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Xiang SW, Deng JC, Wen QQ. Risk factors of cerebrospinal-fluid leakage during endoscopic transsphenoidal pituitary-adenoma resection: A systematic review and meta-analysis. Asian J Surg 2024; 47:1166-1169. [PMID: 37977934 DOI: 10.1016/j.asjsur.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Shao-Wei Xiang
- Surgical Division III, The National Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, 445000, Hubei, PR China
| | - Jun-Chao Deng
- Surgical Division III, The National Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, 445000, Hubei, PR China
| | - Qi-Qiang Wen
- Surgical Division III, The National Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, 445000, Hubei, PR China.
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Ball T, González-Martínez J, Zemmar A, Sweid A, Chandra S, VanSickle D, Neimat JS, Jabbour P, Wu C. Robotic Applications in Cranial Neurosurgery: Current and Future. Oper Neurosurg (Hagerstown) 2021; 21:371-379. [PMID: 34192764 DOI: 10.1093/ons/opab217] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/16/2021] [Indexed: 12/19/2022] Open
Abstract
Robotics applied to cranial surgery is a fast-moving and fascinating field, which is transforming the practice of neurosurgery. With exponential increases in computing power, improvements in connectivity, artificial intelligence, and enhanced precision of accessing target structures, robots are likely to be incorporated into more areas of neurosurgery in the future-making procedures safer and more efficient. Overall, improved efficiency can offset upfront costs and potentially prove cost-effective. In this narrative review, we aim to translate a broad clinical experience into practical information for the incorporation of robotics into neurosurgical practice. We begin with procedures where robotics take the role of a stereotactic frame and guide instruments along a linear trajectory. Next, we discuss robotics in endoscopic surgery, where the robot functions similar to a surgical assistant by holding the endoscope and providing retraction, supplemental lighting, and correlation of the surgical field with navigation. Then, we look at early experience with endovascular robots, where robots carry out tasks of the primary surgeon while the surgeon directs these movements remotely. We briefly discuss a novel microsurgical robot that can perform many of the critical operative steps (with potential for fine motor augmentation) remotely. Finally, we highlight 2 innovative technologies that allow instruments to take nonlinear, predetermined paths to an intracranial destination and allow magnetic control of instruments for real-time adjustment of trajectories. We believe that robots will play an increasingly important role in the future of neurosurgery and aim to cover some of the aspects that this field holds for neurosurgical innovation.
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Affiliation(s)
- Tyler Ball
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | | | - Ajmal Zemmar
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Henan University People's Hospital, Henan University School of Medicine, Zhengzhou, China
| | - Ahmad Sweid
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Science, New Delhi, India
| | | | - Joseph S Neimat
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Chengyuan Wu
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Collaborative Robotic Assistant Platform for Endonasal Surgery: Preliminary In-Vitro Trials. SENSORS 2021; 21:s21072320. [PMID: 33810419 PMCID: PMC8036765 DOI: 10.3390/s21072320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
Endonasal surgery is a minimally invasive approach for the removal of pituitary tumors (sarcomas). In this type of procedure, the surgeon has to complete the surgical maneuvers for sarcoma resection with extreme precision, as there are many vital structures in this area. Therefore, the use of robots for this type of intervention could increase the success of the intervention by providing accurate movements. Research has focused on the development of teleoperated robots to handle a surgical instrument, including the use of virtual fixtures to delimit the working area. This paper aims to go a step further with a platform that includes a teleoperated robot and an autonomous robot dedicated to secondary tasks. In this way, the aim is to reduce the surgeon’s workload so that he can concentrate on his main task. Thus, the article focuses on the description and implementation of a navigator that coordinates both robots via a force/position control. Finally, both the navigation and control scheme were validated by in-vitro tests.
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Campbell RG, Harvey RJ. How close are we to anterior robotic skull base surgery? Curr Opin Otolaryngol Head Neck Surg 2021; 29:44-52. [PMID: 33337610 DOI: 10.1097/moo.0000000000000683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW The application of robotic surgery to anterior skull base disease has yet to be defined despite the potential for improved tumour resection with less morbidity in this region. Complex anatomy and restricted access have limited the development of robotic anterior skull base surgery. RECENT FINDINGS A limited number of transoral robotic surgical anterior skull base procedures have been undertaken; however, there are significant limitations to the utilization of this technology in the anterior skull base. In this article, the advantages, disadvantages and limitations of robotic anterior skull base surgery are discussed. Currently, the major limitation is the size of the robotic endoscope and of the available instrumentation. Technological advancements that provide promise for the future development of robotic anterior skull base surgery are in development, such as single-port robots, flexible instrument systems and miniaturization and growth of minimally invasive platforms. SUMMARY Although transnasal access to the skull base is not possible with the currently available robotic systems, promising technology does exist and is in development. Robotic anterior skull base surgery promises to provide greater access to skull base disease, improve oncologic results, reduce morbidity and to reduce the ergonomic burden on the surgeon.
