Starup-Hansen Joachim, Zimelewicz Oberman Dan, Hanrahan John G, Dimitrakakis Emmanouil, Marcus Hani J, Almeida Joao Paulo
Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
Oper Neurosurg (Hagerstown). 2025 Apr 28. doi: 10.1227/ons.0000000000001582.
Endoscopic skull base surgery aims to reduce surgical morbidity by minimizing tissue manipulation and exposure. However, the anatomic constraints posed by the narrow surgical corridors and constrained operative workspace present technical challenges due to reduced dexterity. This study evaluates the applicability of a novel dexterity-enhancing handheld robot for endoscopic skull base approaches.
The robotic system is comprised of interchangeable articulated end-effectors coupled to a handheld controller. Two attending skull base neurosurgeons and 2 neurosurgery residents performed 8 skull base approaches on cadaveric specimens, spanning anterior, anterolateral, lateral, posterolateral, and posterior approaches. Conventional instruments were used to expose anatomic landmarks, followed by intraoperative tasks using the handheld robot. Participants were interviewed during the procedures to assess the robot's feasibility (ability to safely reach and perform its objective of manipulating tissue at the operative site) and usefulness (ability to perform desired objectives well).
The handheld robotic system was tested across 8 endoscopic skull base approaches, achieving feasibility in all cases. Superior workspace reach compared with standard instruments was demonstrated in 6 of 8 approaches. Tissue manipulation was satisfactory in all approaches. All surgeons reported that the current or a future device prototype could be useful across all 8 approaches. The most frequently cited advantage was the expanded dextrous workspace reach provided by the articulated end-effectors, particularly in approaches with long working channels, such as the endonasal approach. However, the robot encountered difficulties in transcranial approaches (trans-sylvian and subtemporal) due to the lack of shorter, curved shafts, which impaired visualization.
The handheld robotic system demonstrated applicability across various endoscopic skull base approaches, offering increased dextrous workspace and effective tissue manipulation capabilities. Overall, this study supports the potential of handheld robots in endoscopic skull base surgery while highlighting the need for iterative development to optimize instrument design and functionality.
内镜颅底手术旨在通过尽量减少组织操作和暴露来降低手术并发症。然而，狭窄的手术通道和受限的手术操作空间所带来的解剖学限制，由于灵活性降低而带来了技术挑战。本研究评估一种新型的增强灵活性的手持式机器人在内镜颅底手术入路中的适用性。
该机器人系统由与手持式控制器相连的可互换关节式末端执行器组成。两名主治颅底神经外科医生和两名神经外科住院医师在尸体标本上进行了8种颅底手术入路，包括前入路、前外侧入路、外侧入路、后外侧入路和后入路。使用传统器械暴露解剖标志，然后使用手持式机器人进行术中任务。在手术过程中对参与者进行访谈，以评估机器人的可行性（安全到达并在手术部位完成组织操作目标的能力）和实用性（良好完成期望目标的能力）。
手持式机器人系统在8种内镜颅底手术入路中进行了测试，所有病例均实现了可行性。在8种入路中的6种中，与标准器械相比，显示出更好的工作空间可达性。在所有入路中，组织操作均令人满意。所有外科医生都报告说，当前或未来的设备原型在所有8种入路中都可能有用。最常被提及的优点是关节式末端执行器提供了更大的灵活工作空间可达性，特别是在具有长工作通道的入路中，如鼻内镜入路。然而，由于缺乏更短的弯轴，机器人在经颅入路（经侧裂和颞下）中遇到困难，这损害了可视化。
手持式机器人系统在各种内镜颅底手术入路中均显示出适用性，提供了更大的灵活工作空间和有效的组织操作能力。总体而言，本研究支持手持式机器人在内镜颅底手术中的潜力，同时强调需要进行迭代开发以优化器械设计和功能。
