CORDIS - EU research results

Paraendoscopic intuitive computer assisted operating system

Final Report Summary - PICO (Paraendoscopic Intuitive Computer assisted Operating system)

Endoscopic interventions have been performed in growing numbers in neurosurgery. Compared to microscopic interventions, the use of an endoscope has significant advantages mainly resulting from an improved view of the object field and a reduced trauma. Yet, limitations of the endoscopes and auxiliary tools available exclude most of the indications in neurosurgery from endoscopic interventions.

In addition, endoscopic interventions offer significant benefits to the patients. The reduced trauma leads to a reduced stay at hospitals and a faster convalescence. Especially in neurosurgery, a reduced trauma is directly associated with a reduced impact on the brain's functions and shows immediate improvements.

The availability of an endoscopic system integrated with mechanical components and characterised by improvements concerning optical properties and handling concept would have the power to transform microscopic interventions into endoscopic interventions in neurosurgery.

The objective of PICO was the development of an integrated neurosurgical system to create the technical preconditions for a basic change from microsurgical to endoscopic interventions in neurosurgery. The developed system consisted of:
- a holding device for accurate positioning of an endoscope;
- an ergonomic, robust and reliable man-machine interface for remote control of system functions, integrated in a safe overall system control;
- a set of micro mechanical instruments adapted for use in stereo-endoscopic neurosurgery;
- a specially adapted stereo-endoscope for neurosurgery.

The vision of PICO was to combine the benefits of microscopic systems - mainly three-dimensional (3D)-visualisation and well-suited holding concepts - with the benefits of endoscopic systems, thus overcoming the drawbacks in neurosurgery.

At the time of the project, the major part of all neurosurgical operations relied on the surgical microscope. An improved endoscopic instrumentation for the operating room resulting from a coordinated development of the relevant components should enable neurosurgeons to use endoscopic rather than microscopic sight for their interventions.

Following the research results from leading neurosurgical departments during the last years it was quite obvious that the future of less or minimally invasive neurosurgery was based on the use of endoscopes either to assist the microsurgical procedure or more favourably to completely replace the microscope. From the view of the patients this was a most desirable development as it helped to reduce the operative trauma and post-operative problems or losses of brain functionality.

In this project 13 partners from 5 European countries developed in a total time of 27 months a fully functional demonstrator for a neurosurgical, para-endoscopic operating room system containing the following components:
1. a balanced mechanical endoscope holding and motion system with:
- sufficient stiffness;
- motors/breaks avoiding a stick-slip-effect on release of the breaks;
- a fixing to the operating table to pivot the endoscope around the point of trepanation;
- a motor-driven fine adjustment;
- the possibility to fix the holding and motion system to the fixation of the patients head (Mayfield-clamp);
2. a control system and a user interface enabling the surgeon to control the endoscope position intuitively, including:
- steering of the endoscope directly by the surgeon without the need to take his hands from the instruments;
- a suitable input device;
- a control software;
- the necessary hardware to provide the drives with the necessary energy and control signals;
3. a 3D visualisation system with:
- the additional feature of voice controlled delivery of surplus information (preoperative data, ultrasound images, etc.), including
- the possibility of a 3D representation,
- a suitable monitor or alternatively a head mounted display for visualisation,
- a voice control system for the surgeon;
4. a set of instruments for para-endoscopic surgery including:
- instruments that enable the surgeons to perform complex manipulations endoscopically;
- important functions like suction, rinsing, dissection, cutting, grasping, sample taking;
- multifunctional instruments energised by bipolar high frequency current or, radio frequency current;
5. suitable endoscopes for mono- or stereoscopic sight on the sites, including an exoscope camera to visualise the exterior surgical field.

The development of such an integrated neuroendoscopic system made a significant contribution to the future positioning of small and medium-sized enterprises (SMEs) in the field of high-tech medical applications. In addition a large enterprise participated in the project by bringing in its facilities for the development of the stereo-endoscope and making its market entry-points and sales channels available to the SMEs.