Hybrid Robotics for Endoscopic Transnasal Skull Base Surgery: Single-Centre Case Series

BACKGROUND Only preclinical studies and case reports have described robotic surgery for endoscopic transnasal skull base surgery. OBJECTIVE To evaluate the role of a novel robotic endoscope holder, developed for transsphenoidal surgery. METHODS Patients were prospectively enrolled for 3 mo at the Neurosurgery Unit of Brescia. Endoscope Robot® was used to assist during the sphenoidal phase of the approach, tumor removal, and skull base reconstruction. A Likert scale questionnaire was given to all surgeons after each procedure. Patients who underwent robotic-assisted surgery were matched with nonrobotic ones for pathology and type of procedure. All surgical videos were evaluated during bimanual phases. RESULTS Twenty-one patients underwent robot-assisted, endoscopic transsphenoidal surgery for different pathologies (16 pituitary adenomas, 3 chordomas, 1 craniopharyngioma, 1 pituitary exploration for Cushing disease) for a total of 23 procedures (1 patient underwent 2 endoscopic revisions of a skull base reconstruction). Subjective advantages reported by surgeons included smoothness of movement, image steadiness, and improvement of maneuvers in narrow spaces and with angled endoscopes; as the main limitation, Endoscope Robot® appeared to be relatively heavy during the initial endoscope positioning. A comparative analysis with a historical matched cohort documented similar clinical outcomes, while endoscope lens cleaning and position readjustments were significantly less frequent in robotic procedures. CONCLUSION Although confirmation in larger studies is needed, Endoscope Robot® was a safe and effective tool, especially advantageous in lengthy interventions through deep and narrow corridors.

The Improved Techniques of Holding the Lens in Endoscopic Thyroidectomy via Bilateral Areola Approach

Background: Inexperienced endoscope holder often greatly affect the time and quality of endoscopic thyroidectomy (ET) via bilateral areola approach. We summarized some techniques of holding the endoscopic lens to evaluate the value of the technique in ET.Methods: We retrospectively enrolled 200 eligible patients during two time peroids: 2015.6-2018.6 (Control group:inexperienced endoscope holder,n = 100) and 2019.9-2021.2 (Improved group:assistants who master the techniques of holding the endoscopic lens,n = 100). Surgery approach:unilateral lobectomy and isthmus resection plus ipsilateral cervical central lymph nodes dissection via bilateral areola approach of ET. Perioperative indicators included Volume of intraoperative blood loss,the time of three stages in the operation, the indwelling time of drainage tube and postoperative hospitalization time were compared. Postoperative complications were simultaneously compared involved temporary hoarseness, tetany, postoperative bleeding, postoperative infection and postoperative subcutaneous effusion.Results: The time of stage 1 (p < 0.001), stage 2 (p < 0.001) and stage 3 (p < 0.001) in the operation in improved group were significantly shorter than those in control group. The volume of intraoperative blood loss was smaller (p < 0.001), postoperative hospitalization time was shorter (p < 0.001) and the indwelling time of drainage tube was shorter (p < 0.001) for improved group. In terms of postoperative complications, the control group had more cases of temporary hoarseness (p = 0.002), tetany (p = 0.008) and postprocedure subcutaneous effusion (p = 0.009), but there was no difference in postoperative bleeding (p = 0.477) and infection (p = 1.000) between the two groups.Conclusions: The skills of holding the endoscopic lens which shorten the operation time and improve the quality of the operation are effective and suitable for novices.

Control of a Robotic Flexible Endoscope Holder for Laparoscopic Surgery

In this paper, we present an integrated robotic arm with a flexible endoscope for laparoscopy. The endoscope holder is built to mimic a human operator that reacts to the surgeon's push while maintaining both the incision opening through the patient's body and the center of the endoscopic image. An impedance control algorithm is used to react to the surgeon's push when the robotic arm gets in the way. A modified software remote center-of-motion (RCM) constraint formulation then enables simultaneous RCM and impedance control. We derived the kinematic relationship between the robotic arm and line of sight of the flexible endoscope for image center control. Using this kinematic model, we integrated the task control for RCM and surgeon cooperation and the endoscope image centering into a semi-autonomous system. Implementation of the control algorithm with both matlab simulation and the HIWIN RA605-710 robotic arm with a MitCorp F500 flexible endoscope demonstrated the feasibility of the proposed algorithm.