1USC Brain Tumor Center, Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles.
2USC Caruso Department of Otolaryngology, Keck School of Medicine of the University of Southern California, Los Angeles.
Neurosurg Focus. 2022 Jan;52(1):E15. doi: 10.3171/2021.10.FOCUS21505.
The utility of robotic instrumentation is expanding in neurosurgery. Despite this, successful examples of robotic implementation for endoscopic endonasal or skull base neurosurgery remain limited. Therefore, the authors performed a systematic review of the literature to identify all articles that used robotic systems to access the sella or anterior, middle, or posterior cranial fossae.
A systematic review of MEDLINE and PubMed in accordance with PRISMA guidelines performed for articles published between January 1, 1990, and August 1, 2021, was conducted to identify all robotic systems (autonomous, semiautonomous, or surgeon-controlled) used for skull base neurosurgical procedures. Cadaveric and human clinical studies were included. Studies with exclusively otorhinolaryngological applications or using robotic microscopes were excluded.
A total of 561 studies were identified from the initial search, of which 22 were included following full-text review. Transoral robotic surgery (TORS) using the da Vinci Surgical System was the most widely reported system (4 studies) utilized for skull base and pituitary fossa procedures; additionally, it has been reported for resection of sellar masses in 4 patients. Seven cadaveric studies used the da Vinci Surgical System to access the skull base using alternative, non-TORS approaches (e.g., transnasal, transmaxillary, and supraorbital). Five cadaveric studies investigated alternative systems to access the skull base. Six studies investigated the use of robotic endoscope holders. Advantages to robotic applications in skull base neurosurgery included improved lighting and 3D visualization, replication of more traditional gesture-based movements, and the ability for dexterous movements ordinarily constrained by small operative corridors. Limitations included the size and angulation capacity of the robot, lack of drilling components preventing fully robotic procedures, and cost. Robotic endoscope holders may have been particularly advantageous when the use of a surgical assistant or second surgeon was limited.
Robotic skull base neurosurgery has been growing in popularity and feasibility, but significant limitations remain. While robotic systems seem to have allowed for greater maneuverability and 3D visualization, their size and lack of neurosurgery-specific tools have continued to prevent widespread adoption into current practice. The next generation of robotic technologies should prioritize overcoming these limitations.
机器人器械在神经外科中的应用正在不断扩大。尽管如此，用于内镜经鼻或颅底神经外科的机器人实施的成功案例仍然有限。因此，作者对文献进行了系统回顾，以确定所有使用机器人系统进入鞍区或前、中、后颅窝的文章。
根据 PRISMA 指南，对 1990 年 1 月 1 日至 2021 年 8 月 1 日期间发表的文章进行了 MEDLINE 和 PubMed 的系统回顾，以确定所有用于颅底神经外科手术的机器人系统（自主、半自动或外科医生控制）。纳入尸体和人体临床研究。仅耳鼻喉科应用或使用机器人显微镜的研究被排除在外。
从最初的搜索中总共确定了 561 项研究，其中 22 项在全文审查后被纳入。达芬奇手术系统的经口机器人手术（TORS）是最广泛报道的系统（4 项研究），用于颅底和垂体窝手术；此外，它还被报道用于 4 例鞍区肿块切除术。7 项尸体研究使用达芬奇手术系统通过替代的非 TORS 方法（例如经鼻、经上颌和眶上）进入颅底。5 项尸体研究调查了进入颅底的替代系统。6 项研究调查了机器人内窥镜支架的使用。机器人在颅底神经外科中的应用的优点包括改善照明和 3D 可视化、复制更传统的基于手势的运动以及能够进行通常受到小手术通道限制的灵巧运动。局限性包括机器人的尺寸和角度能力、缺乏防止完全机器人手术的钻孔部件以及成本。当使用手术助手或第二外科医生的机会有限时，机器人内窥镜支架可能具有特别的优势。
机器人颅底神经外科的应用越来越受欢迎和可行，但仍存在重大限制。虽然机器人系统似乎允许更大的机动性和 3D 可视化，但它们的尺寸和缺乏神经外科专用工具继续阻止它们广泛应用于当前实践。下一代机器人技术应优先克服这些限制。
