Use of a micromanipulator system (NeuRobot) in endoscopic neurosurgery

Abstract

NeuRobot, a micromanipulator system with a rigid neuroendoscope and three micromanipulators, was developed for less invasive and telecontrolled neurosurgery.This system can be used to perform sophisticated surgical procedures through a small window 10 mm in diameter. The present study was performed to evaluate the feasibility of using NeuRobot in neuroendoscopy. Four different intraventricular neurosurgical procedures were performed using NeuRobot in three fixed cadaver heads: 1) fenestration of the floor of the third ventricle, 2) fenestration of the septum pellucidum, 3) biopsy of the thalamus, and 4) biopsy of the choroid plexus of the lateral ventricle.Each procedure required less than 2 min, and all procedures were performed accurately.After these surgical simulations using cadaver heads, third ventriculostomy was carried out safely and adequately in a patient with obstructive hydrocephalus due to a midbrain venous angioma. Our results confirmed that NeuRobot is applicable to lesions in which conventional endoscopic neurosurgery is indicated. Furthermore, NeuRobot can perform more complex surgical procedures than a conventional neuroendoscope because of its maneuverability and stability. NeuRobot will become a useful *Manuscript H. Takasuna, et al.-2 -neurosurgical tool for dealing with lesions that are difficult to treat by conventional neuroendoscopic surgery.

Initial Experience with High-Definition Camera-On-a-Chip Flexible Endoscopy for Intraventricular Neurosurgery

“…An additional advantage of the flexible endoscope is that it can be used in cases of intraventricular brain tumors for patients who have small ventricles, M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 6 such as in pediatric populations, for whom contemporary rigid endoscopes may not be safely deployed (13). Furthermore, while the cost of the device is likely to be higher than that of rigid rod-lens endoscopes, the flexible HD endoscope, which is fully sterilizable, could offer a more affordable and practical option for intraventricular procedures compared to comprehensive surgical systems that rely on extensive technological development with significant overhead cost (5,19).…”

Avoiding Complications in Endoscopic Third Ventriculostomy

“…A system (NeuRobot, Shinshu University School of Medicine and Hitachi Ltd., Tsuchiura, Japan) using three micromanipulators is also available for ETV. 16 Balancing should be performed on the anteroposterior along with the side movement of the endoscope to check the proper orientation of the camera. It is important to be aware that the camera can rotate during the procedure and may disorient the surgeon.…”

Structural design of a positioning spherical parallel manipulator to be utilized in brain biopsy

“…At the end of their study, authors proved that the proposed system has sufficient constraints to be effective in brain surgery. Hongo et al proposed a micromanipulator system (NeuRobot) for neurosurgery that includes three micromanipulators and an endoscope that are housed on a cylindrical component. Similar to the other mentioned systems, six degrees of freedom serial manipulator is responsible for the positioning of the system during operation.…”

“…The proposed system can be inserted into the target area from an incision of 10‐mm diameter to perform precise neurosurgical operations. In their latter work, authors simulated four different types of operations including biopsy in three cadaver heads by utilizing the proposed system. The results of their work indicated that the designed system is capable of performing sophisticated operations due to its sufficient dexterity and stability …”