An Innovate Robotic Endoscope Guidance System for Transnasal Sinus and Skull Base Surgery: Proof of Concept

Friedrich, Daniel; Sommer, Fabian; Scheithauer, Marc O.; Greve, Jens; Hoffmann, Thomas; Schuler, Patrick J.

doi:10.1055/s-0037-1603974

Cited by 22 publications

(10 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Muto,

Tateya,

Nakatomi

et al. 2024

Neurospine

View full text Add to dashboard Cite

show abstract

“…Even the flexible robotic systems (Medrobotics®) in transoral surgery were optimized and carried out as described before. 1 -3,6,7,20 -23 Transoral robotic surgery as well as the da Vinci Surgical System cannot be applied in skull base surgery due to the fact that these systems are too big for endonasal surgery. Moreover, there are no surgical instruments which can be used with these systems (eg, forceps, drill, piezo system).…”

Section: Discussionmentioning

confidence: 99%

“…Transoral robotic surgery (TORS) has proven to be an effective tool for resection of head and neck tumors. [1][2][3][4][5][6][7] In this field, 3 approved robotic surgery systems are available: The Intuitive da Vinci system, the Medrobotics Flex Robotic Systems for TORS, and the Medineering Robotic Endoscope Guiding System. Originally designed for robotic endoscope guiding in endoscopic sinus and skull base surgery, the Medineering Robotic Endoscope Guiding System is approved for robotic assistance in all ENT procedures, including transoral endoscopic surgery and endoscopic ear surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Friedrich et al already evaluated the robotic arm in advanced transnasal surgery in fresh frozen cadavers and verified the applicability. 3 In a single surgeon procedure, the system allows a ''2-hand technique'' and with 2 surgeons operating a ''4-hand'' technique is possible without an additional hand holding the endoscope. The objective of this study was to evaluate the feasibility and patients' safety by using a robotic endoscope guiding system in 8 patients with GO undergoing endoscopic orbital decompression.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

First Use of a New Robotic Endoscope Guiding System in Endoscopic Orbital Decompression

et al. 2019

View full text Add to dashboard Cite

Purpose: Over the last years, robot-assisted surgery gained in importance in head and neck surgery. In our study, we used a new robotic endoscope guiding system in patients undergoing endoscopic balanced orbital decompression. The aim of the study is to evaluate the feasibility and benefit of a robotic arm in endoscopic orbital surgery. Methods: The Medineering Robotic Endoscope Guiding System is a robotic arm designed for holding an endoscope during interventions. An endoscope equipped with a 4K camera was attached at the tip of the robotic arm and placed in the surgical field. The surgeon controlled the movements of the endoscope with foot pedal. Eight patients underwent balanced endoscopic orbital decompression showing typical symptoms of Graves’ orbitopathy preoperatively. Balanced decompression was performed via a combined approach transnasally and laterally via a small skin incision. Results: Attaching the endoscope to the robotic guiding system and placing it in the nasal cavity were relatively simple procedures. Setup time was less than 10 minutes. Tool motion and control using the foot pedal were comfortable and adequately precise. Movements of the attached endoscope inside the nose were feasible and allowed 2-hand surgery. The patients did not show any adverse events or complications. Conclusion: The Medineering Robotic Endoscope Guiding System seems to be a safe and effective support in endoscopic skull base surgery especially for orbital decompression, thus allowing 2-hand or even 4-hand settings. To the best of our knowledge, this is the first study describing the successful application of a robotic system in orbital surgery.

show abstract

“…Surgical procedures in otolaryngology are extremely varied, and likely benefit from a variety of solutions. These include ergonomic chairs, wrist rests, surgical robots or endoscope holders 25–30 . Ergonomic chairs for surgeons are varied; however, many surgeons prefer to perform their work standing up and find the use of a chair cumbersome 4,5,16,31 .…”

Section: Introductionmentioning

confidence: 99%

Feasibility of an Exoskeleton Armrest to Improve Ergonomics during Endoscopic Sinus and Skull Base Surgery

Lobo,

Sancibrian,

Mesones

et al. 2023

The Laryngoscope

View full text Add to dashboard Cite

ObjectiveThe main objective of this study was to develop and evaluate the feasibility and effectiveness of a novel exoskeleton system designed to provide ergonomic assistance to surgeons while preserving or improving the quality of endoscopic sinus and skull base surgical procedures.MethodsTo evaluate the functionality and ergonomic characteristics of the device, five experiments were conducted in different and increasingly realistic scenarios: silicone model of the nasal cavity, freshly frozen cadavers and finally in a real surgery. Each volunteer's task was recorded and timed. The National Aeronautics and Space Administration Task Load Index (NASA‐TLX) rating scale was used to estimate the surgeons' workload while performing the tasks.ResultsTwenty‐five volunteers took part in the experiments. Volunteers perceived more comfort and less fatigue and pain when using the armrest than when not using the device (3.3, SD 1.75 vs. 5.9 SD 1.49; p = 0.02). Participants found the device intuitive, comfortable, and improving accuracy and stability with endoscope use.ConclusionA new system that provides ergonomic assistance to surgeons was tested in simulation surgery with acceptable usability. Initial results in terms of pain and fatigue reduction and efficiency were excellent, justifying further research into this technology.Level of EvidenceN/A Laryngoscope, 2023

show abstract

An Innovate Robotic Endoscope Guidance System for Transnasal Sinus and Skull Base Surgery: Proof of Concept

Cited by 22 publications

References 34 publications

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

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

First Use of a New Robotic Endoscope Guiding System in Endoscopic Orbital Decompression

Feasibility of an Exoskeleton Armrest to Improve Ergonomics during Endoscopic Sinus and Skull Base Surgery

Contact Info

Product

Resources

About