{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T19:12:59Z","timestamp":1772219579679,"version":"3.50.1"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Percutaneous Dilatational Tracheostomy (PDT) is frequently performed at the intensive care unit bedside. Perioperative movements of instruments, especially inserting and removing the needle and dilators, may cause severe complications in around 10% of total patients. This research aims to reduce the complications associated with PDT instruments and simplify the procedure by proposing a prototype medical device called TrachyPen. Either used robotically or manually, TrachyPen combined the PDT puncture and dilation into a single step to eliminate the use of multiple instruments and their complex operations. Considering the insertion and dilation force as a critical safety factor for PDT, fifty simulated PDT insertion and dilation experiments were conducted on porcine back skins to evaluate the force profiles of TrachyPen and compare them with the Ciaglia Blue Rhino (CBR) dilator, commonly used in current clinical practice. Results illustrated a smaller stoma of 13.67(164) mm and a smaller insertion force of 53.45(807) N by TrachyPen compared with CBR (16.17(205) mm and 69.01(842) N). This research proves the concept of the TrachyPen design and the potential of using it for robotic PDT puncture and dilation.<\/jats:p>","DOI":"10.1371\/journal.pone.0343014","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T18:31:19Z","timestamp":1772217079000},"page":"e0343014","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Design and evaluation of a prototype medical device for robotic and manual percutaneous dilatational tracheostomy"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3098-6571","authenticated-orcid":true,"given":"Yuan","family":"Tang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glen","family":"Cooper","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6879-3460","authenticated-orcid":true,"given":"Damian","family":"Crosby","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3048-3480","authenticated-orcid":true,"given":"Brendan A.","family":"McGrath","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7232-4942","authenticated-orcid":true,"given":"Andrew","family":"Weightman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"issue":"4","key":"pone.0343014.ref001","first-page":"483","article-title":"Indications for and timing of tracheostomy","volume":"50","author":"Jr Durbin CG","year":"2005","journal-title":"Respir Care."},{"issue":"1","key":"pone.0343014.ref002","doi-asserted-by":"crossref","DOI":"10.1016\/j.bja.2020.04.064","article-title":"Improving tracheostomy care in the United Kingdom: results of a guided quality improvement programme in 20 diverse hospitals","volume":"125","author":"BA McGrath","year":"2020","journal-title":"Br J Anaesth."},{"issue":"4","key":"pone.0343014.ref003","article-title":"Estimating the number of tracheostomies performed in critical care in England","volume":"109","author":"B McGrath","year":"2012","journal-title":"British Journal of Anaesthesia."},{"issue":"6","key":"pone.0343014.ref004","doi-asserted-by":"crossref","first-page":"895","DOI":"10.4187\/respcare.02971","article-title":"Tracheostomy: epidemiology, indications, timing, technique, and outcomes discussion","volume":"59","author":"NH Cheung","year":"2014","journal-title":"Respiratory Care."},{"key":"pone.0343014.ref005","first-page":"1388225","article-title":"Comparison between real-time ultrasound-guided percutaneous tracheostomy and surgical tracheostomy in critically ill patients","volume":"2022","author":"HT Kang","year":"2022","journal-title":"Crit Care Res Pract."},{"issue":"10","key":"pone.0343014.ref006","first-page":"529","article-title":"Percutaneous versus surgical bedside tracheostomy in the intensive care unit: a cohort study","volume":"74","author":"F Beltrame","year":"2008","journal-title":"Minerva Anestesiol."},{"issue":"3","key":"pone.0343014.ref007","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1097\/01.mlg.0000251585.31778.c9","article-title":"Meta-analysis comparison of open versus percutaneous tracheostomy","volume":"117","author":"KM Higgins","year":"2007","journal-title":"Laryngoscope."