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Technical Brief

Design and Preliminary Evaluation of a Stiff Steerable Cutter for Arthroscopic Procedures

[+] Author and Article Information
T. Horeman, G. J. M. Tuijthof

Delft University of Technology,
Delft & Academic Medical Centre,
Amsterdam, The Netherlands

F. Schilder, M. Aguirre

Delft University of Technology,
Delft, The Netherlands

G. M. M. J. Kerkhoffs

Academic Medical Centre,
Amsterdam, The Netherlands

Manuscript received December 15, 2014; final manuscript received April 7, 2015; published online August 6, 2015. Assoc. Editor: Rita M. Patterson.

J. Med. Devices 9(4), 044503 (Aug 06, 2015) (6 pages) Paper No: MED-14-1292; doi: 10.1115/1.4030506 History: Received December 15, 2014

This article describes a novel and simple shaft actuated tip articulation (SATA) mechanism that allows arthroscopic instruments to articulate while remaining stiff. Since the SATA mechanism requires only independent rotation of two tubes for hinge articulation, cables, gears, or other internal components that are normally found in steerable endoscopic instruments become obsolete. The SATA mechanism was integrated in a new steerable cutter prototype and tested. Early user, mechanical strength and cadaver experiments were performed that indicate that this first prototype withstands an axial and sideways force of 100 N and 20 N, that trained users can (dis)assemble the instrument in less than 1.5 min and that a surgeon is able to reach all important locations on the menisci.

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References

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Figures

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Fig. 1

Anterior view of right knee. (Top) Surgeons use a cutter and arthroscope to cut meniscus lesions. (Below R) Common lesions of the menisci. (Below L) Side view of a prebend cutter.

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Fig. 2

(Top) Rotating the outer tube results in articulation of the hinge (A) at the tip, since the diagonal cut-outs (B) in the outer tube forces the sliders to move in axial direction. (Middle) To prevent axial rotation of the tip the longitudinal cut-outs (C) in the inner tube prevent axial rotation of the sliders. (Below) View on the inner sliders show that there are no cables used for hinge activation. Only the force exerted by the cut-outs on the driving pins (D) actuates the sliders.

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Fig. 3

Picture of the SATA_V1 prototype with tip actuation handle (A) and wheel mounted to outer tube (B) for sideways tip rotation

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Fig. 7

Steerable cutter prototype used inside the knee by a surgeon. The photographs show that the menisci can be reached and that the prototype allows control in various grip configurations.

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Fig. 6

Setup used to measure the deformation angle Beta under a tangential sideways tip load of 2 kg for sideways and upward tip load (latter condition is not shown in the picture). The inlay picture shows that a custom made angular scale was used to read out the angular deformation Beta.

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Fig. 5

Left: Schematic overview of the steerable cutter tip taken from above showing the reaction forces on hinge pin a under loading P. Right: Detailed impression of hinge part a or b showing that each hinge pin has two cross-sectional areas that both need to resist half of the reaction force.

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Fig. 4

Steerable cutter dismantled by removing the clip and rotation of the pin stop holder (a) and (b)). Subsequently, the steerable cutter can be disassembled into a tip assembly and an outer tube with wheel (c) and handle (d). Opening of the hinge provides better access to all openings for cleaning and inspection ((c) top).

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