Development of a Nasal Corridor Protection Device for Endoscopic Skull Base Surgery

Objectives: Endoscopic skull base surgery involves the passage of instruments through a narrow nasal corridor hundreds of times during an operation. Mucosal trauma from blind passage of instruments results in bleeding that obscures the surgical field and contributes to postoperative nasal morbidity. The purpose of this project was to develop and test a medical device for the protection of the surgical corridor during endoscopic skull base surgery.

Methods: The design of the nasal corridor protection device was perfected using dissected cadaveric models. Structured questionnaires were employed to assess the attributes of the medical device. Outcome measures included the ability to perform endoscopic skull base surgery on cadavers through the protection device with full instrument mobility, minimal friction, and complete target visualization, without displacement of the device.

Results: Study of CT scans, cadaver measurements, and our prior research on instrument motion through a surgical pathway were used to calculate probable dimensions for the intranasal pathway protector. Prototypes were then developed and manufactured with variations in key parameters, and these were then trialed in cadaver procedures modelling endoscopic transnasal pituitary surgery. Once the appropriate dimensions were determined, material prototyping was undertaken to select the optimal handling characteristics. A pilot study to assess the performance of the device is in progress.

Conclusion: We developed a pathway protection device for use in endoscopic skull base surgery. The device appears to allow performance of transnasal pituitary surgery with diminished mucosal trauma and without loss of surgical access or interference with passage of instruments. The device is currently undergoing modification to optimize the handling characteristics prior to clinical testing.