The NeuroPunch

Abstract

During endonasal pituitary surgery - an approach of skull base surgery - long slender instruments are inserted through the nose of the patient, in order to remove a pituitary lesion. One of the instruments which is repeatedly used is the surgical punch, which is able to remove pieces of bone in order to create access to the lesion. The drawback of the currently used surgical punches is twofold: first of all, they do not allow for rotation of the tip relative to the handle orientation in order to align the tip properly to the bone to be cut. Furthermore, the successive introduction and extraction of the instrument from the operational area after each cut, increases the risk of introducing bacteria and slows down the procedure.
A novel surgical punch was designed and developed called NeuroPunch. Throughout the course of this study, a human-centered design approach combined with a systematic engineering process was followed leading to several conceptual solutions for different functional parts of the NeuroPunch. By combining these conceptual solutions, a design was set for a first functional prototype including an ergonomic handle, a mechanism for the storage of punched bone pieces, and a mechanism for rotating the tip relative to the handle orientation.
A first evaluation of the functional 1:1 scale prototype with end users shows positive results indicating that the NeuroPunch might be a proper replacement for the currently used punches in endonasal pituitary surgery. Several iterative steps are required to produce a fully functional prototype of the NeuroPunch which can be evaluated in a preclinical setting (e.g. cadaver study). The NeuroPunch shows much potential to be used for other surgeries as well, and it is demonstrated that the NeuroPunch will enable a safer and more comfortable endonasal pituitary surgery while potentially reducing operating time.