Minchev Georgi, Kronreif Gernot, Ptacek Wolfgang, Dorfer Christian, Micko Alexander, Maschke Svenja, Legnani Federico G, Widhalm Georg, Knosp Engelbert, Wolfsberger Stefan
1Department of Neurosurgery, Medical University of Vienna.
2Austrian Center of Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria; and.
J Neurosurg. 2019 Jan 18;132(1):150-158. doi: 10.3171/2018.8.JNS182096. Print 2020 Jan 1.
As decisions regarding tumor diagnosis and subsequent treatment are increasingly based on molecular pathology, the frequency of brain biopsies is increasing. Robotic devices overcome limitations of frame-based and frameless techniques in terms of accuracy and usability. The aim of the present study was to present a novel, minimally invasive, robot-guided biopsy technique and compare the results with those of standard burr hole biopsy.
A tubular minimally invasive instrument set was custom-designed for the iSYS-1 robot-guided biopsies. Feasibility, accuracy, duration, and outcome were compared in a consecutive series of 66 cases of robot-guided stereotactic biopsies between the minimally invasive (32 patients) and standard (34 patients) procedures.
Application of the minimally invasive instrument set was feasible in all patients. Compared with the standard burr hole technique, accuracy was significantly higher both at entry (median 1.5 mm [range 0.2-3.2 mm] vs 1.7 mm [range 0.8-5.1 mm], p = 0.008) and at target (median 1.5 mm [range 0.4-3.4 mm] vs 2.0 mm [range 0.8-3.9 mm], p = 0.019). The incision-to-suture time was significantly shorter (median 30 minutes [range 15-50 minutes] vs 37.5 minutes [range 25-105 minutes], p < 0.001). The skin incision was significantly shorter (median 16.3 mm [range 12.7-23.4 mm] vs 28.4 mm [range 20-42.2 mm], p = 0.002). A diagnostic tissue sample was obtained in all cases.
Application of the novel instrument set was feasible in all patients. According to the authors' data, the minimally invasive robot-guidance procedure can significantly improve accuracy, reduce operating time, and improve the cosmetic result of stereotactic biopsies.
由于肿瘤诊断及后续治疗决策越来越多地基于分子病理学，脑活检的频率正在增加。机器人设备在准确性和易用性方面克服了基于框架和无框架技术的局限性。本研究的目的是介绍一种新型的、微创的、机器人引导的活检技术，并将结果与标准钻孔活检的结果进行比较。
为iSYS-1机器人引导活检定制设计了一套管状微创器械。在连续的66例机器人引导立体定向活检病例中，对微创组（32例患者）和标准组（34例患者）的可行性、准确性、持续时间和结果进行了比较。
微创器械组在所有患者中均可行。与标准钻孔技术相比，进入点（中位数1.5毫米[范围0.2 - 3.2毫米]对1.7毫米[范围0.8 - 5.1毫米]，p = 0.008）和靶点（中位数1.5毫米[范围0.4 - 3.4毫米]对2.0毫米[范围0.8 - 3.9毫米]，p = 0.019）的准确性均显著更高。切开至缝合时间显著更短（中位数30分钟[范围15 - 50分钟]对37.5分钟[范围25 - 105分钟]，p < 0.001）。皮肤切口显著更短（中位数16.3毫米[范围12.7 - 23.4毫米]对28.4毫米[范围20 - 42.2毫米]，p = 0.002）。所有病例均获得了诊断性组织样本。
新型器械组在所有患者中均可行。根据作者的数据，微创机器人引导程序可显著提高准确性、减少手术时间并改善立体定向活检的美容效果。
