Page 426 - Flexible Robotics in Medicine

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opening the hole in the tracheal wall. Most prominently, the Blue Rhino is a widely used
dilator that we shall examine in-depth as a closely related device. In addition to these
instruments, ENT tubing is an example of other peripherals that are part of the procedure.

19.2.2.1 Blue Rhino dilator

The Griggs and Ciaglia Cook Medical Blue Rhino is an instrument that is used in the
Ciaglia technique for PT. Despite the many advantages of the Blue Rhino and similar
instruments, it is fundamentally limited by the nature of the procedure it was designed to
perform. As per traditional thought, all tracheostomies are performed from the outside with
surgeons using their expertise and senses to identify the third tracheal ring for puncture or
incision. As stated above, this poses problems such as a high risk for nearby tissue damage.
Flexible drill technology has been applied to a variety of situations in the medical field,
including orthopedics. The most similar application is a flexible endoscope. This, however,
does not contain the drill function and serves more to guide a surgeon by providing a view
of the trachea from the inside. This procedure is useful in restoring airflow to patients but
has several clinical problems such as the inability to accurately puncture the trachea from
the outside. Thus, our device aims to provide an accurate method of puncture by having the
drill penetrate the trachea wall cartilage rings from inside the trachea. The advantages of
the minimally invasive nature procedure are clear, with increased accuracy and speed of the
tracheostomy procedure. A flexible drill manipulator can be used to overcome the above-
mentioned problem with the help of a bronchoscope. Rather than puncturing the trachea
externally, we can puncture the hole from inside out, which increases the accuracy of the
puncture since the trachea rings are now visible with the use of a bronchoscope. The
proximal end of the manipulator can be steered by the clinician to navigate the contours in
the oral cavity and oropharynx. The area of application of our device is targeted for
tracheostomy. However, its bending mechanism can be widely applied to other articulated
devices. Hence, our prior art review will include devices targeted for tracheostomy and
articulated medical devices for flexible joint movements.

Currently, the available tracheostomy surgical devices are rarely like flexible drill
manipulators. The more applicable set of devices would be Blue Rhino set developed by
cook medical (US Patent 6637435). After the placement of introducer needle, insertion of J-
tipped guidewire and stylet, a dilator loaded on the stylet with the tip resting on the safety
ridge. The dilator enlarges the opening created from outside-in and stops advancing when the
40 FR mark disappears below the skin level to ensure the dilator does not expand the opening
beyond the desired dimension (John Hopkins Medicine, n.d.). Although the Blue Rhino set is
easy to implement and user-friendly, there are more steps required as compared to the idea of
using a flexible drill manipulator. Furthermore, as mentioned earlier, there are potential risks
associated with the current surgical methods of puncturing a hole from the outside.