Lollis S Scott, Roberts David W
Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA.
Br J Neurosurg. 2009;23(5):516-20. doi: 10.1080/02688690902948192.
The application of robotic technology to surgery holds great promise for improving surgical outcomes and reducing morbidity. We hypothesized that image-guided, robotic placement of a CNS ventriculostomy reservoir for intraventricular chemotherapy is safe, highly accurate, and highly reproducible. Eleven patients requiring catheter ventriculostomy for reservoir placement were included in this retrospective study. All underwent image-guided, robotic placement of a ventricular catheter, using a pre-operatively defined trajectory. All catheters entered the targeted structure. There were no catheter-related hemorrhages and no injury to adjacent neural structures. Mean distance of the catheter tip from target was 1.6 mm. Mean operative time was 42.8 minutes. Robotic placement of a reservoir ventriculostomy using a pre-planned trajectory is safe, highly accurate, and highly reliable. This makes single-pass ventriculostomy possible in nearly all patients, even those with very small ventricles, and may permit catheter-based therapies in patients who would otherwise be deemed poor surgical candidates by virtue of ventricular size. It also permits careful pre-operative study and optimization of the catheter trajectory, which may be beneficial in minimizing risk to bridging veins and sulcal vessels.
将机器人技术应用于手术有望显著改善手术效果并降低发病率。我们推测，在影像引导下，通过机器人放置中枢神经系统脑室造瘘术储液器用于脑室内化疗是安全、高度精确且可高度重复的。本回顾性研究纳入了11例需要通过导管脑室造瘘术放置储液器的患者。所有患者均在影像引导下，使用术前确定的轨迹，通过机器人放置脑室导管。所有导管均进入了目标结构。未发生与导管相关的出血，也未对相邻神经结构造成损伤。导管尖端与目标的平均距离为1.6毫米。平均手术时间为42.8分钟。使用预先规划的轨迹通过机器人放置储液器脑室造瘘术是安全、高度精确且高度可靠的。这使得几乎所有患者，甚至是脑室非常小的患者都有可能进行单次通过脑室造瘘术，并且对于那些因脑室大小而原本被认为手术风险高的患者，也可能允许进行基于导管的治疗。它还允许在术前仔细研究并优化导管轨迹，这可能有助于将对桥静脉和脑沟血管的风险降至最低。
