Ahead of Print: Robotics in Keyhole Transcranial Endoscope-assisted Microsurgery

Hani-Marcus-sketch-version-1Background: Over the last decade, advances in image guidance, endoscopy and tube-shaft instruments have allowed for the development of keyhole transcranial endoscope-assisted microsurgery, utilizing smaller craniotomies, and minimizing exposure and manipulation of unaffected brain tissue. Although such approaches offer the possibility of shorter operating times, reduced morbidity and mortality, and improved long-term outcomes, the technical skills required to perform such surgery are inevitably greater than for traditional open surgical techniques, and they have not been widely adopted by neurosurgeons. Surgical robotics, which has the ability to improve visualization and increase dexterity, therefore has the potential to enhance surgical performance.

Objective: To evaluate the role of surgical robots in keyhole transcranial endoscope-assisted microsurgery.

Methods: The technical challenges faced by surgeons utilizing keyhole craniotomies were reviewed, and a thorough appraisal of presently available robotic systems was carried out.

Results: Surgical robotic systems have the potential to incorporate advances in augmented reality, stereo-endoscopy, and jointed-wrist instruments, and therefore significantly impact on the field of keyhole neurosurgery. To date, over 30 robotic systems have been applied to neurosurgical procedures. The vast majority of these robots are best described as supervisory-controlled, and are designed for stereotactic or image-guided surgery. Few telesurgical robots are suitable for keyhole neurosurgical approaches, and none are in widespread clinical use in the field.

Conclusion: New robotic platforms in minimally invasive neurosurgery must possess clear and unambiguous advantages over conventional approaches if they are to achieve significant clinical penetration.

From: Robotics in Keyhole Transcranial Endoscope-assisted Microsurgery: A Critical Review of Existing Systems and Proposed Specifications for New Robotic Platforms by Marcus et al.

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