Applied Force during Piston Prosthesis Placement in a 3D-Printed Model: Freehand vs Robot-Assisted Techniques. (February 2019)

• Record Type: Journal Article
• Authors: Razavi, Christopher R.; Wilkening, Paul R.; Yin, Rui; Lamaison, Nicolas; Taylor, Russell H.; Carey, John P.; Creighton, Francis X.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 160:Number 2(2019)
• Page Start: 320
• Page End: 325
• Publication Date: 2019-02
• Subjects: robotic surgery -- otosclerosis -- stapes -- otology -- 3D printing; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599818815144
• Languages: English
• ISSNs: 0194-5998

Abstract

Objectives: To describe a 3D-printed middle ear model that quantifies the force applied to the modeled incus. To compare the forces applied during placement and crimping of a stapes prosthesis between the Robotic ENT Microsurgery System ( REMS ) and the freehand technique in this model. Study Design: Prospective feasibility study. Setting: Robotics laboratory. Subjects and Methods: A middle ear model was designed and 3D printed to facilitate placement and crimping of a piston prosthesis. The modeled incus was mounted to a 6–degree of freedom force sensor to measure forces/torques applied on the incus. Six participants—1 fellowship-trained neurotologist, 2 neurotology fellows, and 3 otolaryngology–head and neck surgery residents—placed and crimped a piston prosthesis in this model, 3 times freehand and 3 times REMS assisted. Maximum force applied to the incus was then calculated for prosthesis placement and crimping from force/torque sensor readings for each trial. Robotic and freehand outcomes were compared with a linear regression model. Results: Mean maximum magnitude of force during prosthesis placement was 126.4 ± 73.6 mN and 105.0 ± 69.4 mN for the freehand and robotic techniques, respectively ( P = .404). For prosthesis crimping, the mean maximum magnitude of force was 469.3 ± 225.2 mN for the freehand technique and 272.7 ± 97.4 mN for the robotic technique ( P = .049). Conclusions: Preliminary data demonstrate that REMS -assisted stapes prosthesis placement and crimping are feasible with a significant reduction in maximum force applied to the incus during crimping with the REMS in comparison with freehand.