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A Method Based on 3D Shape Analysis Towards the Design of Flexible Instruments for Endoscopic Maxillary Sinus Surgery

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Abstract

The emergence of steerable flexible instruments has widened the uptake of minimally invasive surgical techniques. In sinus surgery, such flexible instruments could enable the access to difficult-to-reach anatomical areas. However, design-oriented metrics, essential for the development of steerable flexible instruments for maxillary sinus surgery, are still lacking. This paper proposes a method to process measurements and provides the instrument designer with essential information to develop adapted flexible instruments for limited access surgery. This method was applied to maxillary sinus surgery and showed that an instrument with a diameter smaller than 2.4 mm can be used on more than 72.5% of the subjects’ set. Based on the statistical analysis and provided that this flexible instrument can bend up to \(164.4^\circ,\) it is estimated that all areas within the maxillary sinus could be reached through a regular antrostomy without resorting to extra incision or tissue removal in 94.9% of the population set. The presented method was partially validated by conducting cadaver experiments.

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Acknowledgments

This work was supported by a grant from the Belgian FWO [SB/1S98418N].

Author information

Author notes

  1. Julie Legrand and Kenan Niu contributed equally to this work and should be both considered as first author.

  2. Laura Van Gerven and Emmanuel Vander Poorten contributed equally to this work and should be both considered as last author.

Authors and Affiliations

  1. Department of Mechanical Engineering Technology, KU Leuven, Leuven, Belgium

    Julie Legrand, Kathleen Denis & Emmanuel Vander Poorten

  2. Department of Mechanical Engineering, KU Leuven, Leuven, Belgium

    Kenan Niu

  3. Department of Otorhinolaryngology, Head Neck Surgery, University Hospitals Leuven, Leuven, Belgium

    Zhen Qian, Vincent Vander Poorten & Laura Van Gerven

  4. Allergy and Clinical Immunology Research Unit, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium

    Laura Van Gerven

  5. Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium

    Vincent Vander Poorten

Authors
  1. Julie Legrand
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Corresponding authors

Correspondence to Julie Legrand or Kenan Niu.

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Associate Editor Ka-Wai Kwok oversaw the review of this article.

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Appendix A: Extracted Landmarks

Appendix A: Extracted Landmarks

See Figs. 9, 10, 11, 12, 13, and 14.

Figure 9
figure 9

Extracted antrostomy window center point landmark b values from the mean shape and the \(\pm 3\sqrt{\lambda _t}\) variations of the first 27 shape modes in [mm].

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Figure 10
figure 10

Extracted maxillary sinus center point landmark c values from the mean shape and the \(\pm 3\sqrt{\lambda _t}\) variations of the first 27 shape modes in [mm].

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Figure 11
figure 11

Extracted antrostomy window length d thickness and e landmarks values from the mean shape and the \(\pm 3\sqrt{\lambda _t}\) variations of the first 27 shape modes in [mm].

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Figure 12
figure 12

Extracted radius of the maxillary sinus fitting sphere f and antrostomy window width g landmarks values from the mean shape and the \(\pm 3\sqrt{\lambda _t}\) variations of the first 27 shape modes in [mm].

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Figure 13
figure 13

Extracted most lateral point of the maxillary sinus landmark h values from the mean shape and the \(\pm 3\sqrt{\lambda _t}\) variations of the first 27 shape modes in [mm].

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Figure 14
figure 14

Extracted most anterior point of the maxillary sinus landmark i values from the mean shape and the \(\pm 3\sqrt{\lambda _t}\) variations of the first 27 shape modes in [mm].

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Legrand, J., Niu, K., Qian, Z. et al. A Method Based on 3D Shape Analysis Towards the Design of Flexible Instruments for Endoscopic Maxillary Sinus Surgery. Ann Biomed Eng 49, 1534–1550 (2021). https://doi.org/10.1007/s10439-020-02700-z

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