title: Design of an endovascular morcellator for the surgical treatment of equine Cushing's disease.
abstract: BACKGROUND
  A new paradigm of surgical treatment of equine Cushing's disease has been developed using the vascular system combined with a flexible morcellation instrument to reach the pituitary gland.
  
  
  OBJECTIVE
  The goal was twofold: (1) to design, prototype, and test an instrument that can reach the pituitary gland using the vascular system unique to equids and (2) to test the feasibility of the endovascular approach.
  
  
  METHODS
  The morcellator consists of a radial rotating cutting blade for tissue resection, a flexible shaft incorporating a cable drive for flexible actuation, and central morcellated tissue transportation lumen. The morcellator prototype was tested on a horse's cadaver head for the validation of the cutting blade design, actuator design, and feasibility of the endovascular approach.
  
  
  RESULTS
  The overall assembled length of the morcellator tip was 13.9 mm, allowing for non-traumatic steering through the vascular system from the proximal end. The radially rotating cutting blade (barrel of Ø 4 and 4.4 mm width) incorporated multiple cutting edges to deliver the action force during resection and provides the necessary grasping force to draw the tissue towards the second cutting edge of the morcellator incorporated inside the blunted cuboidal static tip element (5 mm square and wall-thickness of 0.3 mm). In the tests, the morcellator was successfully guided towards the pituitary and managed to sample pituitary tissue.
  
  
  CONCLUSIONS
  Continued development of the prototype and the endovascular approach may in time improve the outcome and quality of life of horses suffering from Cushing's disease.
authors.affiliation: a BioMechanical Engineering Department, Bio-Inspired Technology Group , Delft University of Technology , Delft , the Netherlands.
authors.forename: Aimée
authors.initials: A
authors.lastname: Sakes
authors.forename: E A
authors.initials: EA
authors.lastname: Arkenbout
authors.forename: F
authors.initials: F
authors.lastname: Jelínek
authors.forename: J H
authors.initials: JH
authors.lastname: van der Kolk
authors.forename: P
authors.initials: P
authors.lastname: Breedveld
mesh_terms: D000818:Animals; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods / Q000662:veterinary*; D004867:Equipment Design / Q000662:veterinary; D006734:Horse Diseases / Q000601:surgery*; D006736:Horses; D000069577:Morcellation / Q000295:instrumentation / Q000379:methods / Q000662:veterinary*; D047748:Pituitary ACTH Hypersecretion / Q000601:surgery / Q000662:veterinary*
keywords: Cushing's disease; PPID; design; equine; horse; morcellator; treatment