An Experimental Feasibility Study on Robotic Endonasal Telesurgery

Wirz, Raúl; Torres, Luis G.; Swaney, Philip J.; Gilbert, Hunter B.; Alterovitz, Ron; Webster, Robert J.; Weaver, Kyle D.; Russell, Paul T.

doi:10.1227/neu.0000000000000623

Cited by 61 publications

(39 citation statements)

References 30 publications

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“…The new developed instrumentations include high definition 3D endoscopic system, (31) endoscopic augmented reality navigation system, (32) ultrasonographyassisted endoscope, (33) the indocyanine green fluorescence endoscope, (34) and use of highfield intraoperative MRI, (35) et al These are reported to increase the safety and reduce the risk of the endoscopic approach (Table 3). Recently, an experimental feasibility study on (36). 4K (and 8K) ultra-high definition endoscopes are likely to be introduced to this field in the near future (14).…”

Section: Future Advancesmentioning

confidence: 99%

Trans-nasal Trans-sphenoidal Endoscopic Hypophysectomy

Varshney

2020

ANAMS

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Advances in optics, miniaturization, and endoscopic instrumentation have revolutionized surgery in the past decades. Current progress in the field of endoscopy promises to further this evolution: endoscopic telescopes and instruments have improved upon the optical and technical limitations of the microscope, and require an even less invasive approach to the sella. The minimally invasive endoscopic pituitary surgery is performed through the natural nasal pathway without any incisions and is performed via Trans-nasal Trans-sphenoidal approach. pituitary surgery is traditionally within the realm of the neurosurgeon. However, since the introduction of the endoscopic transnasal transsphenoidal approach to the sella turcica for resection of pituitary adenoma, otolaryngologists have been active partners in the surgical management of these patients. Otolaryngologists have lent their expertise in nasal and sinus surgery, assisting the neurosurgeon with the operation. The otolaryngologist has the advantage of familiarity with the techniques and instruments used to gain exposure of the sella turcica by transnasal approach. Hence, the otolaryngologist provides the exposure, and the neurosurgeon resects the tumour. Such collaboration has resulted in decreased rates of complication and morbidity.We hereby discuss our experience of treating 72 cases of pituitary tumour by endoscopic trans-nasal trans-sphenoidal approach. In our study, conducted from 2005 to 2016, the mean age of patients was 32.5 years (18-56 years), Male and female ratio was 1.3:1.0, MRI was done in all the cases, CT scan was done in 94.44 % cases, 9.72% cases had Intra op./ post op. complications which were managed successfully. Subtotal resection could be done in 6.94% cases, recurrence was seen in 7.46% cases and lumbar drain was required in 4.17 % cases. Average hospital stay was 4.4 days and average surgery time was 120 minutes. Close follow-up was maintained for an average period of 09 months. In our experience of 10 years, adopting the endoscope heightens the surgeons' visualization of pituitary tumors, thus no external incision, no nasal packing and minimal stay with minimal complications. Endoscopic transsphenoidal approach is the less traumatic route to the sella turcica, avoiding brain retraction, and also permitting good visualization, with lower rates of morbidity and mortality.

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Section: Future Advancesmentioning

confidence: 99%

Trans-nasal Trans-sphenoidal Endoscopic Hypophysectomy

Varshney

2020

ANAMS

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“…It offers neurosurgeons a minimally invasive surgical technique for procedures in the cranial base in which specific surgical instruments and an endoscope are inserted through the patient's nostrils. This procedure is known as EEA (endoscopic endonasal approach) [22]- [24]. Fig.1 shows the focus of an EEA procedure.…”

Section: Neurosurgerymentioning

confidence: 99%

“…Several clinical teams have performed surgical operations with access to the base of the skull through the nasal fossa [22][23][24] and [49] using Intuitive Surgical's commercial system, Da Vinci: a generalpurpose teleoperated surgical robotic system. Several advantages are described in works with this robot.…”

Section: Robotics In the Neurosurgery Fieldmentioning

confidence: 99%

Neurosurgery and brain shift: review of the state of the art and main contributions of robotics

Correa-Arana

Vivas-Albán

Navarro

2017

TecnoL.

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This paper presents a review about neurosurgery, robotic assistants in this type of procedure, and the approach to the problem of brain tissue displacement, including techniques for obtaining medical images. It is especially focused on the phenomenon of brain displacement, commonly known as brain shift, which causes a loss of reference between the preoperative images and the volumes to be treated during image-guided surgery. Hypothetically, with brain shift prediction and correction for the neuronavigation system, minimal invasion trajectories could be planned and shortened. This would reduce damage to functional tissues and possibly lower the morbidity and mortality in delicate and demanding medical procedures such as the removal of a brain tumor. This paper also mentions other issues associated with neurosurgery and shows the way robotized systems have helped solve these problems. Finally, it highlights the future perspectives of neurosurgery, a branch of medicine that seeks to treat the ailments of the main organ of the human body from the perspective of many disciplines.

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“…"Telesurgery" has since been an active area of technological research and development. Recent trials have attempted to assess the effect of communication latency on surgical performance [22][23][24], expand the scope of procedures achievable through telesurgery [24,25] and improve haptic feedback relayed to remote operators [26]. However, at present, telesurgery requires acquisition and maintenance of a robotic platform that is likely to be prohibitively expensive for rural treatment sites [27].…”

Section: Surgery and Postoperative Carementioning

confidence: 99%