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Flexible drill manipulator utilizing different rolling sliding joints for transoral drilling 419
Table 19.1: PT surgical obstacles and repercussions.

Surgery obstacle Repercussions
Location of incision is estimated “blindly” by palpating Risk of tube misplacement resulting in loss of
the area airway or damage to surrounding tissue [7]
PT is not suitable for obese patients due to the
increased risk of tube misplacement [8]
Surgeon manually drives the introductory needle May accidentally puncture through the trachea
through tracheal cartilage with uncontrolled force and esophagus [5]
Increased risk of infection
No guiding or aligning the mechanism as needle It can cause excessive hemorrhage and fatal
actuates through tissue bleeding

there are several shortcomings with the current methods. Punctures are done externally
and approximated, without a way to determine the exact puncture position. This leads to
other complications such as excessive bleeding or extended wounds. Furthermore, obese
patients are not suitable to undergo this surgery due to increased submental and anterior
cervical adipose tissue, and a short, thick neck, making it hard to determine the trachea
ring positions.

19.2 Limitations of the current devices

Currently, there are two methods for this surgery: OT and PT. Although OT allows
excellent visualization of the surgical field and structures, it results in an elevated risk of
infection and bleeding, making it an unpopular choice among surgeons [2].

19.2.1 Percutaneous tracheostomy

PT is the current minimally invasive alternative to OT. It is done by making a small
incision through which a guiding wire is advanced under direct bronchoscopic visualization.
The incision is then dilated using dilators and until it is wide enough to fit the tracheostomy
tube [3]. It results in less bleeding and infection and is a quicker procedure that can be
performed earlier [4 6].

The risks above (Table 19.1), therefore, demonstrate a clinical need for an accurate,
noninvasive method of conducting tracheostomy. Our device aims to meet this need using a
new method to reduce tissue damage by making an incision from inside the trachea.

19.2.2 Current instruments

Tracheostomy, as a procedure, utilizes a combination of underlying medical tools and dilators.
These are medical instruments that allow a surgeon to increase the size of an opening or
lumen in a patient. In the newer, percutaneous form, dilators are used as part of the process of