frontal sinus are not addressed satisfactorily in the development of prospective flexible instruments, the proposed system shows great potential in terms of therapeutic use owing to its small cross section and dexterity.  \nKeywords Flexible manipulator · Frontal sinus surgery · Handheld · Endoscopic surgery  \nElectronic supplementary material The online version of this article ([https://doi.org/10.1007/s11548-020-02220-0](https://doi.org/10.1007/s11548-020-02220-0)) contains supplementary material, which is available to authorized users.  \n* Suat Coemert[suat.coemert@tum.de](suat.coemert@tum.de)  \nRobert Roth  \n[robert.roth@tum.de](robert.roth@tum.de)  \nGero Strauss  \n[gero.strauss@kopfzentrum-gruppe.de](gero.strauss@kopfzentrum-gruppe.de)  \nPia M. Schmitz  \n[pia.schmitz@kopfzentrum-gruppe.de](pia.schmitz@kopfzentrum-gruppe.de)  \nTim C. Lueth  \n[tim.lueth@tum.de](tim.lueth@tum.de)  \n1 Institute of Micro Technology and Medical Device Technology, Technical University of Munich, Boltzmannstr.  \n15, 85748 Garching, Germany  \n2 IRDC GmbH International Reference and Development Centre for Surgical Technology, Käthe-Kollwitz-Straße 64, 04109 Leipzig, Germany  \nIntroduction Clinical background  \nThe frontal sinus is one of the most variable human anatomical structures. Its size and shape is highly dependent on race and climate [1, 2] . The proportions and shape of the frontal sinus and neighboring anatomical structures can sometimes vary substantially. The frontal sinus (Fig. 1) usually consists of two air-filled volumes situated behind the right and left part of the forehead. They are separated in the left and the right frontal sinus by the frontal septum in the sagittal plane. In adults, both frontal sinuses are roughly pyramid shaped. In the frontal sinus floor, there is a conically tapering constriction, the frontal sinus infundibulum [3] . It leads to the smallest constriction of the passage to the frontal sinus, the frontal ostium. It is the opening of the frontal sinus to the natural frontal sinus outflow tract (frontal recess) . The frontal ","cbCaiemUxjSfnAa2","https://ap.wps.com/l/cbCaiemUxjSfnAa2","pdf",1630322,11,"English","# Abstract\n# Purpose\n# Methods\n# Results\n# Conclusion\n# Keywords\n# Introduction\n## Clinical background\n## State of the art","[{\"question\":\"Why can rigid instruments be insufficient for frontal sinus surgery?\",\"answer\":\"Rigid angled endoscopes and rigid curved instruments cannot reach laterally located pathologies in the frontal sinus, limiting access for complicated cases.\"},{\"question\":\"What design feature enables the system to reach the frontal sinus transnasally?\",\"answer\":\"A 3 mm × 4.6 mm cross section enables transnasal guiding of a 1.4 mm flexible endoscope and a standard flexible surgical instrument up to 1.8 mm into the frontal sinus.\"},{\"question\":\"What performance results were obtained for reachability and force?\",\"answer\":\"Reachability tests showed the manipulator arm can reach the lateral regions following a Draf IIa procedure, exerting at least 2 N vertically and 1 N laterally for manipulation needs.\"}]","A handheld flexible manipulator system for frontal sinus surgery | PDF",1790025090,28]