A third hand to the surgeon: the use of an endoscope holding arm in endonasal sinus surgery and well beyond

Hintschich, Constantin; Fischer, René; Seebauer, Caroline T.; Schebesch, Karl‐Michael; Bohr, Christopher; Kühnel, Thomas

doi:10.1007/s00405-021-06935-x

Cited by 9 publications

(7 citation statements)

References 17 publications

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“…The “EXPERT” was first presented in 2009 [ 21 ], and underwent subsequent improvements; in 2018, the “iArms” was jointly developed by Denso and Tokyo Women’s Medical University. Previously the Evolution 1 [ 22 ], Stewart Platform [ 23 ], Bresciea endoscope assistant robotic holder [ 24 ], Medineering [ 25 ], and ENDOFIX exo [ 26 ] were reported. These surgical robots feature a “hand-placement” function that follows the surgeon’s hand movements during surgery using a passive mechanism.…”

Section: Discussionmentioning

confidence: 99%

Transoral Robotic-Assisted Neurosurgery for Skull Base and Upper Spine Lesions

Muto,

Tateya,

Nakatomi

et al. 2024

Neurospine

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Objective: The application of the da Vinci Surgical System in neurosurgery is limited due to technical difficulties requiring precise maneuvers and small instruments. This study details the advantages and disadvantages of robotics in neurosurgery and the reachable range of the transoral approach to lesions of the skull base and upper cervical spine.Methods: In a cadaver study, the da Vinci Xi robot, lacking haptic feedback, was utilized for sagittal and coronal approaches on 5 heads, facilitating dura suturing in 3, with a 30°-angled drill for bone removal.Results: Perfect exposure of all the nasopharyngeal sites, clivus, sellar, and choana, including the bilateral eustachian tubes, was achieved without any external incisions using this palatal split approach of transoral robotic surgery. The time required to perform a single stitch, knot, and complete single suture in robotic suturing of deep-seated were significantly less compared to manual suturing via the endonasal approach.Conclusion: This is the first report to show the feasibility of suturing the dural defect in deep-seated lesions transorally and revealed that the limit of reach in the coronal plane via a transoral approach with incision of the soft palate is the foramen ovale. This preclinical investigation also showed that the transoral robotic approach is feasible for lesions extending from the sellar to the C2 in the sagittal plane. Refinement of robotic instruments for specific anatomic sites and future neurosurgical studies are needed to further demonstrate the feasibility and effectiveness of this system in treating benign and malignant skull base lesions.

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Section: Discussionmentioning

confidence: 99%

Transoral Robotic-Assisted Neurosurgery for Skull Base and Upper Spine Lesions

Muto,

Tateya,

Nakatomi

et al. 2024

Neurospine

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“…However, it is not a routine solution for all situations, given its high cost. In some other types of surgeries, doctors have tried to invent an endoscopic holding arm to assist in the operation, but it is not applicable to all surgeries ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

Analysis of scene-guided camera assistance in transaxillary gasless endoscopic thyroidectomy: a minor improvement in operative technique

Sun

et al. 2023

Front. Endocrinol.

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BackgroundTransaxillary gasless endoscopic thyroidectomy (TGET) is a widely performed operation, but its side view angle and instrument interference have caused concerns for most surgical groups. The aim of this study was to introduce scene-guided camera assistance (SGA) and analyze its role in facilitating TGET.MethodsWe put forward key points for camera holders, including one pivot, two positions, and three planes, and separated TGET operations into five parts. We also established the view angle for each part of the operation for the camera holder to follow. Then, we reviewed 416 patients who underwent TGET with or without SGA and analyzed their demographic characteristics, operative outcomes, pathologic outcomes, and early complications.ResultsThe TGET and TGET-SGA groups were similar in terms of age, sex ratio, height, weight, tumor size, Hashimoto’s thyroiditis ratio, and cN1 ratio. The operation time and postoperative hospital stay were significantly longer in the TGET group than in the TGET-SGA group (114.43 ± 17.20 minutes vs. 101.82 ± 19.39 minutes and 3.16 ± 0.77 days vs. 2.16 ± 0.55 days, respectively, P < 0.001). The account of retrieved lymph nodes was less in the TGET group than in the TGET-SGA group (5.61 ± 4.27 vs. 6.57 ± 4.96, P = 0.038).ConclusionSGA provided guidance for camera holders, and the data showed that it was an improvement for TGET operations.

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“…The authors concluded that the ENDOFIX unites maneuverability, flexibility and stability. Thus, the surgeon can operate in a bimanual action-even in the absence of an assistant [23].…”

Section: Of 12mentioning

confidence: 99%

The Value of the Endoscope-Holding Arm in Transoral Pharyngeal Surgery

Giotakis,

Kyrodimos

2024

JCM

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Background: Transoral pharyngeal surgery is mainly feasible with the use of a microscope or robotic systems. Data about alternative methods, with lower costs and easier availability, are sparse. We intended to examine to what extent the endoscope-holding arm is a suitable alternative to the microscope or robotic systems. Material and Methods: We retrospectively reviewed subjects who underwent pharyngeal tumor resection with the endoscope-holding arm in our university department. Results: We identified 13 subjects who underwent transoral pharyngeal surgery between November 2020 and November 2023. Most subjects presented with an oropharyngeal tumor (6/11 in the lateral wall or tonsil; 4/11 in the tongue base). The oropharyngeal lateral wall or tonsillar tumors were exposed with a standard mouth gag. The tongue-base tumors or hypopharyngeal tumors were exposed with an operating laryngoscope. Advantages over the microscope included an angled view. Advantages over robotic systems included haptic feedback and a faster setup. Advantages over both the microscope and robotic systems included lower costs and easier availability. Visualization with the endoscope was sufficient and similar to that of the microscope. Bimanual action was possible with surgical forceps and a monopolar electrode. Conclusions: Transoral pharyngeal surgery was feasible with the endoscope-holding arm. The endoscope-holding arm could be a cost-efficient alternative to the microscope or robotic systems.

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A third hand to the surgeon: the use of an endoscope holding arm in endonasal sinus surgery and well beyond

Cited by 9 publications

References 17 publications

Transoral Robotic-Assisted Neurosurgery for Skull Base and Upper Spine Lesions

Transoral Robotic-Assisted Neurosurgery for Skull Base and Upper Spine Lesions

Analysis of scene-guided camera assistance in transaxillary gasless endoscopic thyroidectomy: a minor improvement in operative technique

The Value of the Endoscope-Holding Arm in Transoral Pharyngeal Surgery

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