gms | German Medical Science

Objective: Recently, endoscope-assisted microsurgery has been used for a broad spectrum of indications including tumors, vascular lesions and scull base surgery. Draw backs are inadequate holding devices, incompatibility between subsystems, and inconvenient user interfaces. With “PICO” we present an integrated system particularly designed for endoscope-assisted microsurgery.

Methods: Requirements of the system were 1) intuitive and simple user interface, 2) non-distorted 3D image, 3) reliable and highly flexible holding device, and 4) intuitively steerable and motorized micromanipulator. Between 11/2004 and 11/2006 we developed a system based on these requirements, designed a prototype, and performed first tests in the laboratory.

Results: Finally, the prototype met all requirements. It consists of a speech, movement or touch screen based user interface enabling integration of different image (endoscope, microscope, x-ray etc.) and other data (navigation, neuromonitoring etc.) information. The 4 mm endoscope optic provides a non-distorted 3D image and is connected to a pneumatic arm which may be used with or without a motor driven micromanipulator. The latter can be intuitively steered with any desired instrument, such as a sucker or forceps via navigation.

Conclusions: With “PICO” an integrated system for endoscope-assisted microsurgery could be realized. Most importantly, it provides a multifunctional user interface, an intuitively steerable robotic holding arm, and a non-distorted 3D endoscopic image. Further clinical test are necessary to support the successful tests in the laboratory.