Robotics in keyhole transcranial endoscope-assisted microsurgery: a critical review of existing systems and proposed specifications for new robotic platforms.
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.


CONCLUSIONS
New robotic platforms in minimally invasive neurosurgery must possess clear and unambiguous advantages over conventional approaches if they are to achieve significant clinical penetration.
*The Hamlyn Centre for Robotic Surgery, Institute of Global Health Innovation, Imperial College London, London, United Kingdom; ‡Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, United Kingdom.
Hani J
HJ
Marcus
Carlo A
CA
Seneci
Christopher J
CJ
Payne
Dipankar
D
Nandi
Ara
A
Darzi
Guang-Zhong
GZ
Yang
D000818:Animals; D003399:Craniotomy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008866:Microsurgery / Q000295:instrumentation*; D044582:Neuroendoscopes; D019635:Neurosurgical Procedures / Q000295:instrumentation*; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D017216:Telemedicine / Q000295:instrumentation