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

Abstract

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.

Untitled

“…Compared to surgeries without robotic assistance, the setup time for image-guided skull base surgery was relatively long, but with improved accuracy [11]. For instance, when used on patients undergoing endoscopic skull base surgery, none of the individuals developed side effects such as synechia or acute sinusitis [12,13] (Table 1).…”

Robotic assisted orbital surgery for resection of advanced periocular tumours – a case series report on the feasibility, safety and outcome

“…TORS has demonstrated benefit in oropharyngeal cancers with similar clinical outcomes to conventional treatments, however, improvement in patient-reported outcomes [ 14 , 15 ], has led to increased recognition and use in other head and neck cancers [ 16 ]. Similarly, early experiences are beginning to emerge using DaVinci robotic system for other aspects of orbital surgery, such as thyroid eye disease fat-only decompression [ 17 ], and robotic powered endoscopic devices that aid visualisation without limiting single-handed surgery [ 18 ].…”

Patienten-Benefit und Lebensqualität nach Roboter-assistierten Operationen im Kopf-Hals-Bereich

“…These include the RO-VOT-m system (Synaptive Medical Corporation, Toronto, Canada), the Cirq system (formerly Endoscope Robot, Medineering Surgical Robots, Munich, now Brainlab AG, Munich, ▶ Fig. 4), and the So-loAssist endoscope system (AKTORmed Robotic Surgery, Barbing) [82][83][84][85]. In the systems, the endoscopes are attached to a carrier system and then inserted transnasally.…”

“…Hierzu gehören das ROVOT-m-System (Synaptive Medical Corporation, Toronto, Kanada), das Cirq-System (früher Endoscope Robot, Medineering Surgical Robots, München, mittlerweile Brainlab AG, München, ▶abb. 4) und das SoloAssist-Endoskopsystem (AKTORmed Robotic Surgery, Barbing)[82][83][84][85]. Bei den Systemen werden die Endoskope auf den Trägersystemen befestigt und dann transnasal eingeführt.…”