},{"issue":"1","key":"pone.0343014.ref008","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1002\/lary.22364","article-title":"A multi-institutional analysis of tracheotomy complications","volume":"122","author":"SL Halum","year":"2012","journal-title":"Laryngoscope."},{"issue":"8","key":"pone.0343014.ref009","doi-asserted-by":"crossref","first-page":"5314","DOI":"10.21037\/jtd-19-3716","article-title":"Managing complications of percutaneous tracheostomy and gastrostomy","volume":"13","author":"AN Zouk","year":"2021","journal-title":"J Thorac Dis."},{"issue":"4","key":"pone.0343014.ref010","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1378\/chest.119.4.1282","article-title":"Complications of percutaneous tracheostomy","volume":"119","author":"T Briche","year":"2001","journal-title":"Chest."},{"issue":"4","key":"pone.0343014.ref011","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1067\/mhn.2000.105714","article-title":"Tracheotomy complications: a retrospective study of 1130 cases","volume":"123","author":"D Goldenberg","year":"2000","journal-title":"Otolaryngol Head Neck Surg."},{"issue":"6","key":"pone.0343014.ref012","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1007\/s001340050385","article-title":"Percutaneous dilatational tracheostomy in a medical ICU","volume":"23","author":"S Petros","year":"1997","journal-title":"Intensive Care Med."},{"issue":"3","key":"pone.0343014.ref013","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1046\/j.0003-2409.2001.02452.x","article-title":"Tracheal trauma from percutaneous tracheostomy using the Griggs method","volume":"57","author":"M Watters","year":"2002","journal-title":"Anaesthesia."},{"key":"pone.0343014.ref014","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/00005537-200002010-00007","article-title":"Quantification of the learning curve for percutaneous dilatational tracheotomy","volume":"110","author":"DD Massick","year":"2000","journal-title":"Laryngoscope."},{"issue":"5","key":"pone.0343014.ref015","first-page":"279","article-title":"Learning curve for real-time ultrasound-guided percutaneous tracheostomy","volume":"36","author":"S Petiot","year":"2017","journal-title":"Anaesth Crit Care Pain Med."},{"issue":"1","key":"pone.0343014.ref016","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/1755-7682-1-21","article-title":"Intensive care unit tracheostomy: a snapshot of UK practice","volume":"1","author":"T Veenith","year":"2008","journal-title":"Int Arch Med."},{"issue":"6","key":"pone.0343014.ref017","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1378\/chest.87.6.715","article-title":"Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report","volume":"87","author":"P Ciaglia","year":"1985","journal-title":"Chest."},{"issue":"6","key":"pone.0343014.ref018","first-page":"543","article-title":"A simple percutaneous tracheostomy technique","volume":"170","author":"WM Griggs","year":"1990","journal-title":"Surg Gynecol Obstet."},{"issue":"4","key":"pone.0343014.ref019","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1111\/j.1399-6576.2004.0313.x","article-title":"Percutaneous tracheostomy: Ciaglia Blue Rhino versus Griggs\u2019 Guide Wire Dilating Forceps. A prospective randomized trial","volume":"48","author":"JM A\u00f1\u00f3n","year":"2004","journal-title":"Acta Anaesthesiol Scand."},{"issue":"1","key":"pone.0343014.ref020","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1213\/00000539-200301000-00046","article-title":"PercuTwist: a new single-dilator technique for percutaneous tracheostomy","volume":"96","author":"K Westphal","year":"2003","journal-title":"Anesth Analg."},{"issue":"3","key":"pone.0343014.ref021","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s00134-002-1218-5","article-title":"A new simple method for percutaneous tracheostomy: controlled rotating dilation. A preliminary report","volume":"28","author":"G Frova","year":"2002","journal-title":"Intensive Care Med."},{"issue":"6","key":"pone.0343014.ref022","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1097\/00000539-200212000-00050","article-title":"Percutaneous tracheostomy with single dilatation technique: a prospective, randomized comparison of Ciaglia blue rhino versus Griggs\u2019 guidewire dilating forceps","volume":"95","author":"SP Ambesh","year":"2002","journal-title":"Anesth Analg."