Page 423 - Flexible Robotics in Medicine

CHAPTER 19

Flexible drill manipulator utilizing different

rolling sliding joints for transoral drilling

through the tracheal tissue

1
1
2
1
Shiming Lin ,LuRi , Lim Xue Lun , Chwee Ming Lim and Hongliang Ren 1
1
Department of Biomedical Engineering, National University of Singapore, Singapore,
2
Singapore General Hospital, Bukit Merah, Singapore
Tracheostomy is an operative procedure that creates a surgical airway in the cervical
trachea. Currently, tracheostomy is mostly performed by directly cutting or opening (from
outside) the tissue, which leaves a significant trauma that is potentially prone to infection,
overshoot, and scarring. We hypothesize that if tracheostomy is performed by drilling
(inside out) from an oral-tracheal cavity, minimal invasiveness can be achieved to prevent
the problems above. Thus, the goals of a new device, Goldrill, are to provide proper
guidance to a flexible drill inside the tracheal lumen, to stabilize the drill tip during
operation, and to protect the respiratory duct from any damage from the drill bit. The new
device here aims to give surgeons a reliable, accurate, and easy to implement a solution to
the problem. Thus the current technique does require training even for experienced surgeons
to minimize the incidence of complications. Patients suffering from blockages in the upper
airway due to reasons such as subglottic stenosis, neck fractures, and tumors of the head
and neck need prolonged ventilatory support through tracheostomy. In other applications,
tracheostomy is also used on comatose patients who are unable to expel secretions from
their upper respiratory tract or in the long term for patients with severe chronic conditions
such as obstructive sleep apnea. We aim for oral insertion into the trachea and drilling
through the tracheal tissue cartilage, thereby allowing ventilation to the lungs while
bypassing the upper airway.

19.1 Clinical needs

We look at diseases associated with tracheostomy [1] to give insights into the associated
problems and the need for the tracheostomy procedure. Tracheostomy is related both to
diseases affecting the trachea area and the lower respiratory regions.

Flexible Robotics in Medicine.
DOI: https://doi.org/10.1016/B978-0-12-817595-8.00020-1 417
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