Specialised Surgical Instruments for Endoscopic and ...

While there have been great strides in endoscopic and endoscope-assisted neurosurgical approaches, particularly in the treatment of deep-sited brain and skull base tumours, the greatest technical barrier to their adoption has been the availability of suitable surgical instruments. This systematic review seeks to identify specialised instruments for these approaches and evaluate their safety, efficacy and usability. Conducted in accordance with the PRISMA guidelines, Medline, Embase, CENTRAL, SCOPUS and Web of Science were searched. Original research studies that reported the use of specialised mechanical instruments that manipulate tissue in human patients, cadavers or surgical models were included. The results identified 50 specialised instruments over 62 studies. Objective measures of safety were reported in 32 out of 62 studies, and 20 reported objective measures of efficacy. Instruments were broadly safe and effective with one instrument malfunction noted. Measures of usability were reported in 15 studies, with seven reporting on ergonomics and eight on the instruments learning curve. Instruments with reports on usability were generally considered to be ergonomic, though learning curve was often considered a disadvantage. Comparisons to standard instruments were made in eight studies and were generally favourable. While there are many specialised instruments for endoscopic and endoscope-assisted neurosurgery available, the evidence for their safety, efficacy and usability is limited with non-standardised reporting and few comparative studies to standard instruments. Future innovation should be tailored to unmet clinical needs, and evaluation guided by structured development processes.

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The greatest technical barrier in endoscopic and endoscope-assisted neurosurgery is the instruments employed for these approaches. This systematic review aimed to identify specialised instruments for this type of surgery and evaluate their safety, efficacy and usability. We identified 50 instruments over 60 studies that were broadly safe and effective and generally considered to be ergonomic, though the learning curve was often noted as a disadvantage. Only eight studies compared the new instrument to standard instruments and comparisons were generally favourable to the new instrument. The development of novel and specialised instruments for endoscopic and endoscope-assisted neurosurgery is an area of interest for the field, but these instruments do not meet the need for improved articulation and future development should be based on established guidelines for neurosurgical innovation.

1. Introduction

In Lewis Carroll&#;s novel Through The Looking Glass, and What Alice Found There, Alice falls into a new world that shifts her perception of what she thought she knew and was possible [1]. Over the past 100 years neurosurgeons have been through their own looking glass: the endoscope. In the last 30 years, many new endoscopic and endoscope-assisted neurosurgical approaches and procedures have been developed, facilitated by a rise in complimentary innovation in endoscopic instruments and surgical techniques [2].

The development of endoscopic and endoscope-assisted approaches has played a key role in treating and improving the outcomes of brain tumours. The endoscopic endonasal transsphenoidal approach, for instance, may decrease the incidence of surgical complications when compared with traditional microsurgical cases in treating pituitary adenomas, likely a direct result of the improved visualisation of anatomy this approach provides [3]. Utilisation of endoscopic approaches in treating patients with sinonasal and ventral skull base cancers has also been found to significantly improve patient quality of life scores within the first postoperative year [4].

However, despite the great strides made in endoscopy, it is the use of surgical instruments in endoscopic approaches that has remained the greatest technical barrier to their adoption [5]. Presently, many of the instruments used in endoscopic and endoscope-assisted neurosurgical approaches have been adopted from the armamentarium of neighbouring specialties such as rhinology and urology. These include instruments that grasp, such as forceps, and instruments that cut and divide, such as scissors, knives and punches [6]. Although most such instruments are straight, some angled instruments are also in popular use, particularly in combination with angled endoscopes. Alongside these traditional instruments special classes have been developed, including microdebriders for precise tissue removal, ultrasonic devices for removal of firm tumours that are not easily suctioned and mono- and bipolar forceps for coagulation.

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Historically, the introduction of new instruments such as these has been unstructured and variable. Though assessment frameworks for innovation in neurosurgery, including the development of novel neurosurgical instruments, have been developed [7,8], an instrument may be used for the first time in the form of a dedicated research study but, more often, may be published as a non-comparative trial without special institutional board review. Although many such instruments are safe and effective, the dangers of this process are obvious and have been frequently reported in the literature [9]. The usability of a new instrument, including its ergonomics and learning curve, is also an important factor when considering its adoption within the surgical community.

The aims of this review were therefore first, to identify specialised instruments that have been developed for endoscopic and endoscope-assisted neurosurgery; second, to assess the evidence for the safety and efficacy of these instruments; and third, to assess their usability.

Endoscopy equipment are medical instruments by which doctors can look into organs of our body. These are small, rigid, fixed with light or tubes at the end that helps medical professionals to look into colon, Esophagus, and stomach. In simple terms, these instruments help to look inside the structure of hollow organs.

There are many benefits of Endoscopy equipment, they usually have multiple uses. There are equipment with therapeutic capabilities, along with diagnose. In simple terms, endoscopy products can provide sclerotherapy and perform Biopsies. There are many Endoscopy equipment available these days, some of them are mention below.

ENDOSCOPY EQUIPMENT AND THEIR USES

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• ENCEPHALOSCOPE: This instrument is capable of looking into brain for finding cavities.
• LARYNGOSCOPE: It has been used to examine larynx, which is an organ in our neck containing our vocal cords.
• ESOPHAGOSCOPE: This equipment is used to examine esophagus inside.
• THORACOSCOPE: When need to examine pleural cavity, this instrument helps examine through intercostal space.
• ANGIOSCOPE: it is used for observing blood vessels. There is a very narrow fiber Endoscope in it that captures image and transfer via fused silica image. The small size of this equipment makes it easy to observe parts that are difficult to check by other methods.
• NEPHROSCOPE: If there is need to examine kidneys, this instrument is used.
• COLONOSCOPE: To examine lower part of the bowel, this equipment is essential.
• PROCTOSCOPE: When there is certain problem in rectum, this instrument is used for inspection.
• ARTHROSCOPE: It is an endoscope to examine inside of a joint. Most common arthroscope has a diameter of 4mm with direction of 30 degree. It is used for treating and diagnosing problems concerning knee. These are rigid instruments made of optical lenses. It is normally integrated with a video camera to look into the problem.
• RHINOSCOPE: It is used to examine nasal.
• ESOPHAGOSCOPE: when there is a bigger problem that need examination of passage from Pharynx to stomach, this equipment do the job.
• BRONCHOSCOPE: If need to examine inside of bronchi.
• MEDIASTINOSCOPE: it is used to examine mediastinum, which is mass of organs and tissues separating lungs. It also include heart, large vessels, esophagus, trachea, and etc.
• GASTROSCOPE: If there is need to examine inside of stomach, Gastroscope is used.
• LAPAROSCOPE: It is used to examine peritoneal cavity. This endoscope is one of the most common equipment used by surgeons. The usual size of Laparoscope is 10mm in diameter, and 300 insertion in depth.
• AMNIOSCOPE: when there is certain problem with fetus, Amnioscope is used to look through the cervical canal. It is used before the membrane is damaged.
• CYSTOSCOPE: It is used to examine urinary tract. This is similar to arthroscope but there is longer insertion as compare to it.
• HYSTEROSCOPE: When it require to examine canal of Uterine Cervix and uterine cavity, this equipment is used.