},{"issue":"5","key":"pone.0343014.ref023","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1213\/01.ANE.0000111112.96668.58","article-title":"Tracheal ring fracture during a PercuTwist tracheostomy procedure","volume":"98","author":"E Scherrer","year":"2004","journal-title":"Anesth Analg."},{"issue":"8","key":"pone.0343014.ref024","first-page":"1056","article-title":"Tracheostomy: why, when, and how?","volume":"55","author":"CG Jr Durbin","year":"2010","journal-title":"Respir Care."},{"issue":"4","key":"pone.0343014.ref025","doi-asserted-by":"crossref","first-page":"221","DOI":"10.5539\/gjhs.v6n4p221","article-title":"Comparison of complications in percutaneous dilatational tracheostomy versus surgical tracheostomy","volume":"6","author":"S Yaghoobi","year":"2014","journal-title":"Glob J Health Sci."},{"issue":"1","key":"pone.0343014.ref026","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s00134-001-1151-z","article-title":"Complications of bronchoscopically guided percutaneous dilational tracheostomy: beyond the learning curve","volume":"28","author":"M Beiderlinden","year":"2002","journal-title":"Intensive Care Med."},{"issue":"4","key":"pone.0343014.ref027","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1109\/TMRB.2023.3309946","article-title":"Design requirements of robotic systems for assisting percutaneous tracheostomy: a scoping review and development framework","volume":"5","author":"Y Tang","year":"2023","journal-title":"IEEE Trans Med Robot Bionics."},{"key":"pone.0343014.ref028","doi-asserted-by":"crossref","unstructured":"Tang Y, Cooper G, Adorno BV, McGrath B, Weightman A. Design of a surgical device for performing percutaneous dilatational tracheostomy. In: European Medical and Biological Engineering Conference. Springer; 2024. p. 298\u2013307.","DOI":"10.1007\/978-3-031-61625-9_32"},{"issue":"5","key":"pone.0343014.ref029","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/S0266-4356(03)00125-6","article-title":"Ultrasound imaging in the preoperative estimation of the size of tracheostomy tube required in specialised operations in children","volume":"41","author":"PSGF Hardee","year":"2003","journal-title":"Br J Oral Maxillofac Surg."},{"issue":"11","key":"pone.0343014.ref030","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1383\/anes.5.11.375.53408","article-title":"The role of tracheostomy in ICU","volume":"5","author":"BN Barry","year":"2004","journal-title":"Anaesthesia & Intensive Care Medicine."},{"issue":"6","key":"pone.0343014.ref031","doi-asserted-by":"crossref","first-page":"247","DOI":"10.5005\/jp-journals-10071-23174","article-title":"Comparison of ciaglia and griggs percutaneous tracheostomy techniques - a biomechanical animal study","volume":"23","author":"O Ronen","year":"2019","journal-title":"Indian J Crit Care Med."},{"issue":"3","key":"pone.0343014.ref032","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1111\/j.1365-2044.2007.05327.x","article-title":"An investigation into the length of standard tracheostomy tubes in critical care patients","volume":"63","author":"A Mallick","year":"2008","journal-title":"Anaesthesia."},{"key":"pone.0343014.ref033","first-page":"397270","article-title":"Retrosternal percutaneous tracheostomy: an approach for predictably impossible classic tracheostomy","volume":"2010","author":"P Biderman","year":"2010","journal-title":"Crit Care Res Pract."},{"issue":"1","key":"pone.0343014.ref034","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s11845-021-02530-5","article-title":"Evaluation of a novel emergency front of neck access device in a benchtop model of obesity","volume":"191","author":"SK Chauhan","year":"2022","journal-title":"Ir J Med Sci."}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0343014","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T18:31:25Z","timestamp":1772217085000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0343014"}},"subtitle":[],"editor":[{"given":"Paulo Jorge Sim\u00f5es","family":"Coelho","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0343014","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]}}}