Abstract
The instruments currently used by surgeons for in utero treatment of the twin-to-twin transfusion syndrome (TTTS) are rigid or semi-rigid. Their poor dexterity makes this surgical intervention risky and the surgeon's work very complex. This paper proposes the design, assembly and quantitative evaluation of an add-on system intended to be placed on a commercialized cable-driven flexible endoscope. The add-on system is lightweight and easily exchangeable thanks to the McKibben muscle actuators embedded in its system. The combination of the flexible endoscope and the new add-on unit results in an easy controllable flexible instrument with great potential use in TTTS treatment, and especially for regions that are hard to reach with conventional instruments. The fetoscope has a precision of 7.4% over its entire bending range and allows to decrease the maximum planar force on the body wall of 6.15% compared to the original endoscope. The add-on control system also allows a more stable and precise actuation of the endoscope flexible tip.
Highlights
The twin-to-twin transfusion syndrome (TTTS) is an ailment affecting up to 9% of all monochorionic diamniotic twin pregnancies (Lewi et al, 2010)
Two important questions were investigated on the basis of some defined quantitative metrics: “Can the fetoscope (i.e., Storz’s ureteroscope equipped with the novel add-on and a virtually shorten shaft) be used for a TTTS procedure?,” and “What is its added-value in comparison with the standard Storz’s ureteroscope?”
With regard to the coagulation accuracy, there is no significant difference between both instruments
Summary
The twin-to-twin transfusion syndrome (TTTS) is an ailment affecting up to 9% of all monochorionic diamniotic twin pregnancies (Lewi et al, 2010). By visualizing the placenta with the endoscope, the surgeon can laser, using the therapeutic laser, the anastomoses, i.e., the placental vessels responsible for the blood transfer between the twins (Ville et al, 1998) This surgery induces iatrogenic (i.e., caused by the surgery itself) preterm premature rupture of membranes (iPPROM) in about 30% of the cases (Beck et al, 2012). These instruments are rigid or semi-rigid with poor controllability, which forces the surgeons to approach the vessels under complex angles and apply large forces on the uterus and the fetal membranes This excessively exercised pressure might lead to tissue damage and/or to iPPROM
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