Review of Techniques to Achieve Optical Surface Cleanliness and Their Potential Application to Surgical Endoscopes.

A clear visualization of the operative field is of critical importance in endoscopic surgery. During surgery the endoscope lens can get fouled by body fluids (eg, blood), ground substance, rinsing fluid, bone dust, or smoke plumes, resulting in visual impairment. As a result, surgeons spend part of the procedure on intermittent cleaning of the endoscope lens. Current cleaning methods that rely on manual wiping or a lens irrigation system are still far from ideal, leading to longer procedure times, dirtying of the surgical site, and reduced visual acuity, potentially reducing patient safety. With the goal of finding a solution to these issues, a literature review was conducted to identify and categorize existing techniques capable of achieving optically clean surfaces, and to show which techniques can potentially be implemented in surgical practice. The review found that the most promising method for achieving surface cleanliness consists of a hybrid solution, namely, that of a hydrophilic or hydrophobic coating on the endoscope lens and the use of the existing lens irrigation system.

Method for minimising rolling joint play in the steerable laparoscopic instrument prototype DragonFlex.

INTRODUCTION: The steerable laparoscopic instrument prototype DragonFlex was recently developed with the vision of a minimalistic fully functional design, readily produced by additive manufacturing and requiring little assembly. Steering functionality is provided by rolling joints that, besides simplifying the assembly, help minimise cable fatigue and equalise force requirements on steering cables. However, the perfectly circular rolling joint design introduced some mechanism play, undermining the joint's bending stiffness. Hence, the aim of this paper is to present an innovative solution for play reduction in rolling joints. MATERIAL AND METHODS: The original play-compensating mechanism, a shaft-embedded compression spring, proved unsatisfactory for play reduction. Therefore, a new non-circular rolling joint curvature was designed with the objective to compensate for any cable slack and thus minimise the joint play. The new rolling joint design was evaluated in several tip deflection experiments and compared to the original one. RESULTS AND CONCLUSIONS: The experimental results proved that the optimised rolling joint curvature significantly minimises play, thus being a major improvement compared to the original design. The optimised rolling joint was implemented in a new real-scale DragonFlex prototype. The presented optimisation method enables elimination of a conventionally used cable tensioning device and it is generally applicable to steerable minimally invasive instruments that use a rolling joint.