Hybrid Robotics for Endoscopic Transnasal Skull Base Surgery: Single-Centre Case Series. Issue 6 (8th October 2021)

• Record Type: Journal Article
• Authors: Zappa, Francesca; Madoglio, Alba; Ferrari, Marco; Mattavelli, Davide; Schreiber, Alberto; Taboni, Stefano; Ferrari, Erika; Rampinelli, Vittorio; Belotti, Francesco; Piazza, Cesare; Fontanella, Marco Maria; Nicolai, Piero; Doglietto, Francesco
• Is Part Of: Operative neurosurgery. Volume 21:Issue 6(2021)
• Page Start: 426
• Page End: 435
• Publication Date: 2021-10-08
• Subjects: Endoscopic skull base surgery -- Transsphenoidal surgery -- Robotics -- Case series; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opab327
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: BACKGROUND: Only preclinical studies and case reports have described robotic surgery for endoscopic transnasal skull base surgery. OBJECTIVE: To evaluate the role of a novel robotic endoscope holder, developed for transsphenoidal surgery. METHODS: Patients were prospectively enrolled for 3 mo at the Neurosurgery Unit of Brescia. Endoscope Robot ® was used to assist during the sphenoidal phase of the approach, tumor removal, and skull base reconstruction. A Likert scale questionnaire was given to all surgeons after each procedure. Patients who underwent robotic-assisted surgery were matched with nonrobotic ones for pathology and type of procedure. All surgical videos were evaluated during bimanual phases. RESULTS: Twenty-one patients underwent robot-assisted, endoscopic transsphenoidal surgery for different pathologies (16 pituitary adenomas, 3 chordomas, 1 craniopharyngioma, 1 pituitary exploration for Cushing disease) for a total of 23 procedures (1 patient underwent 2 endoscopic revisions of a skull base reconstruction). Subjective advantages reported by surgeons included smoothness of movement, image steadiness, and improvement of maneuvers in narrow spaces and with angled endoscopes; as the main limitation, Endoscope Robot ® appeared to be relatively heavy during the initial endoscope positioning. A comparative analysis with a historical matched cohort documented similar clinical outcomes, while endoscope lens cleaning and position readjustments were significantly less frequent in robotic procedures. CONCLUSION: Although confirmation in larger studies is needed, Endoscope Robot ® was a safe and effective tool, especially advantageous in lengthy interventions through deep and narrow corridors.