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Affiliation(s)
- Raewyn G Campbell
- Faculty of Medicine, Health and Human Sciences, Macquarie University
- Department of Otolaryngology - Head and Neck Surgery, Royal Prince Alfred Hospital
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Richard J Harvey
- Faculty of Medicine, Health and Human Sciences, Macquarie University
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
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Chumnanvej S, Pillai BM, Chalongwongse S, Suthakorn J. Endonasal endoscopic transsphenoidal approach robot prototype: A cadaveric trial. Asian J Surg 2020; 44:345-351. [PMID: 32951962 DOI: 10.1016/j.asjsur.2020.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Endonasal Endoscopic Transsphenoidal Surgery (EETS) is a minimally invasive procedure to approach and remove pituitary tumors and other sellar lesions. The process causes less pain, faster recovery, and provides further minimal invasive access in critical cases. However, a slight deviation of tools from the target area can be fatal to the patients. The aim of this study is to design and develop a prototype robot to demonstrate neurosurgical robot-assisted EET approach. METHODS The effectiveness of a prototype robot in executing a minimally invasive EET surgery was studied in 6 cadavers. The robot was associated with a multi-information integrated technique for surgery including QR code tracking. The robot was controlled and driven by the neurosurgeon. RESULTS The standard procedure of EET was followed and the robot carried out the first stage of EET under the supervision of neurosurgeon. Finally, the sellar was reached by the neurosurgeon. The result was determined by qualitative analysis and was confirmed by the neurosurgeon. The time for the entire EET surgical procedure showed marked reduction compared to the traditional EET approach. CONCLUSION The robot design was found to be technically feasible and hence can be used for assisting the EET procedure. The robot used was able to assist the neurosurgeon correctly to approach the sinus.
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Affiliation(s)
- Sorayouth Chumnanvej
- Neurosurgery Division, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Branesh M Pillai
- Center for Biomedical and Robotics Technology (BART LAB), Department of Biomedical Engineering, Faculty of Engineering Mahidol University, Salaya, Thailand.
| | - Suwiphat Chalongwongse
- Center for Biomedical and Robotics Technology (BART LAB), Department of Biomedical Engineering, Faculty of Engineering Mahidol University, Salaya, Thailand.
| | - Jackrit Suthakorn
- Center for Biomedical and Robotics Technology (BART LAB), Department of Biomedical Engineering, Faculty of Engineering Mahidol University, Salaya, Thailand.
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Soldozy S, Young S, Yağmurlu K, Norat P, Sokolowski J, Park MS, Jane JA, Syed HR. Transsphenoidal surgery using robotics to approach the sella turcica: Integrative use of artificial intelligence, realistic motion tracking and telesurgery. Clin Neurol Neurosurg 2020; 197:106152. [PMID: 32858256 DOI: 10.1016/j.clineuro.2020.106152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 11/27/2022]
Abstract
While full integration of robotic surgery has been achieved in other surgical domains, its transition into neurosurgery has been more prolonged, especially with respect to pituitary surgery. The confined working space and precise maneuvers required in endoscopic endonasal surgery makes development of an efficacious and safe robotic system difficult. Nevertheless, preclinical studies have attempted to demonstrate the feasibility of the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) in both transnasal and transoral approaches. In addition, unique robotics such as the concentric tube robot have been created. This system is optimized specifically for anterior skull base surgery with smaller shaft diameter arms and improved maneuverability in tight corridors. The possible role of concentric tube robotics surgery in skull base pathologies has been explored, and the novel use of telesurgery incorporated into robotic neurosurgery is discussed. An endoscopic endonasal transsphenoidal surgical system has also been developed, integrating computational methods to create a presurgical reconstructive model for surgical planning and automating the line of dissection for an enhanced approach to the sphenoid sinus. While surgical robotics for transsphenoidal surgery remain in its nascency, these preliminary findings are promising and suggest a role for robotic pituitary surgery.
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Affiliation(s)
- Sauson Soldozy
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States
| | - Steven Young
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States
| | - Kaan Yağmurlu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States
| | - Pedro Norat
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States
| | - Jennifer Sokolowski
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States
| | - Min S Park
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States
| | - John A Jane
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States
| | - Hasan R Syed
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States.
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