Robotics in keyhole transcranial endoscope-assisted microsurgery: a critical review of existing systems and proposed specifications for new robotic platforms
Author(s)
Type
Journal Article
Abstract
BACKGROUND:
Over the past decade, advances in image guidance, endoscopy, and tube-shaft instruments have allowed for the further 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 performed.
RESULTS:
Surgical robotic systems have the potential to incorporate advances in augmented reality, stereoendoscopy, and jointed-wrist instruments, and therefore to significantly impact 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.
Over the past decade, advances in image guidance, endoscopy, and tube-shaft instruments have allowed for the further 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 performed.
RESULTS:
Surgical robotic systems have the potential to incorporate advances in augmented reality, stereoendoscopy, and jointed-wrist instruments, and therefore to significantly impact 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.
Date Issued
2014-03-01
Date Acceptance
2013-07-23
Citation
Operative Neurosurgery, 2014, 10 (1), pp.84-96
ISSN
2332-4252
Publisher
Oxford University Press
Start Page
84
End Page
96
Journal / Book Title
Operative Neurosurgery
Volume
10
Issue
1
Sponsor
National Institute for Health Research
Grant Number
NF-SI-0510-10186
Subjects
Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Surgery
Neurosciences & Neurology
Image-guided intervention
Minimally invasive surgery
Neurosurgery
Robotic surgery
SKULL BASE SURGERY
PEDICLE SCREW PLACEMENT
TELECONTROLLED MICROMANIPULATOR SYSTEM
MINIMALLY INVASIVE NEUROSURGERY
NEUROMATE STEREOTACTIC ROBOT
MOUNTED INSTRUMENT HOLDER
TRANSORAL ODONTOIDECTOMY
SURGICAL ROBOTICS
FRAMELESS MODE
OPEN-MRI
Animals
Craniotomy
Humans
Microsurgery
Neuroendoscopes
Neurosurgical Procedures
Robotics
Surgery, Computer-Assisted
Telemedicine
1103 Clinical Sciences
1109 Neurosciences
Neurology & Neurosurgery
Publication Status
Published
Date Publish Online
2013-08-05