New Miniaturized Wristed Instruments for In-Office Endoscopic Laser Surgery

Chiluisa, Alex

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New Miniaturized Wristed Instruments for In-Office Endoscopic Laser Surgery

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Endoscopic laser surgery is emerging as a promising alternative for the treatment of various pathological conditions that affect the vocal folds. Compared to traditional laryngeal surgery, which requires general anesthesia and hospitalization, in-office surgery is faster, less expensive, and it can be performed without general anesthesia. Despite their documented benefits, in-office laryngeal procedures are still underutilized because of how challenging they can be to perform with available instrumentation. Clinically available instruments (endoscopes and optical fibers) present limited dexterity, which in turn greatly limits surgical access. This dissertation introduces a comprehensive analysis, conceptualization, and implementation of a steerable optical fiber to address these challenges, aiming to enhance surgical precision and extend reach to previously inaccessible regions within the human larynx. First, we establish a simulation framework to identify currently inaccessible regions within the larynx during endoscopic laser surgeries. This framework utilizes three-dimensional models of the human larynx generated from microtomography x-ray scans and formulates the kinematic characterization of the endoscope. Then, we introduce a steerable optical fiber to amplify a physicians reach within the larynx. This work involves designing and modeling a steerable sheath utilizing an asymmetric notch pattern, which provides three independent degrees of freedom (DoF) for precise laser aiming. A control mechanism is also developed to enable single-handed operation of the steerable fiber, minimizing alterations to the clinical setting for in-office laser surgery. Experimental results demonstrate that the proposed device substantially enhances surgical access compared to current clinical fibers. The dissertation concludes by discussing future avenues of research, including further clinical validation and refinement of control mechanisms.

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